Measures can help restore post-RP erectile function

August 15, 2005

No single study on the topic of sexual dysfunction leapt from the podium as a breakthrough at this year's AUA annual meeting, but a number of studies offered valuable observations about various aspects of sexual function/dysfunction. Among these were studies showing that the degree of personal involvement in restoring sexual function after radical prostatectomy correlates with the degree of success, said John Mulcahy, MD, PhD, professor of urology, Indiana University Medical Center, Indianapolis. Also, research showed that erectile dysfunction can be associated with metabolic disorders and heart disease, and when prescriptions with level 1 interactions overlap, they are often for sildenafil citrate (Viagra) and nitrates.

Dr. Mulcahy offered the following insight into these and other studies.

Studies of sexual function after radical prostatectomy demonstrate that recovery of sexual function at 24 months occurs in 51% of men who undergo bilateral nerve-sparing procedures versus 32% for unilateral nerve-sparing procedures; recovery of sexual function correlates with postoperative sexual desire, mood, and incontinence; early transurethral alprostadil (MUSE) therapy increases sexual activity; and climacturia occurs in 45% of men after surgery.

One study from Johns Hopkins, Baltimore, looking at men who had undergone radical prostatectomy by a single surgeon found that 51% of those who had undergone a bilateral nerve-sparing procedure had returned to their baseline sexual function within 2 years compared with 32% of those who underwent a unilateral procedure. More than 90% of these patients returned to baseline urinary function, regardless of the procedure used.

Another study from University Vita-Salute San Raffaele in Milan, Italy, blanketed 704 patients with five differing quality of life and symptom assessment tools 11 months after they had undergone bilateral nerve-sparing prostatectomy. The investigators reported that recovery of erectile function was significantly related to postoperative sexual desire, mood (ie, depression), and rate of urinary incontinence. They also noted no apparent difference in the incidence of recovery between patients who were taking a PDE-5 inhibitor on a daily basis and those who were taking it on demand.

Investigators from The Cleveland Clinic administered transurethral alprostadil three times a week for 6 weeks postoperatively in 65 of 91 patients who had undergone surgery. The remainder of the patients served as controls. The investigators reported that at 6 months, 74% of the patients receiving transurethral alprostadil had resumed sexual activity compared with 37% of the control group.

"The other thing that both physicians and patients should be aware of is that up to 45% of men [who undergo prostatectomy] may have climacturia when they ejaculate. This can be embarrassing for both the man and his partner. It dissuades them from sex or diminishes their interest in sex," Dr. Mulcahy said.

Clinical investigation of dapoxetine for premature ejaculation demonstrates improved intravaginal ejaculatory latency time, improved patient-related outcomes and satisfaction, adequate safety, and no adverse events in concomitant use with alcohol or phosphodiesterase type-5 inhibitors.

Dapoxetine, which is currently in phase III trials, is the first agent to have been developed specifically to treat premature ejaculation.

"It looks promising. It is a short-acting selective serotonin reuptake inhibitor and has limited duration, which is what is wanted in this type of therapy," said Dr. Mulcahy. "Premature ejaculation is even more common than erectile dysfunction. Something like 40% of men experience it."

Erectile dysfunction is often a symptom of a larger medical problem, or as Dr. Mulcahy put it, "The penis is the barometer of a man's health."

A study from Turkey looked at 268 patients admitted to urology and endocrinology clinics, and it found that patients with metabolic syndrome (ie, obesity, dyslipidemia, elevated blood pressure, insulin resistance or glucose intolerance, prothrombotic state, or proinflammatory state) were at significant risk of ED.