THE RATIONALE FOR PROSTAGLANDIN-E1 IN ERECTILE FAILURE - A SURVEY OF WORLDWIDE EXPERIENCE

Purpose: Prostaglandin E1 (PGE1, alprostadil) is used worldwide for se lf-injection therapy in erectile failure and was recently officially a pproved for this purpose in the United States and most European countr ies. Therefore a comprehensive overview on biochemistry, pharmacology and therapeutic results of PGE1 is provided. Materials and Methods: Th e relevant literature on PGE1 was reviewed along with personal experie nce with 4,577 patients during a 7-year period. PGE1 was compared to o ther vasoactive drugs, such as papaverine, the mixture of papaverine a nd phentolamine or linsidomine alone. Results: In Europe PGE1 was offi cially approved for the therapy of peripheral arterial occlusive disea se of the lower limbs in 1984. The drug has direct relaxing effects on smooth muscle cells of vessels and cavernous bodies, shows inhibitory effects on platelet aggregation, on low-density lipoprotein entry int o the vascular wall and on presynaptic noradrenaline release and, ther efore, it prevents the progress of atherosclerosis. In erectile failur e PGE1 shows a response rate of more than 70% and, compared to papaver ine with phentolamine, a considerably lower risk of priapism (0.35% ve rsus 6%, respectively) as well as of local fibrotic complications. Exc ept for rare cases of blood pressure decrease, no systemic side effect s were observed after intracavernous injection of PGE1. Conclusions: F or self-injection therapy, PGE1 presently represents the most efficaci ous and safest drug. Ongoing trials with topical and especially intrau rethral PGE1 are promising and may offer less invasive therapies in th e near future.