Phosphodiesterases 5 Inhibitors and Erectile Dysfunction Recovery after Pelvic Surgery: Future Perspectives for New Drugs and New Formulations

Author:

Lombardo Riccardo1,Tema Giorgia1,De Nunzio Cosimo1ORCID

Affiliation:

1. Ospedale Sant’Andrea, Department of Urology ‘Sapienza’ Univeristy of Rome, Rome, Italy

Abstract

Background: Phosphodiesterase 5 inhibitors (PDE5I) represent the first line treatment in the management of post-operative erectile dysfunction (ED) after pelvic oncological surgery. Aim of our study is to evaluate the available evidence on the efficacy of PDE5Is including new formulations and penile rehabilitation post-pelvic surgery. Evidence Acquisition: A systematic review of the literature was performed until May 2020. The following databases were searched: Scopus, Medline and Web of Science. The MeSH search was conducted by combining the following terms: ‘erectile dysfunction’, ‘radical prostatectomy’ ‘pelvic’ ‘bladder’ ‘phosphodiesterase’ inhibitors’ ‘avanafil’ ‘sildenafil’ ‘tadalafil’ ’lodenafil’ ‘mirodenafil’ ‘udenafil’ ‘vardenafil’ ‘sublingual’ ‘orodispersible’ ‘penile’ ‘rehabilitation’. PRISMA guidelines were followed to select relevant papers (figure 1). Evidence Synthesis: Sildenafil, Tadalafil, vardenafil and Avanafil improves EF compared with placebo in men with all levels of ED severity after radical prostatectomy with good tolerability. No specific recommendations can be suggested regarding the superiority of a drug over the other. The optimal dose, continuous vs on demand and duration of treatment is still under investigation. In vitro and preclinical studies suggest a possible role for lodenafil, mirodenafil and oro-dispersible formulations in patients undergoing oncological pelvic surgery. Few studies demonstrated the efficacy of udenafil in improving ED after rectal surgery or radical prostatectomy. Complete recovery of EF after surgery is still an unmet need in the field of penile rehabilitation after pelvic surgery. Conclusion: PDE5I have a crucial role in the management of post pelvic surgery ED. New drugs and new formulations have shown excellent results in patients with ED, however data in patients after surgery is still scarce. Further well designed RCT should clarify the role of these new compounds and oro-dispersible formulations in the management of ED in patients undergoing pelvic surgery.

Publisher

Bentham Science Publishers Ltd.

Subject

Clinical Biochemistry,Drug Discovery,Pharmacology,Molecular Medicine

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