Incontinence and impotence occur after external-beam irradiation but to a lesser degree. Recovery of potency can take up to 18 months after radical prostatectomy. The man in the case presented above has exceeded that time and will likely not recover spontaneously. Since it may require up to 18 months to achieve natural return of erectile function, many men seek assistance to induce erections. Different options exist, including vacuum devices, intracavernosal injections of pharmacologic agents, penile prosthesis, and oral therapy with sildenafil.
Stimulation is required.
If the 50-mg dose does not work, it should be increased to 100 mg at another time. If this does not work, then I advise patients to try another means. All patients should be advised not to take sildenafil if they are using nitrates. There are several other oral agents in clinical trials, including apomorphine and phentolamine. In the future, combination therapy may be indicated in patients who do not respond to sildenafil.