الفهرس 
Bladder sparing strategiesOnly 14 pages are availabe for public view
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Abstract
Invasive bladder carcinoma is the most common malignant urological tumor in Egyptian males and radical cystectomy is the gold standard treatment. Erectile dysfunction was an inevitable complication before the introduction of nerve sparing technique. Before the introduction of oral drug therapy on 1998, the available treatment options were vacuum devices, urethral alprostadil suppositories, intracavernousal injection of vasoactive medications or penile prostheses. All of these modalities were inappropriate, painful and invasive or associated with high complication rate. In this study we evaluated the efficacy and safety of sildenafil in post RC erectile dysfunction and verified the different clinical and pathological factors that affected patients response to treatment. Sildenafil therapy proved efficacy in treatment of ED following radical cystectomy. There was improvement in the scores of EF domain in 38% of patients after 50 mg and in 58% after 100 mg sildenafil therapy. The efficacy of Sildenafil citrate increased with increasing the dose to 100 mg but this was accompanied by more side effects. Side effects were recorded in 6% of patients after 50 mg and 33% after 100 mg sildenafil. There was good respons to sildenafil in young patients, patients with young wives, patients with domal tumors, low stage tumors, patients with nerve sparing cystectomy, patients with post operative partial tumescence, patients with orthotopic bladder substitution and continent patients after orthotopic bladder substitution, Multivariate analysis revealed that postoperative partial tumescence is the most important single independent factor in predicting patients response to sildenafil, where patients with partial tumescence has 3.5 times more chance of giving good response to sildenafil than those with complete ED. Nerve sparing procedure should be tried when possible.