Zippe C D, Jhaveri F M, Klein E A, Kedia S, Pasqualotto F F, Kedia A, Agarwal A, Montague D K, Lakin M M
Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
Urology. 2000 Feb;55(2):241-5. doi: 10.1016/s0090-4295(99)00441-0.
To determine whether the response to sildenafil citrate (Viagra) in patients with erectile dysfunction after radical prostatectomy was influenced by the presence or absence of neurovascular bundles, the interval from surgery to the initiation of drug therapy, and the dose of the drug.
Baseline and follow-up data from 91 patients presenting with erectile dysfunction after radical prostatectomy were obtained. The patients were stratified according to the type of nerve-sparing (NS) procedure: bilateral NS, unilateral NS, and non-NS. They were interviewed using the Cleveland Clinic Post Prostatectomy (CCPP) questionnaire and the International Index of Erectile Function (IIEF) questionnaire.
The presence or absence of the neurovascular bundles influenced the ability to achieve vaginal intercourse. In the patients who had undergone bilateral NS, 71.7% (38 of 53) responded; in those with unilateral NS, 50% (6 of 12) responded; and in those with non-NS, 15.4% (4 of 26) responded. The IIEF questionnaire confirmed the quality of the positive responses, with significant improvements in response to question 3 (frequency of penetration), question 4 (frequency of maintenance of erection), and question 7 (satisfaction with intercourse). The magnitude of improvement in responses was higher in the bilateral NS group than in the unilateral NS and non-NS groups (P <0.05). When the data of the 48 positive responders were analyzed, no difference in the response rate was found when the interval from surgery to drug therapy was stratified by the following three intervals: 0 to 6 months (44%), 6 to 12 months (55%), and greater than 12 months (53%). Of the positive responders, 14 (29.1%) required the 50-mg dose, and 34 (70.9%) required the 100-mg dose. The most common side effects were transient headaches (28.6%), flushing (21.9%), dizziness (8.8%), dyspepsia (6.5%), and nasal congestion (5.4%), with an increase in the incidence of headaches seen at the higher dose (P = 0.04).
Successful treatment of erectile dysfunction with sildenafil citrate after radical prostatectomy depends on the presence of the neurovascular bundles. Our data suggest that the response to sildenafil is not related to the interval between the surgery and initiation of drug therapy but is related to the dose.
确定根治性前列腺切除术后勃起功能障碍患者对枸橼酸西地那非（万艾可）的反应是否受神经血管束的有无、手术至药物治疗开始的时间间隔以及药物剂量的影响。
获取了91例根治性前列腺切除术后出现勃起功能障碍患者的基线和随访数据。患者根据保留神经（NS）手术的类型进行分层：双侧NS、单侧NS和非NS。使用克利夫兰诊所前列腺切除术后（CCPP）问卷和国际勃起功能指数（IIEF）问卷对他们进行访谈。
神经血管束的有无影响实现阴道性交的能力。在接受双侧NS的患者中，71.7%（53例中的38例）有反应；在单侧NS的患者中，50%（12例中的6例）有反应；在非NS的患者中，15.4%（26例中的4例）有反应。IIEF问卷证实了阳性反应的质量，对问题3（插入频率）、问题4（勃起维持频率）和问题7（性交满意度）的回答有显著改善。双侧NS组的反应改善幅度高于单侧NS组和非NS组（P<0.05）。对48例阳性反应者的数据进行分析时，当手术至药物治疗的时间间隔按以下三个时间段分层时，未发现反应率有差异：0至6个月（44%）、6至12个月（55%）和大于12个月（53%）。在阳性反应者中，14例（29.1%）需要50毫克剂量，34例（70.9%）需要100毫克剂量。最常见的副作用是短暂性头痛（28.6%）、潮红（21.9%）、头晕（8.8%）、消化不良（6.5%）和鼻塞（5.4%），高剂量时头痛发生率增加（P = 0.04）。
根治性前列腺切除术后用枸橼酸西地那非成功治疗勃起功能障碍取决于神经血管束的存在。我们的数据表明，对西地那非的反应与手术和药物治疗开始之间的时间间隔无关，但与剂量有关。
