Bulbocavernosus reflex testing: a preliminary study on the prognostic factors for potency and response to sildenafil citrate after bilateral nerve-sparing radical prostatectomy Academic Article uri icon

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  • OBJECTIVE: Erectile dysfunction (ED) following radical prostatectomy is of major concern for both patients and caring physicians. We evaluated the bulbocavernosus reflex latency (BCRL) and amplitude (BCRA) following bilateral nerve-sparing radical retropubic prostatectomy (NS-RRP) to predict the response to sildenafil citrate (SC). METHODS: Patients were recruited in our ED clinic following NS-RRP. Exclusion criteria included preoperative significant ED, neurological disease, and nitrates treatment. Patients were defined as non-responders only after four consecutive unsuccessful trials of 100 mg SC. RESULTS: Twenty patients at least 3 months after surgery were included in this study. Five patients (25%) regained spontaneous erections, although insufficient for vaginal penetration. All of them had normal BCRL and normal BCRA as well as good response to 100 mg SC. Three patients (15%) lacked spontaneous erections and had prolonged BCRL with normal BCRA. This subgroup eventually regained erections using SC. Twelve patients (60%) lacked spontaneous erections and had prolonged BCRL and low BCRA. They failed SC trials and achieved erections using intra-cavernosal injections (ICI) of 10 microg PGE(1). CONCLUSIONS: Neurophysiologic evaluation consisting of BCRL and BCRA was found to be useful in the prediction of the response to SC following bilateral NS-RRP. Patients who do not regain an erection, and have abnormal BCRL and BCRA 6 months after surgery, will probably be SC non-responders and may benefit from ICI. A subset of patients with preserved BCRA and prolonged latencies has been shown to have a better chance to respond to SC.


  • Shefi, Shai
  • Zwecker, Manuel
  • Pinthus, Jehonathan
  • Mor, Yoram
  • Zeilig, Gabriel
  • Shemesh, Yeheskell
  • Hanani, Jacob I
  • Raviv, Gil

publication date

  • March 2010