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TRANSURETHRAL ALPROSTADIL FOR ERECTILE DYSFUNCTION.

Intracavernous injection of alprostadil (prostaglandin E1) is an increasingly popular treatment for erectile dysfunction (see JW Accession Number 960423003, or N Engl J Med 1996; 334:873). Now a transurethral preparation (a semi-solid pellet inserted into the urethra with a plastic applicator) has been developed.

Researchers enrolled 1511 men with chronic erectile dysfunction of presumed organic etiology. Two-thirds had erections when transurethral alprostadil was administered in the clinic; these 996 men were then randomized to use active drug or placebo for three months at home.

The proportion of men reporting successful intercourse at least once was 65 percent with alprostadil versus 19 percent with placebo, a significant difference. Response was similar regardless of age or cause of erectile dysfunction. During home treatment, penile pain occurred after 11 percent of administrations, and was reported at least once by 33 percent of men. No priapism or penile fibrosis occurred.

Comment: Transurethral alprostadil appears effective and safe with short-term use, and most patients are likely to find it more acceptable than injections. However, a sizable minority of patients did not respond in this study. Alprostadil was approved by the FDA in late November of last year, and is expected to be on the market by early 1997.

— AS Brett

Published in Journal Watch General Medicine January 17, 1997

Citation(s):

Padma-Nathan H et al. Treatment of men with erectile dysfunction with transurethral alprostadil. N Engl J Med 1997 Jan 2 336 1-7.

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