Disappointing Initial Results With Transurethral Alprostadil for Erectile Dysfunction in a Urology Practice Setting

Fulgham, Pat F.; Cochran, James S.; Denman, John; Feagins, Brian A.; Gross, Martha; Kadesky, Kevin M.; Kadesky, M.C.; Clark, August; Roehrborn, Claus G.

doi:10.1016/s0022-5347(01)62238-9

Cited by 85 publications

(27 citation statements)

References 6 publications

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“…Prolonged erections and penile ®brosis are rare, 51 although the clinical success rate is low. 52 (ii) Intracavernosal injection therapy Prior to the approval of sildena®l, intracavernosal selfinjection was the most common medical therapy for erectile dysfunction. 53,54 The two FDA…”

Section: Second-line Therapy Optionsmentioning

confidence: 99%

The process of care model for evaluation and treatment of erectile dysfunction

Rosen

1999

Int J Impot Res

129

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This paper addresses pertinent issues concerning the role of physicians in the assessment and treatment of men with complaints of erectile dysfunction. With the availability of safe and effective oral drug therapy, the ®eld of erectile dysfunction has expanded rapidly to encompass multiple disciplines and specialties. Recognizing the need for evidence-based standards and guidelines in the management of this common disorder, a multidisciplinary panel of experts was convened to examine existing literature and practice standards. This panel employed a modi®ed Delphi methodology to develop consensus on de®nition and classi®cation, rational utilization of diagnostic and therapeutic options, and clinical guidelines for the management of erectile dysfunction in a primary care setting. A`Process of Care Model for Erectile Dysfunction' was thus developed, incorporating a step-wise decision making approach, de®ned in terms of relevant processes, actions and outcomes. According to this method, initial assessment should include a careful clinical history, focused physical examination and selected laboratory tests. Subsequent management should be goal-oriented, taking into account patient and partner needs and preferences. The stepwise treatment algorithm is based on the selection criteria of ease of administration, reversibility, relative invasiveness and cost. In addition, common referral indications for specialized diagnostic testing and treatment are provided. By assisting the primary physician in selecting appropriate assessment tools and treatment interventions, the proposed guidelines are intended to optimize care of the patient with erectile dysfunction.The panel strongly recommends further research into the causes and associated risk factors for erectile dysfunction, prevention and the role of lifestyle modi®cation, and the critical issue of partner-related sexual dysfunction. Considering the strong relationship between sexual dysfunction and overall quality of life, it is incumbent upon physicians to address the sexual needs of their patients in a sensitive and informed manner.Erectile dysfunction is a signi®cant and common medical problem. 1 In the Massachusetts Male Aging Study (MMAS), a community-based survey of men between the ages of 40 and 70 y, 2 52% of respondents reported some degree of erectile dif®culty. Complete erectile dysfunction, de®ned as the total inability to obtain or maintain erections during sexual stimulation, as well as the absence of nocturnal erections, occurred in 10% of respondents. Lesser degrees of mild and moderate erectile dysfunction occurred in 17% and 25%, respectively. In the National Health and Social Life Survey (NHSLS), a nationally representative probability sample of men and women aged 18±59 y, 3 10.4% of men reported being unable to achieve or maintain an erection during the past year (corresponding to the proportion of men in the MMAS reporting complete erectile dysfunction). Both studies observed a strong relationship to age. Although the prevalence of mild erectile dysfu...

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Section: Second-line Therapy Optionsmentioning

confidence: 99%

The process of care model for evaluation and treatment of erectile dysfunction

Rosen

1999

Int J Impot Res

129

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“…[4][5][6][7]11 The primary reasons for discontinuation were inadequate erections and a preference for other treatment. We found adverse side effects to be an infrequent (4/28 (14%)) reason for discontinuing treatment.…”

Section: Discussionmentioning

confidence: 99%

“…PadmaNathan et al 5 reported that 65.9% of men achieved erections sufficient for intercourse after transurethral alprostadil was administered in a clinical setting. Fulgham et al, 6 however, reported only a 30% response rate to transurethral alprostadil and the reason for this discrepancy is not known.…”

Section: Introductionmentioning

confidence: 96%

Long-term efficacy and compliance of MUSE for erectile dysfunction following radical prostatectomy: SHIM (IIEF-5) analysis

et al. 2004

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Baseline and follow-up data of 54 patients from a single surgical series (1998)(1999)(2000)(2001), who used medicated urethral system for erection (MUSE) for the erectile dysfunction (ED) associated with radical prostatectomy (RP), were obtained. Patients were surveyed using the abridged five-item version of the International Index of Erectile Function (IIEF) questionnaire, commonly referred to as the Sexual Health Inventory of Men (SHIM), to determine presence and severity of ED and efficacy of ED treatment modalities. The mean patient age was 63.775.6 y and the mean follow-up period was 2.371.2 y. All patients experienced ED for at least 6 months after their surgery before starting MUSE therapy. Overall, 55% of the patients achieved and maintained erections sufficient for sexual intercourse while on MUSE and 48% continued long-term therapy with a mean use of 2.3271.2 y. The mean presurgery SHIM score in these patients was 19.271.3, which decreased to 5.270.5 after surgery and increased to 16.371.3 after MUSE treatment. A total of 28 patients (52%) discontinued treatment after a mean use of 871.4 months. The reasons for discontinuation were insufficient erections (n ¼ 16, mean SHIM score of 10.574.4), switch to other ED therapies (n ¼ 4), natural return of erections (n ¼ 4) and urethral pain and burning (n ¼ 4). Excluding the patients (n ¼ 8) who preferred other therapies and return of natural erections, the compliance to MUSE was 63%. There were no significant differences in the IIEF-5 responses between the patients who had a nervesparing technique (n ¼ 34) and those who did not (n ¼ 20) or among patients who used different doses (250, 500 or 1000 lg) of MUSE. The results of the current trial indicate that MUSE is a successful treatment option in RP patients with established ED. It appears that a post-treatment SHIM score of Z16 defines a successful outcome with MUSE therapy.

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“…Most physicians who prescribe the agent for patients in their practice were obtaining results of 30 ± 40% or less. 5 In spite of the fact that these data were clearly available in the original article, 4 they were not commented on, even in an editorial section. During home treatment, penile pain occurred in 32.1% of patients receiving the active ingredient alprostadil (10.8% of all applications in all patients).…”

Section: Clinical Trials Of Intraurethral Therapymentioning

confidence: 99%

Review of intraurethral suppositories and iontophoresis therapy for erectile dysfunction

Lewis

2000

Int J Impot Res

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This brief review examines the history of the intraurethral (IU) pharmacotherapy for the treatment of erectile dysfunction (ED). Emphasis is placed on the design, study endpoints and results of a limited number of clinical trials undertaken with PGE 1 -MUSE to demonstrate the ef®cacy of this unique delivery system. Next, the theory of the iontophoretic technique of drug delivery is discussed. Clinical data collected while applying these methods are presented, but are thus far limited to treatment of patients with Peyronie's disease. Iontophoresis as a drug delivery alternative may gain popularity with ED patients who fail other types of therapy or in patients with other penile disorders.

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Disappointing Initial Results With Transurethral Alprostadil for Erectile Dysfunction in a Urology Practice Setting

Cited by 85 publications

References 6 publications

The process of care model for evaluation and treatment of erectile dysfunction

The process of care model for evaluation and treatment of erectile dysfunction

Long-term efficacy and compliance of MUSE for erectile dysfunction following radical prostatectomy: SHIM (IIEF-5) analysis

Review of intraurethral suppositories and iontophoresis therapy for erectile dysfunction

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