Comparison of Transurethral and Intracavernosal Administration of PGE1 in Normal Males and SCI Patients

Choi, Jae Ho; Choi, Seong; Rhew, Hyun Yul

Abstract

Intracavernous self-injection therapy is now being widely used to treat patients with erectile dysfunction. Many men with erectile dysfunction can achieve normal erection with this therapy, but about 50% of men using this therapy eventually discontinue treatment for reasons relating to penile pain, needle-phobia and side effects including corporeal scarring, penile hematoma and priapism. Therefore, the less invasive route of drug administration is highly recommended. We investigated the efficacy and safety of transurethral instillation of PGE1 solution for the treatment of erectile dysfunction in comparison with an intracavernous injection of PGE1. Forty seven normal males and nine neurogenic impotent patients due to spinal cord injury (SCI) were enrolled in this study and all subjects were evaluated with the penile duplex color doppler ultrasonography before and after the drug administration. Penile length and circumference were measured before and after the drug administration. The erectile response was recorded on a five-point erection assessment scale by Padma-Nathan. Of 12 normal males used transurethral instillation of PGE1 solution 5 (42%) were achieved erection allowing sexual intercourse (score 4 or 5). The mean peak systolic velocity at 30 minutes was 75.82+/-56.84cm/sec, 63.11 +/- 48.11cm/sec and end diastolic velocity at 30 minutes was 3.49+/-8.10cm/sec, 10.51 +/- 1.12cm/sec and resistance index was 0.96+/-0.15, 0.78+/-0.15 in normal males and SCI patients respectively. Mean length and circumference of penile shaft before and after transurethral instillation of PGE1 showed significant difference. Of 9 patients, 5 (55.5%) were achieved erection allowing sexual intercourse. With the transurethral instillation of PGE1 solution, urethral pain and burning sense were noticeable complication but systemic side effect was not noticed. In conclusion, transurethral PGE1 instillation can be satisfactorily used for the patients with erectile dysfunction of less prominent organic and neurogenic origin, although the effect of transurethral instillation of PGE1 is obviously less than that of intracavernosal injection.