Use of oral phosphodiesterase type-5 inhibitors before penile prosthesis implantation: duration, predictors, and clinical insights

Background: Phosphodiesterase type-5 inhibitors (PDE5i) are the first-line therapy for erectile dysfunction (ED), offering high efficacy and favorable safety profiles. However, data on how long PDE5i remain effective before the need for penile prosthesis (PP) surgery are limited. This study evaluates the duration from PDE5i initiation to PP surgery and identifies predictors of this interval.
Methods: We conducted a retrospective review of patients with ED who initiated PDE5i therapy and subsequently underwent PP surgery between January 2019 and August 2022. Clinical characteristics, laboratory results, and duration of PDE5i use were extracted from hospital records.
Results: A total of 98 patients were included, with a mean age of 56.1 ± 11.5 years and a mean body mass index (BMI) of 29.8 ± 4.4 kg/m². Comorbidities were present in 88.8 % of patients, including diabetes mellitus (75.5 %), hypertension (54.1 %), and smoking (31.6 %). The mean time from PDE5i initiation to PP surgery was 34.9 ± 24.8 months (≈ 2.9 years). Lower testosterone levels were associated with earlier surgery, while comorbidities were not.
Conclusions: The average duration of PDE5i use prior to PP surgery was approximately three years. Lower testosterone levels may predict earlier surgical intervention, whereas comorbidities did not show a significant association. These findings may assist clinicians in counseling patients and planning treatment strategies.