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Nervenerhaltende radikale Prostatektomie mit niedrig dosiertem Sildenafil

Rehabilitation der erektilen Funktion

Nerve-sparing radical prostatectomy with nightly low-dose sildenafil

Rehabilitation of erectile function

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Zusammenfassung

Fragestellung

Ziel dieser prospektiven Studie war es zu untersuchen, welchen Einfluss niedrig dosiertes Sildenafil (25 mg) auf die Rehabilitation der erektilen Funktion (EF) nach nervenerhaltender radikaler Prostatektomie (RP) nimmt.

Methodik

Bei 43 präoperativ sexuell aktiven Patienten führten wir eine nervenerhaltende RP durch. Die präoperative EF wurde mit dem IIEF-5-Fragebogen evaluiert. Unmittelbar nach Katheterentfernung am 7. bis 14. postoperativen Tag erfolgte eine nächtliche penile Tumeszenz- und Rigiditäts- (NPTR-)Messung. 23 Patienten mit nachweisbaren nächtlichen Erektionen erhielten täglich 25 mg Sildenafil zur Nacht. Als Vergleichsgruppe dienten 18 Patienten, ebenfalls mit positiver NPTR-Messung, ohne PDE-5-Inhibitor. Eine Reevaluation mittels IIEF-5 erfolgte nach 6, 12, 24, 36, 52 und 78 Wochen.

Ergebnisse

Alle Patienten wiesen einen präoperativen IIEF-Score >16 auf. Bei 41 der 43 Patienten (95%) waren im Mittel 2,5 (1–5) nächtliche Erektionen nachweisbar. Im postoperativen Verlauf steigerte sich der IIEF-5-Score unter 25 mg Sildenafil vs. Kontrolle von 3,6 vs. 2,4 nach 6 Wochen auf 3,8 vs. 3,8 nach 12 Wochen, auf 5,9 vs. 5,3 nach 24 Wochen, auf 9,6 vs. 6,4 nach 36 Wochen, auf 14,1 vs. 9,3 nach 52 Wochen und auf 19,3 vs. 13,2 nach 78 Wochen. Es zeigte sich ein signifikanter Unterschied im zeitlichen Verlauf der Wiedererlangung der erektilen Funktion unter 25 mg Sildenafil von 92% vs. Kontrollgruppe (p<0,001) 68% GV-fähige Erektionsfähigkeit.

Schlussfolgerung

Die NPTR-Messung nach nervenerhaltender RP zeigt eine vorhandene EF schon in der 1. Nacht nach Katheterentfernung. Im Falle einer vorliegenden Früherektion führt die supportive Medikation mit niedrig dosiertem Sildenafil (25 mg) zur Steigerung der erektilen Funktion und damit zur weiteren Organrehabilitation im Vergleich zur Spontanerholung.

Abstract

Objective

The purpose of this study was to evaluate the effect of low-dose sildenafil (25 mg) for rehabilitation of erectile function after nerve-sparing radical prostatectomy.

Patients and methods

In a prospective study, 43 sexually active patients underwent nerve-sparing retropubic radical prostatectomy. Rigiscan® measurement of nocturnal penile tumescence and rigidity (NPTR) was carried out 7–14 days after surgery. A group of 23 patients with preserved nocturnal erections received sildenafil 25 mg/day at night to support recovery of erectile function. A control group of 18 patients underwent follow-up without PDE-5 inhibitors. Evaluation using the IIEF-5 questionnaire was performed 6, 12, 24, 36, 52 and 78 weeks after the operation.

Results

Of 43 patients, 41 (95%) showed 1–5 erections during the first night after catheter removal. In the group receiving daily sildenafil, the mean IIEF-5 score decreased or increased from 20.8 preoperatively to 3.6 at 6 weeks, 3.8 at 12 weeks, 5.9 at 24 weeks, 9.6 at 36 weeks, 14.1 at 52 weeks and 19.3 at 78 weeks after prostatectomy. In the control group, the mean preoperative IIEF-5 score of 21.2 decreased or increased to 2.4 at 6 weeks, 3.8 at 12 weeks, 5.3 at 24 weeks, 6.4 at 36 weeks, 9.3 at 52 weeks and 13.2 at 78 weeks. Statistical evaluation showed significant differences regarding the IIEF-5 score and recovery period of erectile function between the groups (p<0.001), with potency rates of 92 vs 68%.

Conclusion

The measurement of NPTR after nerve-sparing radical prostatectomy showed erectile function as early as the first night after catheter removal. In cases of early penile erections, daily low-dose PDE-5 inhibitors lead to a significant improvement/acceleration of erectile function recovery.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Referententätigkeit für Pfizer, Bayer, Lilly, Sanofi-Aventis, Takeda, Pierre Fabre.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein,Campus Kiel, Kiel, Deutschland

    A. Bannowsky, H. Schulze, C. van der Horst & K.-P. Jünemann

  2. Klinik für Urologie und Kinderurologie, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Deutschland

    A. Bannowsky

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  1. A. Bannowsky
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  2. H. Schulze
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  3. C. van der Horst
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  4. K.-P. Jünemann
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Correspondence to A. Bannowsky.

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Bannowsky, A., Schulze, H., van der Horst, C. et al. Nervenerhaltende radikale Prostatektomie mit niedrig dosiertem Sildenafil. Urologe 49, 1516–1521 (2010). https://doi.org/10.1007/s00120-010-2453-y

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