Portal de Periódicos da CAPES

INTRAURETHRAL APPLICATION OF ALPROSTADIL IN PATIENTS WITH FAILED INFLATABLE PENILE PROSTHESIS

2000; Lippincott Williams & Wilkins; Volume: 163; Issue: 3 Linguagem: Inglês

10.1016/s0022-5347(05)67804-4

1527-3792

MARK D. BENEVIDES, Culley C. Carson,

Hormonal and reproductive studies

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Mar 2000INTRAURETHRAL APPLICATION OF ALPROSTADIL IN PATIENTS WITH FAILED INFLATABLE PENILE PROSTHESIS MARK D. BENEVIDES and CULLEY C. CARSON MARK D. BENEVIDESMARK D. BENEVIDES and CULLEY C. CARSONCULLEY C. CARSON View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67804-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Many men who underwent penile prosthesis implantation before the advent of oral and injection therapy present for replacement of a malfunctioning prosthesis but choose not to undergo revision surgery because of personal, medical or reimbursement issues. Others with normally functioning prostheses report significant difficulties with "cold glans," and they and their partners observe decreased engorgement and temperature of the glans penis with the inflated penile prosthesis, despite adequate stimulation. Intracorporal injection therapy is contraindicated in any patient with a penile prosthesis and use of a vacuum erection device may result in prosthesis cylinder rupture. In these patients intraurethral application of alprostadil may restore prosthesis function and permit satisfactory intercourse. We evaluate the efficacy of a medicated urethral system for erection (MUSE * VIVUS, Inc., Menlo Park, California. ) using alprostadil to restore function for men with a failed prosthesis, and improve glans penis temperature sensation and engorgement for those with a functioning prosthesis. Materials and Methods: From February 1997 to February 1998, 28 men 47 to 81 years old (mean age 61.2) with a penile prosthesis were treated with alprostadil. Of the patients 11 had penile prosthesis failure (group 1) and 17 reported decreased glans penis engorgement (group 2). In 18 cases erections were observed at the clinic. Doses of alprostadil varied from 250 to 1,000 μgm. (mean 566). Results: Of the 28 patients 23 had a response to alprostadil. Erections were sufficient for intercourse in 7 of 11 group 1 patients, and 10 of 17 group 2 were satisfied with treatment. There was no device specific morbidity but 12 men discontinued use of alprostadil because of penile pain. A significant or excellent response was noted in 10 of 18 men observed at the clinic. Conclusions: Intraurethral alprostadil may be used to restore or improve function of a penile prosthesis in patients with a malfunctioning device or lack of glans penis engorgement, with low expected morbidity. References 1 : Nitric oxide control of lower genitourinary tract functions: a review. Urology1995; 45: 1071. Crossref, Medline, Google Scholar 2 : Efficacy and safety of outcomes of the AMS 700CX inflatable penile prosthesis: results of a long term, multicenter study. J Urol1999; 161: 259. abstract 999. Google Scholar 3 : Outcome analysis of goal directed therapy for impotence. J Urol1996; 155: 1609. Link, Google Scholar 4 : Comparison of long-term outcomes of penile prostheses and intracavernosal injection therapy. J Urol1998; 159: 811. Link, Google Scholar 5 : Hemodynamic effects of intraurethral alprostadil: the medicated urethral system for erection (MUSE). J Urol1994; 151: 469. Google Scholar 6 : Disappointing initial results with transurethral alprostadil for erectile dysfunction in a urology practice setting. J Urol1998; 160: 2041. Link, Google Scholar 7 : Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. N Engl J Med1997; 336: 1. Google Scholar 8 : Mechanical reliability, surgical complications and patient and partner satisfaction of the modern three-piece inflatable penile prosthesis. Urology1998; 52: 282. Google Scholar 9 : MUSE therapy: preliminary clinical observations. Urology1997; 50: 809. Google Scholar 10 : Intraurethral alprostadil for treatment of erectile dysfunction in patients with spinal cord injury. Urology1999; 53: 199. Google Scholar 11 : Erectile response to transurethral alprostadil, prazosin and alprostadil-prazosin combinations. J Urol1998; 159: 1523. Link, Google Scholar 12 : Long term survival if inflatable penile prostheses. Urology1991; 38: 533. Google Scholar From the Division of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 163Issue 3March 2000Page: 785-787 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordsimpotencealprostadilpenile prosthesisMetricsAuthor Information MARK D. BENEVIDES More articles by this author CULLEY C. CARSON More articles by this author Expand All Advertisement PDF downloadLoading ...