Sexual rehabilitation and penile pain associated with intracavernous alprostadil after radical prostatectomy.
BACKGROUND
Intracavernous alprostadil injection (IAI) is widely used for sexual rehabilitation (SR) after radical prostatectomy (RP). However, the rate of spontaneous erection recovery with IAI remains unclear, and IAI causes pain that may hinder SR.


OBJECTIVE
To assess SR in IAI users after RP and to evaluate the course and impact on SR of postinjection penile pain.


METHODS
We prospectively studied 87 patients who underwent nerve-sparing laparoscopic RP, reported normal preoperative erectile function, and used IAI for 12 months. Patients started with 2.5 µg alprostadil and were advised to increase the dose gradually until erection hardness allowed vaginal penetration.


METHODS
At 6 and 12 months, the International Index of Erectile Function (IIEF-15) and Erection Hardness Score (EHS) were determined with and without IAI, and injection-related penile pain was assessed using a numeric rating scale. Correlations linking penile pain, IIEF-15, and EHS scores were evaluated.


RESULTS
The mean alprostadil dose was 8.1 µg after 6 months and 9.9 µg after 12 months. With/without IAI, mean IIEF-15 scores for erectile and orgasmic function and mean EHS score were 14.6/4.6, 4.1/2.1, and 2.5/0.4, respectively, after 6 months; and 17.2/5.4, 4.9/2.6, and 2.7/0.9 after 12 months. Pain scores were 3.2±2.5/10 and 2.5±2.5/10 after 6 and 12 months, respectively. Pain intensity correlated with erectile function (r=-0.23), intercourse satisfaction (r=-0.23), and overall satisfaction (r=-0.24) after 6 months but not after 12 months. Follow-up was short and only patients who used IAI for 12 months were included.


CONCLUSIONS
In patients who were willing and able to use IAI, erectile function improved after 1 year but remained below preoperative levels. The adverse impact of pain on SR was significant during the first 6 months and diminished over time. These data may help to counsel IAI users with painful erections.
Yiou
René
R
Urology Department, Henri Mondor Teaching Hospital, 51 av du Maréchal de Lattre de Tassigny, Créteil, France. rene.yiou@hmn.aphp.fr
Cunin
Patrick
P
de la Taille
Alexandre
A
Salomon
Laurent
L
Binhas
Michele
M
Lingombet
Odile
O
Paul
Murielle
M
Abbou
Claude
C
D000527:Alprostadil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003075:Coitus; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008297:Male; D010146:Pain / Q000453:epidemiology / Q000209:etiology*; D010147:Pain Measurement; D017060:Patient Satisfaction; D010413:Penis / Q000187:drug effects*; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000534:rehabilitation*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D014665:Vasodilator Agents; D000527:Alprostadil