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The effect of topical and intraurethral alprostadil on erectile function: A systematic review and meta-analysis
Iason Papadopoulos1,2,3, Maksim Tishukov4, Ioannis Sokolakis5
1Department of Urology, University Hospital, LMU Munich, Munich, Germany.
Background:
Erectile dysfunction (ED) affects up to 50% of men over 40. While phosphodiesterase-5 inhibitors (PDE5i) are the first line of medical treatment, they are not always effective. Alprostadil, available in injectable, topical, and intraurethral forms, offers an alternative treatment modality.
Objectives:
This systematic review and meta-analysis aim to evaluate the efficacy and safety of topical and intraurethral forms of alprostadil.
Materials And Methods:
The objectives and methods of this systematic review and meta-analysis were predefined in a protocol registered on PROSPERO (CRD42021260894). We systematically searched PubMed, EMBASE, and the Cochrane Library up to April 2024. Using a random-effects model, we compared the efficacy of topical and intraurethral forms of alprostadil against placebo. Additionally, we performed a qualitative assessment of the studies using RoB-2 and ROBINS-I tools.
Results:
The analysis included 11 randomized controlled trials and 4 non-randomized studies, encompassing 5869 patients with a mean age of 60 ± 9.4 years. The meta-analysis showed a statistically significant improvement in the IIEF score by 4.7 points (95% CI: 2.4-7.1, I2 = 97%) in patients using the topical form of alprostadil compared to placebo. There was also a statistically significant improvement of ED in patients using intraurethral alprostadil compared to placebo, with a pooled odds ratio of 0.08 (95% CI: 0.04-0.16, I2 = 54%). The most common adverse events reported were penile pain and erythema.
Discussion:
These results are limited by the variability in study designs and the relatively small number of included studies in the meta-analysis. Moreover, the low methodological quality of the included studies further limits the strength of the conclusions.
Conclusions:
Topical and intraurethral alprostadil significantly improve ED symptoms compared to placebo and are generally safe, with no serious adverse events. Further trials are necessary to confirm and expand on these findings.
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