PENILE HEMODYNAMIC RESPONSE TO PHOSPHODIESTERASE TYPE V INHIBITORS AFTER CAVERNOSAL SPARING INFLATABLE PENILE PROSTHESIS IMPLANTATION A PROSPECTIVE IMPLANTATION: A PROSPECTIVE RANDOMIZED OPEN-BLINDED END-POINT (PROBE) STUDY

J ALI; MH BANGASH; M HAMZA; M SHAHID; F TARIQ; M HAMMAD; F ASIM

doi:10.54112/bcsrj.v2024i1.1434

Authors

J ALI ITTEHAD Medical & Diagnostic Complex Karak/type D Hospital Latamber Karak, Pakistan
MH BANGASH Department Of Urology, Mardan Medical Complex Mardan, Pakistan
M HAMZA Department Of Pharmacy, University of The Punjab Lahore, Pakistan
M SHAHID Department Of Pharmacy, University of The Punjab Lahore, Pakistan
F TARIQ Riphah International University Lahore, Pakistan
M HAMMAD Faculty of Pharmaceutical Sciences, Shifa College of Pharmaceutical Sciences Shifa Tameer-e-millat University, Islamabad, Pakistan/ Faculty of Management Sciences, School of Business and Management, Riphah International University, Islamabad, Pakistan
F ASIM Department of Pharmacy, The University of Lahore (UOL), Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1434

Keywords:

Phosphodiesterase Inhibitors Penile Erection Prostheses And Implants Hemodynamics Erectile Dysfunction

Abstract

Oral phosphodiesterase type V inhibitors (PDE5i), such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), have become the first-line pharmacological treatment for most cases of ED. Objective: The main objective of the study is to find the penile hemodynamic response to phosphodiesterase type v inhibitors after cavernosal-sparing inflatable penile prosthesis implantation prospective implantation. Objective: To evaluate the penile hemodynamic response, erectile function, and patient satisfaction associated with PDE5i therapy after cavernosal sparing IPP implantation. Methods: This Prospective Randomized Open-Blinded End-Point (PROBE) was conducted at Mardan Medical Complex Peshawar from June 2024 to December 2024. Data were collected from 25 male patients. Patients underwent cavernosal sparing IPP implantation and were randomly assigned to two groups: Group A (n=13) received PDE5i postoperatively, while Group B (n=12) received a placebo. Hemodynamic measurements using Doppler ultrasound were conducted at baseline, 6 weeks post-surgery, and the 6-month follow-up. International Index of Erectile Function (IIEF) scores and patient satisfaction were also assessed. Results: Group A showed significant improvements in penile hemodynamics compared to Group B, with a higher peak systolic velocity (PSV: 38.7 ± 6.1 cm/s vs. 24.5 ± 5.3 cm/s), reduced end-diastolic velocity (EDV: 4.8 ± 2.3 cm/s vs. 8.9 ± 2.4 cm/s), and improved resistance index (RI: 0.88 ± 0.07 vs. 0.64 ± 0.09) at 6 months. Group A also reported higher IIEF scores and greater satisfaction with sexual function. Conclusions: Cavernosal sparing IPP implantation combined with PDE5i therapy significantly improves penile hemodynamics, erectile function, and patient satisfaction compared to IPP alone. This dual approach offers enhanced outcomes for managing severe ED.

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References

Medicines A. Oral PDE5 inhibitors for erectile dysfunction. US Pharm. 2018;43(6):29-33.

Liu JL, Burnett AL, Herati AS. Molecular Biology and Physiology of Erectile Function and Dysfunction. Men's Reproductive and Sexual Health Throughout the Lifespan: An Integrated Approach to Fertility, Sexual Function, and Vitality. 2023:289.

Hassanin AM, Abdel-Hamid AZ. Cavernous smooth muscles: innovative potential therapies are promising for an unrevealed clinical diagnosis. International Urology and Nephrology. 2020;52(2):205-17.

Ziegelmann MJ, Trost LW, Russo GI, Levine LA. Peyronie's disease intervention studies: an exploration of modern-era challenges in study design and evaluating treatment outcomes. The Journal of Sexual Medicine. 2020;17(3):364-77.

Chung E. Penile prosthesis implant: scientific advances and technological innovations over the last four decades. Translational andrology and urology. 2017;6(1):37.

Wassersug R, Wibowo E. Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction. Translational Andrology and Urology. 2017;6(Suppl 5):S776.

Chung E, Bettocchi C, Egydio P, Love C, Osmonov D, Park S, et al. The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nature Reviews Urology. 2022;19(9):534-46.

Zaazaa A, Bayerle-Eder M, Elnabarawy R, Elbitar M, Mostafa T. Penile Hemodynamic Response to Phosphodiesterase Type V Inhibitors after Cavernosal Sparing Inflatable Penile Prosthesis Implantation: A Prospective Randomized Open‐Blinded End‐Point (PROBE) Study. Advances in Urology. 2021;2021(1):5548494.

Andersson KE. PDE5 inhibitors–pharmacology and clinical applications 20 years after sildenafil discovery. British journal of pharmacology. 2018;175(13):2554-65.

Miltiadous O, Hou M, Bussel JB. Identifying and treating refractory ITP: difficulty in diagnosis and role of combination treatment. Blood, The Journal of the American Society of Hematology. 2020;135(7):472-90.

Warburton NM, Bateman PW, Fleming PA. Anatomy of the cavernous muscles of the kangaroo penis highlights marsupial–placental dichotomy. Journal of Anatomy. 2019;234(3):306-15.

Scherzer ND, Dick B, Gabrielson AT, Alzweri LM, Hellstrom WJ. Penile prosthesis complications: planning, prevention, and decision making. Sexual medicine reviews. 2019;7(2):349-59.

Argiolas A, Argiolas FM, Argiolas G, Melis MR. Erectile dysfunction: Treatments, advances and new therapeutic strategies. Brain Sciences. 2023;13(5):802.

Asker H, Yilmaz‐Oral D, Oztekin CV, Gur S. An update on the current status and future prospects of erectile dysfunction following radical prostatectomy. The Prostate. 2022;82(12):1135-61.

De Nunzio C, Roehrborn CG, Andersson K-E, McVary KT. Erectile dysfunction and lower urinary tract symptoms. European urology focus. 2017;3(4-5):352-63.

Retzler K. Erectile dysfunction: a review of comprehensive treatment options for optimal outcome. Journal of Restorative Medicine. 2019;8(1).

Sun X, Guan W, Liu H, Tang K, Yan L, Zhang Y, et al. Efficacy and safety of PDE5-Is and α-1 blockers for treating lower ureteric stones or LUTS: a meta-analysis of RCTs. BMC urology. 2018;18:1-12.