PENILE FIBROSIS IN INTRACAVERNOSAL PROSTAGLANDIN-E1 INJECTION THERAPYFOR ERECTILE DYSFUNCTION

Penile fibrosis (PF) may be a complication of intracavernosal injectio n therapy (ICI). It has been well documented as a side effect of papav erine, but there have been few reports associating penile fibrosis wit h prostaglandin E1 (PGE1, Alprostadil). Many authors did not find fibr otic changes in the penis while others reported penile fibrosis as a c omplication of intracavernosal PGE1 in only 0.76-2.1% of their patient s. Recent studies, however, suggest that the incidence may be as high as 15%. Three hundred consecutive patients who returned to our Institu te for repeat prescription of PGE1 were asked about penile curvature a nd deformity and the penis was examined for fibrotic change. Twenty-tw o were excluded because of concurrent or previous use of papaverine an d/or phentolamine, 30 patients had pre-ICI evidence of fibrotic change and 3 had incomplete data. Of the remaining 245 patients, 57 (23.3%) were found to have penile fibrosis. These men, mean age 62 y (21-79), had been self injecting an average of 5.2 times per month (1-16) for a n average period of 29.2 months (2-86). The mean dose of PGE1 used was 13 mu g (2-60) and an average of 65.6 mu g of PGE1 (3-360) was used p er month. The mean total number of injections was 142.4 (8-810) and th e mean total amount of PGE1 1703 mu g (105-11520). Penile fibrosis is hence a significant complication of intracavernosal PGE1 therapy. It i s mandatory to examine patients methodically for fibrotic changes in t he penis prior to commencement of treatment and at subsequent regular reviews. Patients should be specifically warned of the possibility of penile fibrosis and should be instructed on self examination so that t hey may report early changes if and when these occur.