Titration study of MUSE (medicated urethral system for erection) in erectile dysfunction

Purpose: We assessed the erectile responses and adverse reactions to prosta glandin E-1 delivered via the medicated urethral system for erection (MUSE) in a titration study to determine optimal dose. Methods: Sixty-four patients with erectile dysfunction underwent ill-office testing with MUSE to determine erectile response. Following thorough instr uctions, patients were taught how to use MUSE themselves. The titration stu dy started with a dose of 125 mug, and increased to 250 mug, 500 mug, and f inally 1,000 mug. Tn patients who had an erectile response, erection scorin g, color duplex Doppler study, blood pressure monitoring, recording of subj ective complaints, and repeated laboratory examinations were performed to e valuate the positive and adverse effects of MUSE. Results: Forty-three of the 64 patients achieved a maximal erection with MU SE, as shown by systolic peak flow velocities in the deep penile arteries o f greater than 27 cm/s on Doppler ultrasonography. One patient was unsatisf ied with his erectile response and dropped out of the study. Of the 49 pati ents who completed the study, most (35) were satisfied with the response ac hieved at the higher doses of 500 mug and 1,000 mug. A modified soft rubber band was needed to achieve a satisfactory erectile response in 18 patients . Only four patients experienced serious urethral burning during MUSE appli cation. Conclusions: MUSE was effective and safe in most patients with erectile dys function in this study. For patients not satisfied with the extent of penil e rigidity achieved with MUSE, the use of a modified soft rubber band for e rectile assistance, as well as a program for improved patient education, ma y help to achieve a better erectile response and facilitate compliance with treatment regimens at home.