Intracavernous self-injection of prostaglandin E1 in the treatment of erectile dysfunction

Abstract

In a three-year follow-up study of 69 patients found that erectile dysfunction (ED) impairs many elderly men's life: up to 25% of the men aged 65 y and 80% of those aged 75 y suffer from erectile dysfunction. The most effective non-surgical treatment of ED is intracavernosal pharmacotherapy, and the most common vasoactive agent currently used is prostaglandin E1 (PGE1). The purpose of this study was to assess the long-term outcome of PGE1 treatment and the patients' overall satisfaction with their sexual life.Sixty-nine patients who had started ICI therapy three years earlier were invited to a control examination. The mean age of the patients was 60.5 y. The patients ®lled in a questionnaire, which included questions about the use of PGE1 treatment at home. All the patients evaluated their own satisfaction with their erection, ejaculation, orgasm and libido on a visual analytical scale (VAS, 0 ± 100%). A clinical examination was made, and the penile shaft was examined by ultrasonography. Erection with the home dose of PGE1 was estimated by Rigiscan, and the degree of erection was also estimated clinically (grades 0 ± 5) by a doctor.The most common doses of PGE1 used at home were between 10 and 20 m (58%), 46.4% of the patients had discontinued PGE1 therapy, the mean time of using PGE1 was 23.3 months. The mean coital frequency with PGE1 was 2.8 times per month. 34.8% of the patients (24 out of 69) reported that their own spontaneous erections had improved after the beginning of PGE1 therapy. The most common problem was hematomas in 10.1% of the patients (7 out of 69), which, however, were small and did not cause discontinuation of the therapy. There were three instances of priapism (4.3%), and four patients (5.8%) had ®brosis in ultrasonography. The patients' satisfaction with their erection at home was 67.3% with PGE1.The mean coital frequency with PGE1 therapy was quite low, 2.8 times per month, even though the patients' mean age was only 60.5 y, one reason may be the high price of PGE1 injections. The rate of improvement of spontaneous erections while using PGE1 was quite high, accounting for 34.8% of the patients. Most of the patients who discontinued the PGE1 therapy had a psychogenic etiology. There were no systemic side-effects with PGE1. Only 7.2% of the patients had prolonged pain after the injection, leading to drug discontinuation.It can be concluded that treatment with intracavernous injections of PGE1 is well tolerated and involves only minor problems. The patients' satisfaction with their erections at home with PGE1 therapy was good. Precise determination of the home dose of PGE1 and the teaching of the technique of injection are important at the beginning of this treatment modality.

SOP Conservative (Medical and Mechanical) Treatment of Erectile Dysfunction

“…In another study, patients' satisfaction rates with PGE1‐induced erections at home were 67.3% [137].…”

“…Both prevalences of diabetes and metabolic syndrome were inversely related to intracavernosal injection (ICI) test response [134]. Doses used in ED usually range between 5 and 40 µg, with the most commonly used doses between 10 and 20 µg [135–138].…”

“…The injection frequency in various PGE1 self‐injection studies ranged between two and four per month [135–138].…”

Intracavernosal Prostaglandin Injection Prior to Circumcision Allows More Precise Removal of Foreskin

“…ICI has traditionally been used in the management of erectile dysfunction but also has been described in the correction of penoscrotal webbing [7,8]. We believe that a pharmacologically induced erection at the time of surgery is the best way to plan the removal of the most precise amount of foreskin during circumcision.…”

Oral sildenafil (Viagra™) in male erectile dysfunction: use, efficacy and safety profile in an unselected cohort presenting to a British district general hospital.

“…However, both the method of administration (self-injection) and the risks of major adverse events, such as intracorporeal fibrosis and priapism [3], strongly suggested the need for further therapeutic advances in the treatment of impotence. Transurethral alprostadil (as MUSE™) was the next to arrive on the scene, but the response rate has been variable and enthusiasm has waned [4].…”