[Dose adaptation during training of intracavernous self-injections of prostaglandin E1]

Dose adaptation in self-administered intracavernous PGE1 injections is poorly defined in learning protocols and its degree of difficulty depends on the aetiology of the erectile dysfunction. The authors tried to standardize this phase by studying the results and complications of a protocol using an identical initial dose of PGE1 regardless of the aetiology of erectile dysfunction.

101 patients consulting for erectile dysfunction participated in a learning protocol of self-administered intracavernous PGE1 injections, consisting of 3 injections systematically starting with 10 micrograms of PGE1, following assessment of the aetiology.

For an efficacy of 58.4%, 79.2% and 88.1% after one, two or three injections, respectively, the prolonged erection rate (> or = 6 hours) was 2.7% after the first injection and 0% after the other injections. However, erection durations of 2 to 6 hours have frequently been reported in neurological patients. Discontinuations during the learning phase were only observed in patients presenting with tumescence without rigidity after one injection (5.4%) or two injections (21%).

In the light of these results and to minimize prolonged erections and discontinuations, while ensuring efficacy, PGE1 dose adaptation can be simply performed by starting with 10 micrograms in all patients except for neurogenic patients (5 micrograms) with an increase to 20 or 30 micrograms in the case of failure.