title: Safety and efficacy of intraurethral alprostadil in patients with erectile dysfunction refractory to treatment using phosphodiesterase-5 inhibitors.
abstract: BACKGROUND
  Phosphodiesterase-5 inhibitors (PDE5i) are the first choice for treating erectile dysfunction (ED) but are not always effective. The aim of this study was to present our experience in treating patients with ED, refractory to treatment with PDE5i, using intraurethral alprostadil (MUSE).
  
  
  METHODS
  We conducted a review of 82 patients with ED and no response to PDE5i, from March 2013 to October 2014. Forty-seven patients (57%) had hypertension (AHT), 24 (29%) had diabetes (DM) and 20 (24%) had AHT and DM. Additionally, 19 (23%) had undergone radical prostatic (RP) surgery. The patients were evaluated after the treatment was applied and at 4 weeks using the following validated questionnaires: International Index of Erectile Function (IIEF-5/SHIM), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile (SEP) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS).
  
  
  RESULTS
  The mean patient age was 60.5 years (40-80), and the mean follow-up was 11.3 months (1-20). Sixty-eight percent of the treated patients responded to MUSE(®) (74% in the AHT group, 65% in the AHT+DM group, 62.5% in the DM group and 58% in the RP group). The mean IIEF-5 score was 11.7±4.7, which increased to 18.6±4.9 after MUSE was administered (P=.027). The mean EDITS score at 4 weeks was 61.6 (6-81.9). The most common adverse effect was urethral burning, which occurred in 24 patients (29%). There were no cases of urinary tract infection, syncope or priapism.
  
  
  CONCLUSIONS
  Intraurethral alprostadil is an effective treatment and has a broad safety profile for treating patients with erectile dysfunction refractory to oral treatment with PDE5i.
authors.affiliation: Servicio de Urología, Hospital del Henares, Coslada, Madrid, España. Electronic address: pgabad@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Garrido Abad
authors.affiliation: Servicio de Urología, Hospital del Henares, Coslada, Madrid, España.
authors.forename: B
authors.initials: B
authors.lastname: Sinués Ojas
authors.affiliation: Servicio de Urología, Hospital del Henares, Coslada, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Martínez Blázquez
authors.affiliation: Servicio de Urología, Hospital del Henares, Coslada, Madrid, España.
authors.forename: P
authors.initials: P
authors.lastname: Conde Caturla
authors.affiliation: Servicio de Urología, Hospital del Henares, Coslada, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: Fernández Arjona
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000008:administration & dosage* / Q000009:adverse effects; D007172:Erectile Dysfunction / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D016896:Treatment Outcome; D014521:Urethra
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D000527:Alprostadil
keywords: Alprostadil; Disfunción eréctil; Erectile dysfunction; Intraurethral; Intrauretral