Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

Authors

  • Matthew Eric Hyndman University of Calgary Southern Alberta Institute of Urology
  • Trinity J Bivalacqua James Buchanan Brady Urological Institute, Johns Hopkins University
  • Zhaoyong Feng Johns Hopkins Hospital
  • Lynda Z Mettee James Buchanan Brady Urological Institute, Johns Hopkins University.
  • Li-Ming Su University of Florida College of Medicine
  • Bruce J Trock James Buchanan Brady Urological Institute, Johns Hopkins University
  • Christian P Pavlovich James Buchanan Brady Urological Institute, Johns Hopkins University

DOI:

https://doi.org/10.5489/cuaj.3169

Abstract

Introduction: This is a report on urinary function results from a randomized trial of nightly versus on-demand sildenafil after nerve-sparing radical prostatectomy (RP), a secondary objective. We analyzed the effects of these sildenafil administration schemes on urinary health-related quality of life after RP.

Methods: In total, 100 potent men were equally randomized to nightly and on-demand sildenafil 50 mg after minimally-invasive RP for 1 year. Health-related quality of life questionnaires were administered at various postoperative intervals. Urinary function was assessed using appropriate expanded prostate cancer index composite (EPIC) subscales. Analyses of covariance and linear mixed-effects modeling were used to compare the effects of treatment over time on urinary recovery, controlling for age, nervesparing score, and time from surgery.

Results: The nightly (n = 50) and on-demand (n = 50) sildenafil groups were well-matched at baseline. Nightly sildenafil patients had worse EPIC urinary bother and urinary irritative/obstructive subscale scores at 3 and 6 months after RP, even after controlling for multiple variables. On mixed-model analyses, the differences between groups for these EPIC subscales (4.9 and 2.5, respectively) were greater than documented thresholds for clinical significance. Increasing nerve-sparing score was associated with improvements in EPIC urinary summary, bother, incontinence, and function scores; time from surgery was associated with improvements in all EPIC urinary health-related quality of life subscales.

Conclusions: In this specific population and drug dose, we found that on-demand short-acting phosphodiesterase-5 inhibitor (PDE5i) dosing may be more effective after RP to maximize early urinary health-related quality of life. In preoperatively potent men, nightly sildenafil 50 mg impaired urinary health-related quality of life more than on-demand use in the early months after nerve-sparing RP, independent of effects on urinary continence.

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Author Biography

Matthew Eric Hyndman, University of Calgary Southern Alberta Institute of Urology

Department of Surgery, Division of Urology

Assitant Professor

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Published

2015-12-14

How to Cite

Hyndman, M. E., Bivalacqua, T. J., Feng, Z., Mettee, L. Z., Su, L.-M., Trock, B. J., & Pavlovich, C. P. (2015). Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens. Canadian Urological Association Journal, 9(11-12), 414–9. https://doi.org/10.5489/cuaj.3169

Issue

Vol. 9 No. 11-12 (2015): CUAJ December

Section

Original Research

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