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Les injections intracaverneuses de prostaglandine E1: un reel progres dans l’efficacite et la securite des injections intracaverneuses

Prostaglandin E1: a real progress in the efficacy and safety of intracavernosal injections

Abstract

Intracavernosal injections of vaso-active agents were a major breakthrough in the investigation and treatment of impotence. However the first generation agents (papaverine ± phentolamine, phenoxybenzamine) result in a too high rate of complications (prolonged erection, priapism, corporeal fibrosis,), what requires strict precautions, making their use cumbersome and even stressing. A tremendous development of the pharmacological research arises in order to find agents not resulting in those risks. This article reviews the litterature concerning one of them, Prostaglandin E1 (PGE1), and compares its effects in near 4000 patients to those of papaverine ±phentolamine in over 5000. Experimental data suggests that PGE1 might act in normal erection, and its local tolerance might be better than that of Papaverine, specially as regards the risk of fibrosis. The studies without intraindividual comparison done in men tend to confirm this better tolerance: during the workup period, PGE1 induces prolonged erection in 2.7% of men (requiring treatment in only 0.3%) compared to 9.5% with papaverine and 5.3 % with papaverine + phentolamine (p<0.001); during auto-intracavernosal therapy, the rate of prolonged erections is 0.8% with PGE1 compared to 8.7% with papaverine, and the rate of fibrosis is 0.4% versus 3.5 to 5.4% with papaverine (p<0.001). PGE1 induces slightly more erections compatible with penetration than papaverine ± phentolamine (77% vs 73 %). However it induces pain in 23% of the cases, either at the time of injection, or, more specifically, during erection. This pain is intense in only 3.9% of the cases. General tolerance is excellent. The studies with intra-individual comparison confirm the statistically significant reduction of the risk of prolonged erection requiring treatment (1.7% with PGE1 versus 4.3% with papaverine and 6% with the combination, p<0.05) and the increase in efficacy (75% versus 64% with the combination), though papaverine is superior to PGE1 in a minority of the cases. By reducing the risks, PGE1 allows directly using the effective dosage as regards the diagnostic injections. Its higher effectiveness reduces the false-negative rate in the psychogenic patients, and widens the possibilities of the intracavernosal therapy.

Resume

Les injections intracaverneuses (IIC) de substances vasoactives ont constitué une avancée majeure dans l’exploration et le traitement de l’impuissance. Les substances de première génération (papavérine ± phentolamine et phenoxybenzamine) sont cependant à l’origine d’un taux notable de complications. Cet article fait la revue de la littérature consacrée à une substance de 2ème génération, la prostaglandine E1 (PGE1) et compare ses résultats chez près de 4000 patients à ceux obtenus de la papavérine ± phentolamine chez plus de 5000. Des données expérimentales suggèrent que la PGE1 pourrait jouer un rôle dans l’érection normale et que sa tolérance locale devrait être meilleure que celle de la papavérine. Les études cliniques sans comparaison intra-individuelle tendent à confirmer cette meilleure tolérance: érection prolongée en cours de bilan chez 2,7% des patients (dont seulement 0,3% nécessitent un traitement) contre 9,5% avec la papavérine et 5,3% avec l’association; après un traitement par auto-IIC, fibrose chez 0,4% contre 3,5 à 5,4% après papavérine. La PGE1 induit un peu plus souvent que la papavérine ± phentolamine une érection compatible avec la pénétration (77% vs 73 %). Elle entraine cependant dans 23% des cas une douleur accompagnant l’injection ou, plus spécifiquement l’érection (intense dans seulement 3,9% des cas). Les études avec comparaison intraindividuelle confirment la diminution statistiquement significative du risque d’érection prolongée nécessitant un traitement, et l’efficacité supérieure, bien que la papavérine soit supérieure à la PGE1 dans une minorité des cas. En réduisant les risques, la PGE1 permet d’utiliser d’emblée les doses efficaces pour les injections diagnostiques. Son efficacité supérieure réduit le taux des faux négatifs chez les psychogènes, et repousse les limites des traitements par auto-IIC.

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Correspondence to Jacques Buvat.

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Buvat, J., Buvat-Herbaut, M., Lemaire, A. et al. Les injections intracaverneuses de prostaglandine E1: un reel progres dans l’efficacite et la securite des injections intracaverneuses. Androl. 1, 78–82 (1991). https://doi.org/10.1007/BF03034178

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Key-words

  • Impotence
  • Intracavernosal injection
  • Pabaverine
  • Phentolamine
  • Phenoxybenzamine
  • Prostaglandin E1
  • Complications
  • Prolonged erection
  • Fibrosis

Mots clés

  • Impuissance
  • injection intracaverneuse
  • Papavérine
  • Phentolamine
  • Phenoxybenzamine
  • Prostaglandine E1
  • Complications
  • Erection prolongée
  • Fibrose