Transurethral alprostadil as therapy for patients who withdrew from or failed prior intracavernous injection therapy

Patients experiencing erectile dysfunction who fail intracavernous injection (ICI) therapy are commonly believed to have exhausted pharmacologic options. We evaluated the efficacy and safety of transurethral alprostadil (MUSE) in patients experiencing erectile dysfunction who underwent prior ICI therapy (alprostadil, papaverine, phentolamine, or a combination of these).

Of the 1511 patients enrolled in a multicenter trial of transurethral alprostadil, 452 (30%) reported prior ICI therapy and its effects. These patients tested up to four dose levels of transurethral alprostadil in the clinic, and those who achieved an erection satisfactory for intercourse were treated at home in a double-blind, placebo-controlled trial.

Prior ICI therapy was reported to be "not effective" by 95 of 452 patients (21%), "sometimes effective" by 119 of 452 (26%), and "effective" by 238 of 452 (53%). In patients reporting ICI therapy as "not effective," 58% achieved an erection sufficient for intercourse following transurethral alprostadil therapy in the clinic; 47% of these responsive patients reported successful sexual intercourse after transurethral alprostadil therapy during home treatment. For patients reporting ICI therapy as "sometimes effective" or "effective," 68% achieved an erection sufficient for intercourse following transurethral alprostadil therapy in the clinic setting and 67% of these responsive patients reported successful intercourse following transurethral alprostadil therapy at home. Few adverse effects were encountered. The most common adverse effect was penile pain, which occurred with 7.8% of administrations.

Transurethral alprostadil therapy is an effective therapeutic option for patients with erectile dysfunction and may even "rescue" some patients who have failed prior intracavernous injection therapy.