[Prostaglandin treatment in neurological patients with erectile dysfunction].
OBJECTIVE
To evaluate the efficacy of prostaglandin E1 in the treatment of erectile dysfunction in patients with spinal cord or head injury.


METHODS
The study comprised 41 patients; 5 head and 36 spinal cord injury. Of these 36 patients, 20 had a lesion in the dorsal and 26 in the lumbosacral spine; 11 were complete and 25 incomplete. Mean age was 38.5 years. Therapy was started at a minimum dose of 5 mg up to maximum of 20 mg in each patient. All patients were taught the correct use of intracavernous self injection of prostaglandin E1. The analyses, ECG and penile echo Doppler evaluations of all patients showed no significant findings that contraindicated treatment. The overall response and the response according to the site of lesion, type of lesion and age were evaluated.


RESULTS
The overall response rate was 78.8%. Erection was not achieved in 9 patients even with the 20 mg maximum dose. The response rate was 100% in the group of patients with head injury. In the spinal cord injured patients, the response rate was 83.3% in patients < 30 years and 57.2% in patients > 30 years old. The 2 mg dose was effective in 1 patient, the 10 mg in 17 and the 20 mg dose in 14 patients. A positive response was achieved in 55.5% of the patients with complete and 72.7% of the patients with incomplete spinal lesions. No complications of intracavernous injection of prostaglandin were found. Prostaglandin self injection therapy achieved satisfactory results in all patients.


CONCLUSIONS
Prostaglandin injection is very effective in the treatment of erectile dysfunction in patients with spinal cord or head injury. A higher percentage of efficacy was found in the younger patients, in those with incomplete lesions and those with head injury. The dose required is usually lower than in the non neurological patients.
Conejero Sugrañes
Juan
J
Servicio de Urología, Hospital Universitario Vall d'Hebrón, Barcelona, España. 6018jcs@comb.es
Muñoz Villellas
Aurelio
A
Sarrias Lorenz
Fabián
F
Ramírez Garceran
Lucrecia
L
D000328:Adult; D000367:Age Factors; D000527:Alprostadil / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications*; D004341:Drug Evaluation; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007267:Injections; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects*; D012447:Sacrum; D012646:Self Administration; D013119:Spinal Cord Injuries / Q000150:complications*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
D014665:Vasodilator Agents; D000527:Alprostadil