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

In a three-year follow-up study of 69 patients found that erectile dysfunct ion (ED) impairs many elderly men's life: up to 25% of the men aged 65 y an d 80% of those aged 75 y suffer from erectile dysfunction. The most effecti ve non-surgical treatment of ED is intracavernosal pharmacotherapy, and the most common vasoactive agent currently used is prostaglandin E1 (PGE1). Th e purpose of this study was to assess the long-term outcome of PGE1 treatme nt and the patients' overall satisfaction with their sexual life. Sixty-nine patients who had started ICI therapy three years earlier were in vited to a control examination. The mean age of the patients was 60.5 y. Th e patients filled in a questionnaire, which included questions about the us e of PGE1 treatment at home. All the patients evaluated their own satisfact ion with their erection, ejaculation, orgasm and libido on a visual analyti cal scale (VAS, 0-100%). A clinical examination was made, and the penile sh aft was examined by ultrasonography. Erection with the home dose of PGE1 wa s estimated by Rigiscan, and the degree of erection was also estimated clin ically (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 pe r month. 34.8% of the patients (24 out of 69) reported that their own spont aneous 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. The re were three instances of priapism (4.3%), and four patients (5.8%) had fi brosis in ultrasonography. The patients' satisfaction with their erection a t home was 67.3% with PGE1. The mean coital frequency with PGE1 therapy was quite low, 2.8 times per mo nth, 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 e rections while using PGE1 was quite high, accounting for 34.8% of the patie nts. Most of the patients who discontinued the PGE1 therapy had a psychogen ic etiology. There were no systemic side-effects with PGE1. Only 7.2% of th e patients had prolonged pain after the injection, leading to drug disconti nuation. It can be concluded that treatment with intracavernous injections of PGE1 i s well tolerated and involves only minor problems. The patients' satisfacti on with their erections at home with PGE1 therapy was good, Precise determi nation of the home dose of PGE1 and the teaching of the technique of inject ion are important at the beginning of this treatment modality.