Effect of PGE1 on Duration and Rigidity of Erection

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Effect of Intracavernosal Injection of Prostaglandin E1 on Duration and Rigidity of Erection in Patients with Vasculogenic Erectile Dysfunction: Is it Dose-Dependent?




Objective:
To assess if the effect of intracavernosal injection (ICI) of prostaglandin E1 (PGE1) on duration and rigidity of erection is dose-dependent in patients with different types of vasculogenic erectile dysfunction (ED)?

Methods: A hundred patients with ED were assigned into 4 groups (n=25/each); group (A) patients with arteriogenic ED, group (B) patients with veno-occlusive ED, group (C) patients with mixed (arteriogenic and veno-occlusive) ED, and group (D) patients who have only psychogenic ED (control). After ICI of PGE1 patients were assessed using penile doppler ultrasonography and erection hardness score together with calculation of erection duration. The starting dose of PGE1 was 5μg which was increased to 10µg and 20µg as a maximal dose when needed.

Results: The mean PSV of patients in groups A, B, C, and D were 24.38±3.3, 37.74±8.28, 22.24±3.85, and 47.76±6.27 respectively. In group D, 88% have achieved the best response at a dose of 5 µg while 5.3%, 21.7%, and 0% have achieved the best response at a dose of 5µg in groups A, B and C respectively ( p<0.05 for each). The rest of the patients have required either 10 or 2 0 µg to achieve the best response. Patients in group C have required the highest dose of PGE1 to achieve the best response ( p<0.05).

Conclusion: Intracavernosal injection of PGE1 in escalating doses have improved the rigidity and duration of erection in patients with different types of vasculogenic ED. Patients with mixed arteriogenic and veno-occlusive ED have required the highest dose of PGE1 to achieve the best response.









Introduction: Vasculogenic ED is the most common type of organic ED and can be caused by arterial insufficiency, veno-occlusive dysfunction, or a combination of arterial insufficiency and venous leak (1). Several reports in the early 1980s concerning intracavernosal injection (ICI) of papaverine and phenoxybenzamine have opened the door to a new era in the diagnosis and treatment of ED. Virag and Adaikan demonstrated the ability of intracavernously injected prostaglandin E1 (PGE1) to induce penile erection (2), and it was proven to be the safest vasoactive agent, as well as an effective one (3).



Alprostadil was FDA approved in 1994 and its high efficacy and low side effect rates prompted the clinical guidelines panel on ED of the American Urological Association (4) and several consequent studies (5,6) to recommend that alprostadil monotherapy should be preferred to other vasoactive drugs in self-injection therapy.






Comment: Intracavernosal injection therapy was considered the first-line treatment for ED until the introduction of oral phosphodiesterase type 5 inhibitors (PDE5I) in 1998 (14). However, it is still the second-best choice treatment option in men who do not respond to oral treatment or have contraindications for PDE5I treatment (15). Virag and Adaikan demonstrated the ability of ICI of PGE1 to induce penile erection, and it was proven to be the safest vasoactive agent, as well as an effective one (2).








Conclusion: This study clearly has demonstrated that patients with mixed arteriogenic and veno-occlusive ED have required the highest dose of PGE1 to achieve the best response which defined as a grade 4 erection that lasted at least 15 minutes. Further, this study has assessed the dose needed to achieve the best response in patients with different types of vasculogenic ED that could be of clinical implication.
 

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