ERECTILE DYSFUNCTION - EFFECTIVENESS AND TOLERANCE OF SELF-ADMINISTERED INTRACAVERNOUS ALPROSTADIL INJECTIONS

Objectives: Self-administered intracavernous injections, notably with alprostadil are currently the most widely used non-psychotherapeutical treatment of erectile dysfunction. We assessed the effectiveness of this treatment after 6 months of self-injections. Methods: Efficacy, acceptability and tolerance to alprostadil self-administered via intracavernous injections for 6 months was evaluated in 144 men, age 24 to 72 years, and followed monthly after an initial training period and search for the optimal dose. Results: The mean number of self-injections was 5.5 at a mean dose of 18.6 mu g per injection. From the first to sixth month, the frequency of complete erections after self-injection rose from 62% to 77% and failures declined from 8% to 3%. After six months, 40% of the patients had abandoned the treatment including 9% who abandoned during the first month, usually due to poor acceptance and because of cure in two patients (4.5%). Patients reported sexual intercourse after self-injections as satisfactory in 81% of the cases; 66% of their partners reported satisfactory intercourse. Tolerance assessment revealed pain in 14% of the patients and decreasing effect with time in two patients who discontinued self-injections for this reason. Other undesirable side effects were infrequent, usually related to technical injection errors and decreasing effect with time. One case of priapism and two indurations of the cavernous bodies were also observed. Conclusion: Self-administration of intracavernous alprostadil can lead to rigid erection in patients with erectile dysfunction. Patients are generally well satisfied and tolerance is good.