Investig Clin Urol.  2016 Sep;57(5):357-363. 10.4111/icu.2016.57.5.357.

Phosphodiesterase type 5 inhibitor administered immediately after radical prostatectomy temporarily increases the need for incontinence pads, but improves final continence status

• Kaiho Y
• Yamashita
• Ito A
• Kawasaki Y
• Izumi H
• Kawamorita N
• Adachi H
• Mitsuzuka
• Arai Y

• KMID: 2427015
• DOI: http://doi.org/10.4111/icu.2016.57.5.357

Abstract

PURPOSE
To evaluate the effects of phosphodiesterase type 5 inhibitor (PDE5i) on urinary continence recovery after bilateral nerve-sparing radical prostatectomy (BNSRP).
MATERIALS AND METHODS
Between 2002 and 2012, 137 of 154 consecutive patients who underwent BNSRP in our institution retrospectively divided into 3 groups that included patients taking PDE5i immediately after surgery (immediate PDE5i group, n=41), patients starting PDE5i at an outpatient clinic after discharge (PDE5i group, n=56), and patients taking no medication (non-PDE5i group, n=40). Using self-administered questionnaires, the proportion of patients who did not require incontinence pads (pad-free patients) was calculated preoperatively and at 1, 3, 6, 12, 18, and 24 months after BNSRP. Severity of incontinence was determined based on the pad numbers and then compared among the 3 groups.
RESULTS
Proportions of pad-free patients and severity of incontinence initially deteriorated in all of the groups to the lowest values soon after undergoing BNSRP, with gradual improvement noted thereafter. The deterioration was most prominent in the immediate PDE5i group. As compared to the non-PDE5i group, both the PDE5i and immediate PDE5i groups exhibited a better final continence status.
CONCLUSIONS
PDE5i improves final continence status. However, administration of PDE5i immediately after surgery causes a distinct temporary deterioration in urinary incontinence.

Keyword

Incontinence pads; Phosphodiesterase inhibitors; Prostatectomy; Recovery of function; Urinary incontinence

MeSH Terms

Aged
Drug Administration Schedule
Drug Evaluation/methods
Follow-Up Studies
Humans
Incontinence Pads/*utilization
Male
Middle Aged
Phosphodiesterase 5 Inhibitors/*administration & dosage/adverse effects/therapeutic use
Postoperative Care/methods
Prostatectomy/*adverse effects/methods
Recovery of Function/drug effects
Retrospective Studies
Severity of Illness Index
Urinary Incontinence/etiology/physiopathology/*prevention & control
Urination/drug effects
Phosphodiesterase 5 Inhibitors

Figure

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  Fig. 1 In all groups, the proportions of pad-free patients decreased to a nadir at 1 month after surgery, after which all patients showed a gradual improvement. At 12 months postoperatively, the proportions of pad-free patients in the phosphodiesterase type 5 inhibitor (PDE5i) and immediate PDE5i groups recovered to levels that were almost the same as those for the preoperative levels, while levels in the non-PDE5i group remained under approximately 80%.

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  Fig. 2 In all groups, pad usage scores worsened at 1 month after the surgery, and then gradually improved. The deterioration at 1 month after the surgery was most prominent in the immediate phosphodiesterase type 5 inhibitor (PDE5i) group. Better pad usage scores were seen after 6 months postoperatively for the PDE5i and immediate PDE5i groups versus the non-PDE5i group. Asterisks (*) indicate statistical significance between the immediate PDE5i and PDE5i groups. The dagger (†) indicates statistical significance between the immediate PDE5i and non-PDE5i groups. Double daggers (‡) indicate statistical significance between the PDE5i and non-PDE5i groups. Score of pad usage: 3, no pads; 2, one or two pads per day; 1, three or more pads per day.

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