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Viagra Useful for Impotence Following Prostate Surgery

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WebMD Health News

Nov. 30, 1999 (Washington) -- Men with prostate cancer who have their prostate removed are usually free of cancer, but the procedure often comes with a cost -- impotence. A new study, however, shows that Viagra (sildenafil), the popular medication for erectile dysfunction, can restore impotency lost in surgery. Whether men respond, however, depends on how much nerve damage occurred during surgery.

Each year some 200,000 men are diagnosed with prostate cancer and, of those, 50,000 will have to undergo surgical removal of the prostate.

"Incontinence and impotence are the two most common [prostatectomy] side effects. A large number of patients, even with nerve-sparing techniques, end up with erectile dysfunction," Milton Lakin, MD, who leads the medical urology section at Cleveland Clinic Foundation, tells WebMD. "The first thing [doctors] want to do is a very good cancer operation. Cancers are being discovered early enough that in many cases it is possible to spare both nerves, or at least one."

The new study, which appears in the November Journal of Urology, was completed by physicians at Baylor College of Medicine in Houston. It involved about 80 men who ranged in age from 47 to 76 years old. All were prescribed Viagra following prostate removal surgery. Based on their responses to a series of questionnaires, 53% had improved erections and 40% had improved ability to have intercourse.

Among those with nerves spared on both sides of the prostate, almost 60% had improved erections and about 45% reported improvement in their ability to have intercourse. Of men who had nerves spared on one side of the prostate, close to 40% had improvement of their ability to have intercourse. For men with no nerves spared, the reported increase in erections dropped to 20%, with only 10% noting an improvement in the ability to have intercourse.

At least one side effect each was experienced by 63% of the men, most commonly flushing, headache, nasal congestion, and heartburn.

Brian Miles, MD, one of the study authors, called the results "gratifying" and noted that the findings indicate patients should start on the medication about six months after surgery. He tells WebMD that he has had success with nerve transfers that involve implanting a leg nerve in the pelvis, which can help maintain normal erectile function.

These findings confirm previous study results and put a greater spotlight on the prostate surgery itself, says Lakin, who was not involved in this study but has been part of nearly identical studies that produced similar results. "I am not a surgeon. I deal primarily with sexual dysfunction. But where I think this [study] will have the most impact is in causing physicians to pay more attention to nerve sparing," he says.

Lakin says that he commonly prescribes Viagra following surgery for prostate cancer because other options are more invasive. "Unfortunately, it's very hard not to offer a patient a pill even if their nerves have been cut, but I am very honest with them. And if they call and say it didn't work, we go on from there."

If Viagra fails, physicians can recommend other options, including injections and vacuum devices, both of which have good success rates, even among men whose nerves were damaged, according to Lakin.

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