Phosphodiesterases 5 Inhibitors and Erectile Dysfunction Recovery after Pelvic Surgery: Future Perspectives for New Drugs and New Formulations
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…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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