Intracavernosal alprostadil is effective for the treatment of erectile dysfunction in diabetic men

Abstract

The efficacy and safety of intracavernosal alprostadil was evaluated for the treatment of erectile dysfunction in men with type I or type II diabetes mellitus. This was an open-label, flexible doseescalating study involving 336 men (77% of whom were Asian=Oriental) enrolled by 15 centres in Australia, Canada and seven countries in Asia. The effective alprostadil dose, ie the dose producing penile rigidity adequate for intercourse and lasting up to 60 min, was established by titration at the clinic prior to entry into the 6 month self-treatment home phase. All men were fully trained in the self-injection technique before entry into the home phase. Efficacy and safety were assessed using patient and partner diaries and by interview at clinic visits during the titration phase and after 1, 3 and 6 months of treatment. An effective home dose was established by titration for 94% of the 336 men (median dose 20 mg, range 2.5 -60 mg). Of 278 (83%) men who entered the home phase, 277 men (247 with type II diabetes and 30 with type I diabetes) had evaluable data for alprostadil dosage and clinical response. During the home phase, a satisfactory erectile response was achieved after 99% of injections, and the median alprostadil dose remained unchanged. The initial home dose and clinical response were similar in type I and type II diabetic men. Treatment was generally well tolerated with a low incidence of penile pain (24%) In conclusion, intracavernosal alprostadil was effective and well tolerated in type I and type II diabetic men with erectile dysfunction of mixed aetiology.

Do Impotent Men With Diabetes Have More Severe Erectile Dysfunction and Worse Quality of Life Than the General Population of Impotent Patients?

“…Whereas this report clearly documents that the sildenafil group had superior outcomes at the conclusion of the 12-week trial (56% of subjects in the active treatment arm reported improved erections compared with 10% in the placebo group), the results of the current study question how durable this response is. Similarly, Heaton et al (14) reported favorable 6-month outcomes in a cohort of 336 diabetic men with ED treated with intracavernosal alprostadil injection therapy. Although these results are encouraging, the current study documents that diabetic men can expect favorable results at 6 months after baseline but that the response to therapy may not be durable.…”

Specific aspects of erectile dysfunction in endocrinology

“…Second-line treatments include alprostadil (not marketed in Spain), which is administered intraurethrally at a dose of 250-1000 mg or injected into the corpora cavernosa at doses of 5-20 mg, and has achieved acceptable results in diabetics. 26 Hypogonadism. Screening for hypogonadism, in addition to a thorough medical history and physical examination, should include total or, preferably, free plasma testosterone levels to make the appropriate corrections for the age of the patient.…”

Dysfonction érectile et diabète

“…Dans une étude à propos de 336 hommes souffrant de DE diabétique, 83 % des patients ont rapporté des érections satisfaisantes, permettant un rapport sexuel après une injection intracaverneuse de PGE 1 [9]. La plus grande familiarité de ces patients avec le principe de l'injection ainsi que la fréquente absence d'alternative en cas de diabète expliquent la meilleure observance à ces traitements des patients diabétiques par rapport aux autres patients.…”