Sexual and Reproductive Health

Intraurethral Preparations

The application of intraurethral prostaglandin E1 (alprostadil) can be done by a urologist or self-administered to the distal male urethra via a drug deliver system. It appears to produce cavernosal vasodilation to initiate erection.

Author Year; Country
Score
Research Design
Total Sample Size		 Methods Outcome
Strebel et al. 2004
Switzerland
Post-test
Level 4
N=22		 Population:
All 22 patients had a chronic SCI lasting a
median (range) of 63 (7–156) months; 11
had an UMN lesion (six complete, five
incomplete), eight a LMN (seven complete,
one incomplete) and three a mixed lesion.
Treatment:
Eight tablets of apomorphine sublingual
(SL) 3 mg, as a primary or secondary
treatment for erectile dysfunction (ED)
Outcome Measures: International Index of
Erectile Function questionnaire, patient
diaries. A neurophysiological evaluation
included somatosensory evoked potentials
of the pudendal nerve, palmar and plantar
sympathetic skin responses and
bulbocavernous reflex recordings.		 1. There were no significant correlations
for electrophysiological or urodynamic
findings and treatment success.
2. Seven patients had some response and
reported that the drug helped them to
obtain an erection, but only two
reported erections sufficient for
intercourse and would agree to continue
apomorphine SL as their standard
treatment; all the others reported being
disappointed. Nine patients reported
side-effects.
Bodner et al. 1999;
USA
Post-test
Level 4
N=15		 Population: 15 men; Age range: 30-70 yrs,
Injury level: 7 tetraplegia, 8 paraplegia.
Treatment: Intraurethral alprostadil (125-
1000µg); MUSE (medicated transurethral
system for delivery of alprostadil to the male
urethra).
Outcome Measures: Efficacy of
intraurethral prostaglandin E1.		 1. 12 achieved grade 1-3 erections, 3
achieved grade 4 erections.
2. All could achieve grade 5 erections with
intracavernosal injections therapy. The
three that achieved grade 4 erections all
tried MUSE at home and were
dissatisfied.

Discussion

There are no RCT studies in this area. In a series of 15 men with SCI, Bodner et al. (1999) found that the use of intraurethral alprostadil (PGE1) was ineffective in sustaining an adequate erection, and without a penile ring to sustain any increase in penile circumference (tumescence), patients experienced hypotension from the medication. Based on the evidence to date, such studies do not appear to be worth pursuing.

Conclusion

There is level 4 evidence (from a post-test study: Bodner et al. 1999) which suggests that the use of intraurethral preparations is not effective as treatment for erectile dysfunction in men with SCI.

There is level 4 evidence (from a pre-post study: Strebel et al. 2004) that found some success using apomorphine SL to facilitate erections.

Intraurethral preparations are not effective for treatment of erectile dysfunction in men with SCI. Limited evidence suggests apomorphine SL may facilitate erections in men with SCI.

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