TRANSURETHRAL APPLICATION OF ALPROSTADIL WITH MUSE(TM) (MEDICATED URETHRAL SYSTEM FOR ERECTION) - ACTUAL OVERVIEW AND PERSONAL EXPERIENCES

An analysis of the presently available results concerning transurethra l application of Al-prostadil with MUSE(TM) (Medicated Urethral System for Erection) up to 1000 mu g indicates a 20-30% lower efficacy if co mpared to 20 mu g i.c. injected Alprostadil. Whereas in prospective ho me-treatment trials only each second MUSE(TM)-application was successf ul in responders 87%-94% of the administrations in self-injection ther apy resulted in successful coitus. In an own comparative trial in 73 p ts the succes rates after MUSE(TM) up to 1000 mu g were 48% compared t o 71% after i. c. Alprostadil. Reported side-effects of MUSE(TM) in th e literature were: Hypotension 3-8%, syncopes 0,4%, penile/urethral pa in 29%, urethral bleeding 5%, vaginal irritations 3%, priapisms < 0,1% . After MUSE(TM)-applikation the average Alprostadil contents of the e jaculate increased 40%. Whereas in prospective long-term studies of se lf-injection therapy with Alprostadil the risk of persistent fibrotic alterations of the penis varied between 5-7%, the risk of penile fibro sis after MUSE(TM) can not be finally estimated. Also the potential ri sk for urethral strictures after MUSE(TM) is presently not: foreseable . The advantage of the technically easy use is confronted with a consi derably lower efficacy. Therefore self-injection therapy must be furth er on considered the ''golden standard'' in Alprostadil administration .