The effect of intracavernosal alprostadil use in erectile dysfunction second line treatment on sexual functions

Year 2022, Volume: 17 Issue: 1, 1 - 5, 23.02.2022

Hakan Taşkapu , Mehmet Giray Sönmez , Muzaffer Kılınç , Nurullah Altınkaya , Arif Aydın , Mehmet Balasar

https://doi.org/10.33719/yud.2022;17-1-940774

Abstract

Objective: In patients treated through the application of intracavernosal alprostadil in second-line treatment due to erectile dysfunction, the effect of the treatment on sexual functions measured with a 15-question International Index of Erectile Function (IIEF-15) questionnaire was investigated in this study.
Material and Methods: Twenty-one patients treated due to erectile dysfunction between June 2018-October 2019, taking inadequate response from first-line treatment modalities, were applied intracavernosal alprostadil in second-line treatment and continued it for more than 12 weeks were included in the study, retrospectively. Ages, comorbid diseases, drug usage duration, drug-related side effects, penile Doppler ultrasonography (USG) parameters before application and the erection functions before and 12 weeks after drug use were evaluated with IIEF-15 form for the patients. Intracavernosal alprostadil was started with a dose of 5 μg and was continued with a dose of 10 μg as the result of dose titration.
Results: The mean peak systolic blood flow velocity (PS) value of the patients was 24.4 ±15.1 cm/sec, and the mean end-diastolic flow velocity (ED) value was measured as 4.3±4.5 cm/sec based on the pre-treatment penile Doppler USG.Although the IIEF scores were measured in the 12th week, mean drug usage durations were measured as 21.9±16.6 weeks. Erectile Function Score was 9.2±5.3 before application; it was detected as 20.33±6.2 after the application. Orgasmic Function Score was 3.2±2.5 before application; it was detected as 7.5±2.4 after the application. Sexual Desire Score was 3.72±1.48 before application; it was detected as 8.9±1.4 after the application. Intercourse Satisfaction Score was 3.7±2.8 before application; it was detected as 9.1±2.7 after the application. Overall Satisfaction Score was 4±1.7 before application; it was detected as 8.1±1.7 after the application (All parameters p<0.001).
Conclusion: Intracavernosal alprostadil treatment used in erectile dysfunction second-line treatment is a cost-effective and efficient treatment method with a tolerable side effect profile and provides recovery in sexual parameters that can be measured with IIEF-15 parameters.

Keywords

Alprostadil , Erectile dysfunction , intracavernosal treatment

Erektil disfonksiyon 2.basamak tedavide intrakavernozal alprostadil kullanımının cinsel fonksiyonlar üzerine etkisi

Abstract

Amaç: Bu çalışmada erektil disfonksiyon nedeniyle ikinci basamak tedavide intrakavernozal alprostadil uygulanarak tedavi edilen hastalarda tedavinin 15 soruluk  Uluslararası Erektil Fonksiyon Endeksi (IIEF-15) anketi ile ölçülen cinsel fonksiyonlar üzerine etkisi araştırılmıştır.
Gereç ve Yöntemler: Haziran 2018 – Ekim 2019 arasında erektil disfonksiyon nedeniyle tedavi gören, birinci basamak tedavi modalitelerinden yetersiz yanıt alınan, ikinci basamak tedavide intrakavernozal alprostadil uygulanan ve 12 haftadan daha uzun süre tedaviye devam eden hastaların verileri retrospektif olarak incelenerek 21 hasta çalışmaya dahil edildi. Hastaların yaşları, ek hastalıkları, ilaç kullanım süreleri, ilaca bağlı yan etkiler, uygulama öncesi penil Doppler ultrasonografi (USG) parametreleri ve ilaç kullanımı öncesi ve 12 hafta sonrası ereksiyon fonksiyonları IIEF-15 formu ile değerlendirildi. İntrakavernozal alprostadil’e 5 μg dozdan başlandıktan sonra doz titrasyonu neticesinde 10 μg dozunda devam edildi.
Bulgular: Tedavi öncesi yapılan penil Doppler USG de hastaların ortalama peak sistolik akım hızı (PS) değeri 24,4 ±15,1 cm/sn, ortalama end diastolik akım hızı (ED) değeri 4,3±4,5 cm/sn olarak ölçüldü. IIEF skorları 12. haftada ölçülmesine rağmen ortalama ilaç kullanım süreleri 21,9±16,6 hafta olarak ölçüldü. Erektil Fonksiyon Skoru uygulama öncesi 9.2±5.3 iken uygulama sonrası 20.33±6.2 olarak tespit edildi. Orgazmik İşlev Skoru uygulama öncesi 3,2±2,5, uygulama sonrası ise 7,5±2,4 olarak tespit edildi. Cinsel İstek Skoru uygulama öncesi 3,72±1,48, uygulama sonrası 8,9±1,4 olarak tespit edildi. Cinsel Memnuniyet Skoru uygulama öncesi 3,7±2,8, uygulama sonrası ise 9,1±2,7 olarak tespit edildi. Genel Memnuniyet Skoru uygulama öncesi 4±1.7 iken uygulama sonrası 8.1±1.7 olarak tespit edildi (Tüm parametreler p<0,001).
Sonuç: Erektil disfonksiyon ikinci basamak tedavisinde kullanılan intrakavernozal alprostadil tedavisi IIEF-15 parametreleri ile ölçülebilen cinsel parametrelerde düzelme sağlayan, tolere edilebilir yan etki profiline sahip, kostefektif ve etkin bir tedavi yöntemidir.

Keywords

Alprostadil , Erektil disfonksiyon , intrakavernozal tedavi

References

• 1. Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013;381(9861):153-65.
• 2. Hatzimouratidis K, Salonia A, Adaikan G, et al. Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med. 2016;13(4):465-88.
• 3. Yiou R, Ebrahiminia V, Mouracade P, Lingombet O, Abbou C. Sexual quality of life in women partnered with men using intracavernous alprostadil injections after radical prostatectomy. J Sex Med. 2013;10(5):1355-62.
• 4. Eardley I, Donatucci C, Corbin J, et al. Pharmacotherapy for erectile dysfunction. J Sex Med. 2010; 7(1-2):524-40.
• 5. Palmer LS, Valcic M, Melman A, et al. Characterization of cyclic AMP accumulation in cultured human corpus cavernosum smooth muscle cells. J Urol. 1994;152:1308-14. 6. Coombs PG, Heck M, Guhring P, Narus J, Mulhall JP. A review of outcomes of an intracavernosal injection therapy programme. BJU Int. 2012;110(11):1787-91.
• 7. Linet OO, Ogrinc FG. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. N Engl J Med. 1996; 334(14):873-77.
• 8. Sharlip ID. Evaluation and nonsurgical management of erectile dysfunction. Urol Clin North Am. 1998;25:647–5.
• 9. Porst H, Burnett A, Brock G, et al. SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med 2013;10:130-71.
• 10. Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol.2018;07:07.