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.
