Intracavernosal versus intraurethral alprostadil: a prospective randomized study

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Abstract

Objective

To compare the medicated urethral system for erection (MUSE) with standard intracavernosal prostaglandin E1 (PGE1) in the treatment of erectile dysfunction.

Patients and methods

Sixty consecutive men with organic erectile dysfunction were prospectively randomized to receive either 20 µg of intracavernosal PGE1 (group 1, 30 patients) or 1 mg MUSE (group 2, 30 patients). Response to the drugs was recorded in the outpatient clinic and all patients continued a home-treatment programme for 3 months. After each home administration, patients recorded the grade of erection in diaries, whether or not sexual intercourse occurred and any adverse reactions to the drugs. Comfort and ease of administration were also recorded.

Results

The characteristics of the patients of both groups were similar; 10 patients in group 1 and 25 in group 2 completed the 3-month treatment programme, i.e. a withdrawal rate of 67% and 17% for groups 1 and 2, respectively (P < 0.05). During outpatient dosing, 27 (90%) patients in group 1 and 18 (60%) patients in group 2 achieved a good erection (P < 0.05). Intercourse during the 3 months of home treatment was reported at least once in 26 (87%) patients in group 1, compared with 16 (53%) patients in group 2 (P < 0.05). After 3 months of home treatment, patients had administered a total of 242 doses of intracavernosal PGE1 and 360 doses of MUSE; intercourse was reported after 206 (85%) and 198 (55%) administrations of PGE1 and MUSE, respectively (P < 0.05). The most common adverse reaction was urogenital pain, reported by 14 (47%) patients in group 1 and two (7%) patients in group 2 (P < 0.05). Home treatment was assessed as easy by 12 (40%) patients in group 1 and 27 (90%) in group 2 (P < 0.05).

Conclusion

Although MUSE is less effective than intracavernosal PGE1, it is more attractive and accepted well by most patients as an easy method of treatment with minimal or no discomfort.

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