Intracorporeal and transurethral application of alprostadil: A review of the literature.

Authors: TN Flynn, J Plumb & JF Guest.
Source: The 8th World Meeting on Impotence Research, pp255 - 259. Monduzzi Editore S.p.A. Bologna, Italy 1998.

ABSTRACT

As part of an ongoing economic evaluation of treatments for erectile dysfunction (ED), Catalyst has reviewed the literature pertaining to alprostadil therapies. Efficacy and adverse event rates for intracorporeal injection (ICI), and transurethral (TU) therapy were stratified according to psychogenic, neurogenic, vasculogenic and diabetic aetiology, where possible. ICI restores erection sufficient for intercourse in over 70% of men suffering from ED (unstratified) whereas the figure for TU therapy is only 45%. On average, pain occurs in 20% of men for both treatments, but 5% of men using TU therapy suffer urethral bleeding. ED of psychogenic origin is successfully treated in nearly all ICI-treated men, but in only 50% of TU-treated men. Adverse event rates are similar to those for ED (unstratified). Success rates for ICI in neurogenic ED are similar to those for psychogenic ED. Vasculogenic and diabetic ED can be successfully treated in 40% and 60% of cases respectively with ICI. Pain is common in 40% of men with vasculogenic ED and <20% of men with diabetic ED. More work is needed to provide rates for TU therapy in neurogenic, vasculogenic and diabetic ED. However, there is evidence that ICI of alprostadil is superior to TU application in individual aetiologies, as well as in ED when unstratified. Stratification of efficacy rates may ensure better targeting of patients with the most appropriate treatment and will provide a basis for cost-effectiveness analysis to aid policy-makers.