Penis rehab after prostate surgery mildly useful
NEW YORK (Reuters Health) - There's evidence that giving men small doses of erectile dysfunction drugs very soon after they have their prostates removed for cancer may help keep the penis in shape, basically by keeping oxygen flowing to the organ.
But a new study of this strategy, which compared sildenafil (Viagra) to alprostadil (Muse, a drug that's inserted into the urethra) found both had the same effect in restoring men's erectile function, and neither did much.
"Really at this point there's a lot of experimental data saying that it is beneficial to be doing something in the postoperative period, we just don't know what it is," said Dr. Andrew R. McCullough of the New York University School of Medicine, one of the new study's authors. "But we clearly know that if guys sit back and wait for it to come back they are doing themselves a disfavor."
Even after two months, he added, men will show penis shrinkage and deterioration of smooth muscle tissue in the penis if they don't do some type of "penile rehabilitation."
"Nerve sparing" surgery for prostate removal was first introduced in 1983, and touted as curing the problem of erectile dysfunction after surgery, but eventually it became clear that the operation was little better than the previous approach for preserving men's ability to develop erections, McCullough told Reuters Health.
Meanwhile, he added, a 1999 study showed that men who injected themselves in the penis with alprostadil twice a week beginning a month after surgery were three times as likely to be able to achieve erections. While there were problems with the study, according to McCullough, other researchers have since demonstrated in both humans and animals that giving aloprostadil, Viagra and similar drugs improves oxygenation of the penile tissue after prostate removal.
In the current study, McCullough and his colleagues randomly assigned men to start using Muse or taking Viagra (50 milligrams) every night for nine months. Muse is a formulation of alprostadil that is inserted into the urethra, rather than being injected into the penis.
After nine months, the men stopped taking the drugs for one month, and then tried having sex after taking a larger dose of Viagra (100 milligrams) six times in a month.
Men in both groups had gradual increases in their abilities to have erections, as well as their ability to have sex over the course of the study, but there were no significant differences between the two groups. Their intercourse success rate went from about 25 percent to about 50 percent, while their erectile function scores rose from around 10 (indicating severe erectile dysfunction) to around 16 (indicating moderate dysfunction).
The jury's still out on the best approach to helping men maintain their erectile function after prostate surgery, McCullough said. "My regimen for my patients is a combination of many things," he added, including a vacuum device used to help men achieve erections, penile injections, Viagra, and Muse.
He and his colleagues are now planning a study that will compare Viagra to the vacuum device for helping to restore erectile function after surgery. The current negative findings don't mean early rehabilitation doesn't work, he added; "it just kind of shows that we need to learn so much more about this."
SOURCE: http://www.jurology.com/article/S0022-5347%2810%2900205-3/abstract The Journal of Urology, online April 19, 2010.
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