Objectives: Erectile dysfunction (ED) is a common and often distressing complication following radical prostatectomy for prostate cancer, with a profound impact on quality of life. While oral phosphodiesterase type 5 inhibitors (PDE5i) are standard first-line therapy, their efficacy is often limited in this cohort by suboptimal efficacy, delayed onset, side effects, and the requirement for premeditated sexual activity. Intracavernosal injections (ICI) may be effective but are invasive and poorly tolerated by many. There remains a clear need for therapies that offer improved spontaneity, tolerability, and satisfaction. Intranasal delivery of PDE5 inhibitors represents a novel approach.
Methods:
This case series of four men (aged 66–68) with persistent ED following robotic-assisted radical prostatectomy. All had inadequate response to at least two oral PDE5i; three had previously trialled and discontinued ICI due to discomfort or limited success. Each was commenced on a novel intranasal vardenafil spray (5 mg; one spray per nostril) used immediately prior to sexual activity. Outcomes assessed included Erectile Hardness Score (EHS), onset time, duration of effect, and patient-reported satisfaction.
Results:
All participants reported a rapid onset of effect (within 5–30 minutes) and improved EHS from 0–2 at baseline to 3–4 post-treatment. Successful penetration and intercourse occurred “most times” or “always.” Mild side effects, including nasal irritation and facial flushing, were reported but did not result in treatment discontinuation. All four men preferred the intranasal delivery over oral or injectable options, citing greater spontaneity and ease of use.
Conclusions:
These findings suggest that intranasal vardenafil may offer a promising alternative for men with ED post-radical prostatectomy, especially those who are dissatisfied with or refractory to existing treatments. Larger, controlled studies are warranted to further evaluate its efficacy, safety, and long-term tolerability in this growing patient population.