Intraurethral alprostadil for treatment of erectile dysfunction in patients with spinal cord injury

Objectives. To assess the efficacy of intraurethral prostaglandin E-1 (alpr ostadil, MUSE) in treating erectile dysfunction in patients with spinal cor d injury (SCI). Methods. Intraurethral alprostadil was tested in 15 patients with SCI to ev aluate its effectiveness in treating SCI-associated erectile dysfunction. A ll patients were at least I year after injury, and all had previously used intracavernosal injections successfully (Schramek's grade 5 erection). The intraurethral drug was administered in the office, in the presence of a phy sician, with monitoring of blood pressure. If effective, the patient was th en able to use MUSE at home. The first 3 patients underwent gradual dose es calation starting with 125 mu g, without the use of a constriction ring. Be cause of hypotension, the remaining 12 patients all used a penile constrict ion ring prior to intraurethral drug administration using 1000 mu g. The qu ality of the erection was compared with that achieved with intracavernosal injections using Schramek's grading. Results. The dose escalation (titration) in the first patients demonstrated that the 1000-mu g dose was the most effective in creating an erectile res ponse, Transient hypotension was noted in these first 3 patients in whom th e constricting band was not used. The highest dose of MUSE (1000 mu g) was, therefore, used in the remaining 12 patients, with the constriction band. The quality of the erection varied and appeared to be less rigid in all pat ients (12 patients with grade 1 to 3; 3 patients with grade 4) than that no ted with intracavernosal injection therapy (15 patients with grade 5), Ther e was no incidence of priapism. The 3 patients with grade 4 erections tried the MUSE at home. All 3 patients were dissatisfied with the quality of the erection and did not continue to use the MUSE at home and returned to intr acavernosal injection therapy. Conclusions. MUSE appears to be somewhat effective in creating erections; h owever, these were less rigid erections than those obtained with intracaver nosal therapy and provided less overall satisfaction. It should always be u sed in the patient with SCI after placement of a constriction ring to preve nt hypotension. Its ultimate use depends on the patient's level of satisfac tion with the quality of the erection compared with intracavernosal injecti ons. UROLOGY 53: 199-202, 1999. (C) 1999, Elsevier Science Inc. All rights reserved.