title: Sexual rehabilitation and penile pain associated with intracavernous alprostadil after radical prostatectomy.
abstract: 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.
authors.affiliation: Urology Department, Henri Mondor Teaching Hospital, 51 av du Maréchal de Lattre de Tassigny, Créteil, France. rene.yiou@hmn.aphp.fr
authors.forename: René
authors.initials: R
authors.lastname: Yiou
authors.forename: Patrick
authors.initials: P
authors.lastname: Cunin
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Michele
authors.initials: M
authors.lastname: Binhas
authors.forename: Odile
authors.initials: O
authors.lastname: Lingombet
authors.forename: Murielle
authors.initials: M
authors.lastname: Paul
authors.forename: Claude
authors.initials: C
authors.lastname: Abbou
mesh_terms: 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*
chemical_list: D014665:Vasodilator Agents; D000527:Alprostadil