[Retrospective study on the incidence and cause of drop-out during intracavernous pharmaco-prosthesis therapy].
OBJECTIVE
We report a retrospective analysis of 394 patients affected by erectile dysfunction and enrolled in a self-injection program after a positive injection test with alprostadil or vasoactive mixture, evaluating the rate and the causes of drop-out. We analyzed these data in two different groups of patients, classified on the basis of the training received before home therapy.


METHODS
286 patients, included in group I, were trained in a single visit, in which the technique of injection was demonstrated on a rubber model. 108 patients, included in group II, were trained in a first office visit, consisting in demonstration and guided self-injection, and a home training trial of 3 self-injections, each followed by an office visit in which any questions or problems encountered during home therapy were discussed with the physician. All the patients enrolled in the self-injection program were contacted, after a follow-up of 2-8 years, and invited to an office visit or a phone interview, in order to answer to a questionnaire.


RESULTS
62% of the patients of group I had discontinued therapy. Among these inactive patients, 79% had ceased therapy during the initial four self-injections. The most commonly cited reason for attrition was ineffectiveness (61%), followed by recovery of spontaneous erectile activity (17%). Satisfaction rate with therapy in active patients was high, with 89% of patients reporting a score of 3 (satisfied) or 4 (very satisfied). Among the 99 patients of group II, only 4 had discontinued therapy. Two of them had dropped out because of a recovery of potency. A high rate of patients satisfied with therapy was observed also in this group (78%).


CONCLUSIONS
Data provided by the patients enrolled in a self-injection protocol confirm alprostadil as a very effective and well tolerated therapeutic option for erectile dysfunction. The high drop-out rate registered during the initial period of therapy, and ineffectiveness as the most cited reason, underline the importance of a closer monitoring of patients in the early therapy in order to improve acceptance.
Giammusso
Bruno
B
Servizio di Andrologia, Clinica Urologica II, Università di Catania. brunogiammusso@hotmail.com
Motta
Mario
M
D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007267:Injections; D007558:Italy; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010410:Penile Erection / Q000187:drug effects*; D010413:Penis; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012646:Self Administration; D017211:Treatment Failure; D016896:Treatment Outcome
D000527:Alprostadil
Studio retrospettivo su incidenza e cause di drop-out durante terapia farmacoprotesica intracavernosa.