Elsevier

Urology

Volume 66, Issue 5, November 2005, Pages 1080-1085
Urology

Adult urology
Acetyl-l-carnitine plus propionyl-l-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy

https://doi.org/10.1016/j.urology.2005.05.014Get rights and content

Abstract

Objectives

To determine whether propionyl-l-carnitine (PLC) plus acetyl-l-carnitine (ALC) improves the effectiveness of sildenafil in restoring sexual potency after bilateral nerve-sparing radical retropubic prostatectomy.

Methods

We analyzed the data from 96 patients who had undergone bilateral nerve-sparing radical retropubic prostatectomy: 33 were given placebo (group 1), 32 used PLC 2 g/day plus ALC 2 g/day plus sildenafil 100 mg when needed (group 2), and 35 used sildenafil alone (group 3). The studied variables were sexual function (assessed through sexual behavior interviews and the International Index of Erectile Function), peak systolic velocity and end-diastolic velocity of cavernosal arteries (assayed by dynamic echo-color Doppler), the percentage of patients able to achieve a positive intracavernous injection test, and side effects.

Results

Placebo proved ineffective and sildenafil and sildenafil plus ALC and PLC proved effective. The International Index of Erectile Function-15 scores of the group 2 patients were significantly greater than those of group 3 in the following domains: erectile function, sexual intercourse satisfaction, orgasm, and general sexual well-being. The drugs did not significantly modify the score in the sexual desire domain or in the peak systolic velocity or end-diastolic velocity of the cavernosal arteries. Sexual behavior interviews revealed that 2 of 29 in group 1, 28 of 32 in group 2, and 20 of 39 in group 3 attained satisfactory sexual intercourse (P <0.01). Only group 2 had a significantly increased percentage of patients with a positive intracavernous injection test after therapy (36.4% versus 63.6%; P <0.01). ALC plus PLC did not significantly improve the side effects of sildenafil.

Conclusions

PLC and ALC proved to be safe and reliable in improving the efficacy of sildenafil in restoring sexual potency after bilateral nerve-sparing radical retropubic prostatectomy.

Section snippets

Material and methods

This prospective trial was performed according to the CONSORT statement.10 It was authorized by our institutional review board (IRB) and was conducted from April 1, 1999 to February 1, 2004.

The studied population included all patients complaining of ED after BNSRRP. The eligibility criteria included completely functional erections before surgery (corroborated by the partner and documented in the patient file), BNSRRP (indicated on the surgical report) performed for pathologically proven

Results

A total of 96 men underwent surgery by 17 different surgeons in 12 different institutions. They were randomized into three groups. Of these 96 men, 14 (13.5%) discontinued prematurely (Fig. 1). Of these 14, 3 from group 2 discontinued the study because they achieved satisfying sexual intercourse without sildenafil. The differences among the treatment groups with respect to demographic variables were not clinically meaningful (Table I).

The modifications in the analyzed variables with respect to

Comment

These results may indicate that PLC plus ALC improves the efficacy of sildenafil in restoring and/or in ameliorating sexual ability after BNSRRP. Three patients in group 2 were able to achieve spontaneous intercourse without sildenafil. The efficacy of the drugs proved similar to the placebo in modifying the PSV and EDV of cavernosal arteries; therefore, these patterns are not involved in the return of erectile potency. The side effects of sildenafil administration proved consistent with

Acknowledgment

To Tracy Hammerstrom for her technical assistance during the course of the trial and for editing the manuscript.

References (24)

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    Citation Excerpt :

    The use of sildenafil before VED-induced erections has also been shown to improve sexual function [78]. A summary of human trials specific to the treatment of post-prostatectomy ED is shown in Table 1 [79–82]. With increased understanding of the molecular mechanisms underpinning cavernosal apoptosis, attempts to manipulate these processes are being investigated.

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This study was funded by Sigma-Tau, Industrie Farmaceutiche Riunite.

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