Feng M I, Huang S, Kaptein J, Kaswick J, Aboseif S
Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California.
J Urol. 2000 Dec;164(6):1935-8.
We assess the effect of sildenafil in a subgroup of patients after prostatectomy with erectile dysfunction and determine whether nerve preservation improves sildenafil response in this subgroup.
Between April 1998 and January 1999, 53 patients who had undergone radical retropubic prostatectomy and were prescribed oral sildenafil were surveyed using a confidential mail questionnaire. Of the patients 21 underwent bilateral and 15 unilateral neurovascular bundle sparing procedures, while in 17 a nonnerve sparing procedure was performed. All patients received 25 to 100 mg. sildenafil in a flexible dose escalation manner. Response, satisfaction and side effects were assessed using a modified, self-administered International Index of Erectile Function questionnaire. Response was defined as erection sufficient for intercourse. Preoperative and postoperative/pretreatment erectile functions were assessed for baseline comparison in each patient, and partner overall satisfaction with sildenafil was measured. Statistical data analysis was performed using analysis of variance and Newman-Keuls multiple comparison tests.
Of the 21 patients who underwent a bilateral nerve sparing procedure 15 had a positive response. Of the 15 patients who had undergone a unilateral nerve sparing procedure 12 had a positive response, and only 1 of the 17 patients who had undergone a nonnerve sparing procedure responded to sildenafil. The most commonly reported adverse events of all causes were headaches (21%), flushing (8.3%), visual disturbance (6.3%) and nasal congestion (6.3%).
Sildenafil is an equally effective treatment for erectile dysfunction after bilateral and unilateral nerve sparing procedures, and patient response to sildenafil is confirmed by the partners. However, patients who undergo nonnerve sparing procedures do not respond satisfactorily to sildenafil.
我们评估西地那非对前列腺切除术后勃起功能障碍患者亚组的疗效，并确定保留神经是否能改善该亚组患者对西地那非的反应。
1998年4月至1999年1月期间，对53例行根治性耻骨后前列腺切除术并开具口服西地那非处方的患者进行了保密邮件问卷调查。其中21例患者进行了双侧神经血管束保留手术，15例进行了单侧神经血管束保留手术，17例进行了非神经保留手术。所有患者均采用灵活的剂量递增方式接受25至100毫克西地那非治疗。使用改良的、患者自行填写的国际勃起功能指数问卷评估反应、满意度和副作用。反应定义为勃起足以进行性交。评估每位患者术前和术后/治疗前的勃起功能以进行基线比较，并测量伴侣对西地那非的总体满意度。采用方差分析和纽曼-丘尔斯多重比较检验进行统计数据分析。
在21例进行双侧神经保留手术的患者中，15例有阳性反应。在15例进行单侧神经保留手术的患者中，12例有阳性反应，而在17例进行非神经保留手术的患者中，只有1例对西地那非有反应。所有原因导致最常报告的不良事件为头痛（21%）、潮红（8.3%）、视觉障碍（6.3%）和鼻充血（6.3%）。
西地那非对双侧和单侧神经保留手术后的勃起功能障碍同样有效，伴侣证实了患者对西地那非的反应。然而，进行非神经保留手术的患者对西地那非的反应并不令人满意。
