Penile fibrosis in intracavernosal prostaglandin E1 injection therapy for erectile dysfunction

Penile fibrosis (PF) may be a complication of intracavernosal injection therapy (ICI). It has been well documented as a side effect of papaverine, but there have been few reports associating penile fibrosis with prostaglandin E1 (PGE1, Alprostadil). Many authors did not find fibrotic changes in the penis while others reported penile fibrosis as a complication of intracavernosal PGE1 in only 0.76-2.1% of their patients. Recent studies, however, suggest that the incidence may be as high as 15%. Three hundred consecutive patients who returned to our Institute for repeat prescription of PGE1 were asked about penile curvature and deformity and the penis was examined for fibrotic change. Twenty-two were excluded because of concurrent or previous use of papaverine and/or phentolamine, 30 patients had pre-ICI evidence of fibrotic change and 3 had incomplete data. Of the remaining 245 patients, 57 (23.3%) were found to have penile fibrosis. These men, mean age 62 y (21-79), had been self injecting an average of 5.2 times per month (1-16) for an average period of 29.2 months (2-86). The mean dose of PGE1 used was 13 micrograms (2-60) and an average of 65.6 micrograms of PGE1 (3-360) was used per month. The mean total number of injections was 142.4 (8-810) and the mean total amount of PGE1 1703 micrograms (105-11,520). Penile fibrosis is hence a significant complication of intracavernosal PGE1 therapy. It is mandatory to examine patients methodically for fibrotic changes in the penis prior to commencement of treatment and at subsequent regular reviews. Patients should be specifically warned of the possibility of penile fibrosis and should be instructed on self examination so that they may report early changes if and when these occur.