Efficacy and safety of avanafil 200 mg versus sildenafil 100 mg in the treatment of erectile dysfunction after robot-assisted unilateral nerve-sparing prostatectomy: A prospective multicentre study

Abstract

Phosphodiesterase type 5 inhibitors represent the standard treatment of erectile dysfunction after nerve-sparing prostatectomy. Avanafil is a second-generation phosphodiesterase type 5 inhibitor with a high selectivity for phosphodiesterase type 5 isoform. To date, there are no studies comparing the outcomes of avanafil versus sildenafil in this scenario. In this study, we evaluated the efficacy and safety of avanafil versus sildenafil as a drug for post-prostatectomy rehabilitation. Overall, 160 patients submitted to robot-assisted nerve-sparing prostatectomy for localized prostate cancer at three hospitals were enrolled for the present study. After 6 months of treatment, patients in the two groups showed no significantly different sexual function scores, except for the Erection Hardness Score and Sexual Encounter Profile-Q2 that were higher in the Sildenafil group. Adverse events in the Avanafil group occurred in four (5%) patients and in 16 (20%) patients in the Sildenafil group. According to our experience, in patients undergoing nerve-sparing prostatectomy, penile rehabilitation with avanafil compared to sildenafil showed a lower ability to produce a valid erection in the initial phase of sexual intercourse, a difference that disappears in the continuation of the same. Avanafil showed a greater tolerance profile with a lower rate of AEs and discontinuation of therapy due to AEs.

Keywords

Erectile dysfunction prostatectomy rehabilitation avanafil sildenafil impotence

Get full access to this article

View all access options for this article.

References

Dall’Era

Jesse

Mills Hari

et al. Penile rehabilitation after radical prostatectomy: important therapy or wishful thinking? Rev Urol 2006; 8: 209–215.

Ficarra

Novara

Ahlering

et al. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 2012; 62(3): 418–430.

Montorsi

Guazzoni

Strambi

et al. Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J Urol 1997; 158: 1408–1410.

Mulhall

Bivalacqua

Becher

EF.

Standard operating procedure for the preservation of erectile function outcomes after radical prostatectomy. J Sex Med 2013; 10(1): 195–203.

Natali

Masieri

Lanciotti

et al. A comparison of different oral therapies versus no treatment for erectile dysfunction in 196 radical nerve-sparing radical prostatectomy patients. Int J Impot Res 2015; 27(1): 1–5.

Goldstein

Lue

Padma-Nathan

et al. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group. N Engl J Med 1998; 338: 1397–1404.

Feng

Huang

Kaptein

et al. Effect of sildenafil citrate on post-radical prostatectomy erectile dysfunction. J Urol 2000; 164: 1935–1938.

Tavukcu

Aytac

Atug

Nerve-sparing techniques and results in robot-assisted radical prostatectomy. Investig Clin Urol 2016; 57(Suppl. 2): S172–S184.

Goldstein

Mulhall

Bushmakin

et al. The erection hardness score and its relationship to successful sexual intercourse. J Sex Med 2008; 5(10): 2374–2380.

10.

Parisot

Yiou

Salomon

et al. Erection hardness score for the evaluation of erectile dysfunction: further psychometric assessment in patients treated by intracavernous prostaglandins injections after radical prostatectomy. J Sex Med 2014; 11(8): 2109–2118.

11.

Vignozzi

Morelli

Filippi

et al. Effect of sildenafil administration on penile hypoxia induced by cavernous neurotomy in the rat. Int J Impot Res 2008; 20(1): 60–67.

12.

Gur

Sikka

Pankey

et al. Effect of avanafil on rat and human corpus cavernosum. Andrologia 2015; 47(8): 897–903.

13.

Montorsi

Brock

Stolzenburg

et al. Effects of tadalafil treatment on erectile function recovery following bilateral nerve-sparing radical prostatectomy: a randomised placebo-controlled study (REACTT). Eur Urol 2014; 65(3): 587–596.

14.

Cui

Liu

Shi

et al. Efficacy and safety of phosphodiesterase type 5 (PDE5) inhibitors in treating erectile dysfunction after bilateral nerve-sparing radical prostatectomy. Andrologia 2016; 48(1): 20–28.

15.

Mulhall

Burnett

Wang

et al. A phase 3, placebo controlled study of the safety and efficacy of avanafil for the treatment of erectile dysfunction after nerve sparing radical prostatectomy. J Urol 2013; 189(6): 2229–2236.

16.

Siena

Mari

Canale

et al. Sexual rehabilitation after nerve-sparing radical prostatectomy: free-of-charge phosphodiesterase type 5 inhibitor administration improves compliance to treatment. J Sex Med 2018; 15(2): 120–123.

17.

Corona

Rastrelli

Burri

et al. The safety and efficacy of Avanafil, a new 2(nd) generation PDE5i: comprehensive review and meta-analysis. Expert Opin Drug Saf 2016; 15(2): 237–247.

18.

Avulova

Zhao

Lee

et al. The effect of nerve sparing status on sexual and urinary function: 3-year results from the CEASAR study. J Urol 2018; 199: 1202–1209.