Study Of PDE-5I For Treatment Of Erectile Dysfunction After Bilateral Nerve-Sparing Radical Prostatectomy

BackgroundWith the improvement of living standards,the incidence of prostate cancer in China has increased significantly.Early screening and treatment of prostate cancer make most patients have a long life span.The patients put forward higher requirements for the quality of life after surgery,especially the recovery of erectile function and urinary control after surgery greatly affect life treatment.Radical prostatectomy is the golden standard for the treatment of localized prostate cancer.With the progress of surgical methods.BNSRP can effectively reduce the incidence of erectile dysfunction after operation.However,clinically,it is found that the recovery of erectile function after operation is very slow,and most of them need rehabilitation therapy to restore erectile function.PDE-5 inhibitors are the first-line treatment for post-operative erectile dysfunction.Many clinical studies abroad have confirmed that various PDE-5 inhibitors are effective in the treatment of post-operative erectile dysfunction.However,due to the differences in the course of treatment,the use of drugs and the evaluation of efficacy,the efficacy and saf'ety of low-dose sildenafil in patients with erectile dysfunction after bilateral nerve-sparing radical prostatectomy in our hospital were retrospectively analyzed.The efficacy and safety of PDE-51 in patients with erectile dysfunction after bilateral nerve-sparing radical prostatectomy were evaluated by meta-analysis.Part1 Clinical observation of phosphodiesterase type 5 inhibitors on recovery of erectile function after bilateral nerve-sparing radical prostatectomy ObjectiveTo evaluate the efficacy and safety of daily oral low-dose sildenafil in the treatment of erectile dysfunction following nerve-sparing radical prostatectomy.MethodsThe sildenafil treatment group received oral sildenafil 25mg daily at 6 month after surgery once a day for 3 months,while the non-sildenafil treatment group was not treated with any type 5 phosphodiesterase inhibitor or Other rehabilitation methods.The IIEF scores of 9 months after operation were recorded and the therapeutic effect of sildenafil was evaluated.The recovery rate of sexual function after operation was compared between the two groups.Adverse reactions during treatment were recorded.ResultsThere was no significant difference in clinical data between the two groups.The IIEF score of sildenafil treatment group at 9 months after surgery was 9-19 points(12.6±2.7),while the IIEF score of non-sildenafil treatment group at 9 months after surgery was 5-16 points(9.6±2.9),and the difference between the two groups was statistically significant(p=0.01).According to IIEF score,the curative effect of'sildenafil after treatment was evaluated.The results showed that there were 0 cured.10 markedly effective and 1 effective,and the total effective rate was 100%.The postoperative recovery rate of erectile function in the sildenafil treatment group was 64%(7/11),while that in the non-sildenafil treatment group was 15%(p=0.03)During the follow-up,2 patients presented with slight intermittent headache,2 with early nasal congestion and discomfort,and 1 with transient facial flushing,without any serious adverse reactionsConclusionDaily oral low-dose sildenafil treatment for erectile dysfunction after bilateral nerve-sparing radical prostatectomy can promote the recovery of erectile function.The total effective rate was 100%.There were no serious adverse reactions in the treatment and the safety was good.Part2 Efficacy and safety of phosphodiesterase type 5 inhibitors on recovery of bilateral erectile function after nerve-sparing radical prostatectomy:a meta-analysisObjectiveTo systematically evaluate the effectiveness of phosphodiesterase type 5 inhibitors on recovery of erectile function after bilateral nerve-sparing radical prostatectomy.MethodsSuch databases as PubMed.,MEDLINE.,The CoChrane Library,CNKI,WangFang Data were searched from the date of their establishment to October 2017 collect the randomized controlled trials(RCTs)about PDE-5I in the treatment of ED following BNSRP.According to the inclusion and exclusion criteria,two reviewers independently screened literature,extracted data and assessed the quality of the included studies.then the meta-analysis was conducted using RevMan5.3 and Stata12 software.ResultsA total of 11 RCTs were included in this study.The IIEF score of phosphodiesterase type 5 inhibitors in the treatment of erectile dysfunction after BNSRP was significantly higher than that in the placebo group(NMD:5.84.95%CI 4.35-7.33),P<0.05.Subgroup analysis was conducted according to the duration of treatment and the types of PDE-5.The results of subgroup analysis indicated that PDE-5 inhibitors could significantly improve IIEF score after BNSRP compared with placebo.The aggregate effect after sensitivity analysis still shows statistical significance.Egger's test and Begg's test showed that there was no obvious publication bias.After PDE-5I treatment,the recovery rate of erectile function was 27%.compared with 17%in placebo group,RR=1.65,95%CI(1.24.2.20).The difference between the two groups was statistically significant(P=0.0006).The success rate of PDE-5I group in question 2 of diary evaluation of sexual life was 52%,while that of placebo:group was 31%.RR=1,57,95%C.I(1.03,2.38).There was significant difference between the two groups(P=0.03).Sensitivity analysis excluded three studies respectly and the combined effect was still statistically significant.indicating that the results were robustIn PDE-5I group,the success rate was 40%in question 3 of sexual diary evaluation,compared with 22%in placebo group,RR=1.84.95%CI(1.19,2.82).The aggregate effect after sensitivity analysis is still statistically significant,and the results are robust and credible.Three RCT studies reported in detail the proportion of patients discontinuing treatment due to adverse reactions.The results showed that PDE-5I did not increase the proportion of patients discontinuing treatment due to adverse reactions compared with placebo group(P = 0.06).A meta-analysis of headache,dyspepsia,blush,rhinitis and other adverse events in the study was carried out.The heterogeneity among the studies was small.The four groups of adverse reactions showed significant statistical diff'erences between the PDE-5I treatment group and the control group.It showed that the use of PDE-5I could increase adverse events,but most of the adverse reactions were short-term and mild to moderate.ConclusionPDE-5 inhibitors can significantly improve IIEF score,erectile function recovery rate.sexual intercourse insertion rate and success rate of sexual intercourse after BNSRP.PDE-5 inhibitors did not increase the discontinuation rate of ED after BNSRP.Most of the adverse reactions were short-term and mild to moderate.The patients had better tolerance to drugs and fewer serious adverse reactions.