Self‐Injection, Trans‐Urethral and Topical Therapy in Erectile Dysfunction

Porst, Hartmut; Adaikan, Ganesh

doi:10.1002/9780470755235.ch8

Cited by 13 publications

(12 citation statements)

References 61 publications

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“…Typical frequent side effects of MUSE® are penile/urethral pain between 25% and 43% and [128] 68 53% 83% (at home use) Flynn, 1998 [129] Literature review 45% >70% MUSE = Medicated Urethral System for Erection urethral bleeding (around 5%). Infrequent adverse events are dizziness because of blood pressure fall (1-5%) and even the occurrence of syncope between 0.4% and 3% [123].…”

Section: Transurethral Alprostadil (Pge1) With Medicated Urethral Sysmentioning

confidence: 99%

SOP Conservative (Medical and Mechanical) Treatment of Erectile Dysfunction

Porst¹,

Burnett

Brock

et al. 2013

The Journal of Sexual Medicine

Self Cite

175

128

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Introduction Erectile dysfunction (ED) is the most frequently treated male sexual dysfunction worldwide. ED is a chronic condition that exerts a negative impact on male self-esteem and nearly all life domains including interpersonal, family, and business relationships. Aim The aim of this study is to provide an updated overview on currently used and available conservative treatment options for ED with a special focus on their efficacy, tolerability, safety, merits, and limitations including the role of combination therapies for monotherapy failures. Methods The methods used were PubMed and MEDLINE searches using the following keywords: ED, phosphodiesterase type 5 (PDE5) inhibitors, oral drug therapy, intracavernosal injection therapy, transurethral therapy, topical therapy, and vacuum-erection therapy/constriction devices. Additionally, expert opinions by the authors of this article are included. Results Level 1 evidence exists that changes in sedentary lifestyle with weight loss and optimal treatment of concomitant diseases/risk factors (e.g., diabetes, hypertension, and dyslipidemia) can either improve ED or add to the efficacy of ED-specific therapies, e.g., PDE5 inhibitors. Level 1 evidence also exists that treatment of hypogonadism with total testosterone < 300 ng/dL (10.4 nmol/L) can either improve ED or add to the efficacy of PDE5 inhibitors. There is level 1 evidence regarding the efficacy and safety of the following monotherapies in a spectrum-wide range of ED populations: PDE5 inhibitors, intracavernosal injection therapy with prostaglandin E1 (PGE1, synonymous alprostadil) or vasoactive intestinal peptide (VIP)/phentolamine, and transurethral PGE1 therapy. There is level 2 evidence regarding the efficacy and safety of the following ED treatments: vacuum-erection therapy in a wide range of ED populations, oral L-arginine (3–5 g), topical PGE1 in special ED populations, intracavernosal injection therapy with papaverine/phentolamine (bimix), or papaverine/phentolamine/PGE1 (trimix) combination mixtures. There is level 3 evidence regarding the efficacy and safety of oral yohimbine in nonorganic ED. There is level 3 evidence that combination therapies of PDE5 inhibitors + either transurethral or intracavernosal injection therapy generate better efficacy rates than either monotherapy alone. There is level 4 evidence showing enhanced efficacy with the combination of vacuum-erection therapy + either PDE5 inhibitor or transurethral PGE1 or intracavernosal injection therapy. There is level 5 evidence (expert opinion) that combination therapy of PDE5 inhibitors + L-arginine or daily dosing of tadalafil + short-acting PDE5 inhibitors pro re nata may rescue PDE5 inhibitor monotherapy failures. There is level 5 evidence (expert opinion) that adding either PDE5 inhibitors or transurethral PGE1 may improve outcome of penile prosthetic surgery regarding soft (cold) glans syndrome. There is level 5 evidence (expert opinion) that the combination of PDE5 inhibitors and dapoxetine is effective and safe in patients suffering from both ED and premature ejaculation.

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Section: Transurethral Alprostadil (Pge1) With Medicated Urethral Sysmentioning

confidence: 99%

SOP Conservative (Medical and Mechanical) Treatment of Erectile Dysfunction

Porst¹,

Burnett

Brock

et al. 2013

The Journal of Sexual Medicine

Self Cite

175

128

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“…For example, a major barrier to the use of intracavernosal injection is the concept of penile injections. Despite a higher efficacy rate [32,36,40,[48][49][50][51][52][53], many men may not be willing to inject themselves. On the contrary, for example, all males who have undergone radical prostatectomy have experienced an intraurethral catheter, so patients in this population are likely to be more amenable to considering the option of intraurethral therapy.…”

Section: Expert Commentary and Future Perspectivementioning

confidence: 99%

The role of intraurethral alprostadil as a first-choice erectile dysfunction treatment option in special populations: a proposed treatment algorithm

Dinsmore¹,

Lopes²,

Potempa³

et al. 2014

Clinical Practice

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“…For topical agents, only with prostaglandin E1 (alprostadil) have placebo-controlled trials with reasonable numbers of patients been published [47][48][49]. Equally, only a limited number of adequately controlled trials on transurethral and intracavernosal applications of alprostadil as MUSE or alprostadil alfadex or sterile powder have been published [48,[50][51][52].…”

Section: Special Considerations For Ed Trials With Topical Transuretmentioning

confidence: 99%

Standards for Clinical Trials in Male Sexual Dysfunctions

Porst¹,

Vardi

Akkuş

et al. 2010

The Journal of Sexual Medicine

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Introduction Clinical trials in male sexual dysfunction (MSD) are expanding. Consequently, there is a need for consensus standards in this area. Aim To develop an evidence-based, state-of-the-art consensus report on standards for clinical trials in MSD. Methods A literature review was performed examining clinical trials in erectile dysfunction (ED), premature ejaculation (PE), delayed/absent ejaculation, libido disorders/loss of desire, hypogonadism, and Peyronie’s disease, focusing on publications published in the last 20 years. This manuscript represents the opinions of eight experts from seven countries developed in a consensus process. This document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. Main Outcome Measure Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Results According to experience and recent publications in dealing with clinical trials in sexual dysfunction, recommendations have been made for conducting trials in patients with ED, PE, delayed ejaculation, libido disorders, hypogonadism, and Peyronie’s disease. Conclusions It is important that future clinical trials are conducted using standards upon which investigators can rely when reading manuscripts or conducting new trials in this field.

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Self‐Injection, Trans‐Urethral and Topical Therapy in Erectile Dysfunction

Cited by 13 publications

References 61 publications

SOP Conservative (Medical and Mechanical) Treatment of Erectile Dysfunction

SOP Conservative (Medical and Mechanical) Treatment of Erectile Dysfunction

The role of intraurethral alprostadil as a first-choice erectile dysfunction treatment option in special populations: a proposed treatment algorithm

Standards for Clinical Trials in Male Sexual Dysfunctions

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