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Place de la prostaglandine E1 intra urétrale dans le traitement de l’impuissance érectile

What is the place left for transurethral alprostadil in the treatment of erectile dysfunction?

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La place de l’asprostadil intra-urétral (Muse) dans le traitement de l’insuffisance érectile reste maintenant à définir depuis l’avènement des thérapeutiques per os et en particulier bien sûr le Sildenafil. L’alprostadil intra-urétral est un traitment local efficace de l’insuffisance érectile dans environ 35 à 40 % des cas. Les études comparatives avec les injections intra-caverneuses et le sildenafil sont en faveur de ces derniers mais le Muse conserve des indications et doit rester une arme dans l’arsenal thérapeutique en particulier dans les contre-indications du sildenafil et les cas de refus des injections intracaverneuses.

Abstract

Transurethral alprostadil (Muse) is an effective and safe treatment of erectile dysfunction. Nevertheless, the result after its exit on the US market two years ago were not as good as the investigational studies which claimed aroud 60% of sccess rate. In the litterature success rate were between 35% and 40% all together. The Muse had a better acceptance than the intra-cavernous injection despite a lower success rate (40 % v.s 75 %). Since Sildenafil came on the market, it seems that the place of Muse is reduced because comparative studies give better results for Sildenafil than Muse (70 % v.s 40 %) and of course with a better acceptance. Nevertheless there are absolute and relative counter-indications to the Sildenafil which could benefit to the treatment by Muse.

All the comparative studies, IIC, v.s Muse and sildenafil v.s Muse will be studied in this article.

In conclusion Muse should be used as an alternative and should remain an effective tool that must be available to all physicians dealing with erectile dysfunction, perhaps using new formula with a combination of alprostadil with an alpha-blocker.

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Correspondence to E. Amar.

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Amar, E. Place de la prostaglandine E1 intra urétrale dans le traitement de l’impuissance érectile. Androl. 9, 60–67 (1999) doi:10.1007/BF03034381

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Mots-Clés

  • Insuffisance érectile
  • Alprostadil intraurétral
  • Prostaglandine E1
  • injections intra-caverneuses
  • Sildenafil
  • Etude comparative

Key-Words

  • Erectile dysfunction
  • transurethral alprostadil
  • intra-cavernous injection
  • Sildenafil
  • comparative study
  • Prostaglandine E1