[Retrospective study on the incidence and cause of drop-out during intracavernous pharmaco-prosthesis therapy]

We report a retrospective analysis of 394 patients affected by erectile dysfunction and enrolled in a self-injection program after a positive injection test with alprostadil or vasoactive mixture, evaluating the rate and the causes of drop-out. We analyzed these data in two different groups of patients, classified on the basis of the training received before home therapy.

286 patients, included in group I, were trained in a single visit, in which the technique of injection was demonstrated on a rubber model. 108 patients, included in group II, were trained in a first office visit, consisting in demonstration and guided self-injection, and a home training trial of 3 self-injections, each followed by an office visit in which any questions or problems encountered during home therapy were discussed with the physician. All the patients enrolled in the self-injection program were contacted, after a follow-up of 2-8 years, and invited to an office visit or a phone interview, in order to answer to a questionnaire.

62% of the patients of group I had discontinued therapy. Among these inactive patients, 79% had ceased therapy during the initial four self-injections. The most commonly cited reason for attrition was ineffectiveness (61%), followed by recovery of spontaneous erectile activity (17%). Satisfaction rate with therapy in active patients was high, with 89% of patients reporting a score of 3 (satisfied) or 4 (very satisfied). Among the 99 patients of group II, only 4 had discontinued therapy. Two of them had dropped out because of a recovery of potency. A high rate of patients satisfied with therapy was observed also in this group (78%).

Data provided by the patients enrolled in a self-injection protocol confirm alprostadil as a very effective and well tolerated therapeutic option for erectile dysfunction. The high drop-out rate registered during the initial period of therapy, and ineffectiveness as the most cited reason, underline the importance of a closer monitoring of patients in the early therapy in order to improve acceptance.