Raina Rupesh, Lakin Milton M, Agarwal Ashok, Ausmundson Sandra, Montague Drogo K, Zippe Craig D
Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Urology. 2004 Mar;63(3):532-7; discussion 538. doi: 10.1016/j.urology.2003.10.074.
To assess whether long-term users of intracavernous (IC) injections after radical prostatectomy can switch to oral therapy with sildenafil citrate.
Forty-nine patients (mean age 60.9 years) with erectile dysfunction after radical prostatectomy were identified as long-term users of IC injections (3.7 +/- 1.9 years). These patients received open-label treatment with sildenafil citrate (50 to 100 mg) for a minimum of 4 weeks or five attempts. The primary outcome measure of our study was assessed by the Sexual Health Inventory of Men (SHIM) questionnaire (International Index of Erectile Function-5 [IIEF]). A successful switch was prospectively defined as erection sufficient for vaginal penetration after sildenafil use and compliance to therapy. Patients were designated as responders or nonresponders on the basis of their ability to achieve vaginal penetration.
Of 49 patients, only 36 agreed to receive oral open-label sildenafil (50 to 100 mg) for a minimum of 4 weeks or five attempts. Prostaglandin E1 (PGE1) was used in 70% and triple therapy (PGE1, papaverine, and phentolamine) in the remaining 30%. Of the 36 patients, 15 (41%) successfully switched to sildenafil and discontinued IC injections. When the results were stratified by the type of IC solution, patients with high-dose triple therapy had a poor success rate of switch (7%) compared with patients using PGE1 treatment (67%). Of the 36 patients, 14 (38%) found sildenafil ineffective and continued using IC injections. Patients who switched to oral therapy had had a greater (P <0.001) total mean SHIM (IIEF-5) score with IC injections than those who did not switch (12.3 +/- 7.8 versus 20.0 +/- 4.9). Of the 36 patients, 7 (19%) found sildenafil alone to be suboptimal but continued using it, enhancing the efficacy of IC injections alone. The three predictive factors for a successful switch were high preoperative SHIM (IIEF-5) score, high post-IC injection SHIM score, and type of IC medication used (PGE1 alone versus high-dose triple therapy).
Long-term users of IC injection therapy can potentially switch to sildenafil citrate with acceptable sexual satisfaction. Patients will accept a lower degree of sexual satisfaction as measured by the IIEF-5 (SHIM) score if oral therapy is effective.
评估根治性前列腺切除术后长期使用海绵体内（IC）注射治疗的患者是否可以改用枸橼酸西地那非口服治疗。
49例（平均年龄60.9岁）根治性前列腺切除术后勃起功能障碍患者被确定为IC注射的长期使用者（3.7±1.9年）。这些患者接受了枸橼酸西地那非（50至100毫克）的开放标签治疗，最少4周或进行5次尝试。我们研究的主要结局指标通过男性性健康量表（SHIM）问卷（国际勃起功能指数-5[IIEF]）进行评估。成功改用是指使用西地那非后勃起足以进行阴道插入且依从治疗。根据患者实现阴道插入的能力将其指定为有反应者或无反应者。
49例患者中，只有36例同意接受口服开放标签的西地那非（50至100毫克）治疗最少4周或进行5次尝试。70%的患者使用前列腺素E1（PGE1），其余30%使用三联疗法（PGE1、罂粟碱和酚妥拉明）。36例患者中，15例（41%）成功改用西地那非并停止IC注射。当结果按IC溶液类型分层时，与使用PGE1治疗的患者（67%）相比，高剂量三联疗法的患者改用成功率较低（7%）。36例患者中，14例（38%）发现西地那非无效并继续使用IC注射。改用口服治疗的患者IC注射时的总平均SHIM（IIEF-5）评分高于未改用的患者（12.3±7.8对20.0±4.9，P<0.001）。36例患者中，7例（19%）发现单独使用西地那非效果欠佳但继续使用，从而提高了单独IC注射的疗效。成功改用的三个预测因素是术前高SHIM（IIEF-5）评分、IC注射后高SHIM评分以及所用IC药物的类型（单独使用PGE1与高剂量三联疗法）。
IC注射治疗的长期使用者有可能改用枸橼酸西地那非并获得可接受的性满意度。如果口服治疗有效，患者会接受IIEF-5（SHIM）评分所衡量的较低程度的性满意度。
