These observations, coupled with my lack of confidence in PDE-5 inhibitors as a useful on-demand solution for erections during the first year of recovery after prostatectomy, have led to my preferential use of MUSE as part of a penile rehabilitation http://www.selleckchem.com/products/Gefitinib.html program. I think MUSE RP-01
would have been even more informative if patients had been given Inhibitors,research,lifescience,medical both MUSE at the 1000-µg dose and/or sildenafil at the 100-mg dose for on-demand intercourse. I anecdotally witnessed 60% on-demand success with 250 µg of MUSE during RP-01. This is the success rate typically reported with much higher doses of MUSE, so I suspect such a higher dose would have shown even higher success within the confines of a trial. Herbert Lepor, MD: There are men who do not achieve an erection with PDE-5 inhibitors during the early recovery phase after RP. Many of these men will not embark on a
penile injection regimen. For these men, MUSE is an excellent alternative for achieving erections adequate for intercourse. I believe it is underutilized in the management of post-RP ED. What is the mechanism Inhibitors,research,lifescience,medical for MUSE in penile rehabilitation? Andrew McCullough, MD: Costabile and colleagues30 evaluated the erectile response to intraurethral Inhibitors,research,lifescience,medical PGE1 in 384 men with ED after RP, with treatment beginning no less than 3 months after surgery. This was a multi-institutional study before the approval of PDE-5 inhibitors Inhibitors,research,lifescience,medical and included men at differing times from surgery and with both NSRRP and NNSRRP. Initial doses were 125 or 250 µg, which were increased to 500 or 1000 µg if the erectile response was inadequate. When treatment was administered in the clinic, 70% of the participants developed an erection sufficient for intercourse. These Inhibitors,research,lifescience,medical subjects were then randomized to a 3-month at-home trial with either PGE1 or placebo. During this phase 57% of the PGE1 subjects had successful intercourse at least once at home, compared to an intercourse rate of 6.6% of men treated with placebo. These rates compare favorably with PDE-5 inhibitor response rates in younger men
with bilateral NSRRP. Adverse events included penile pain and urethral pain/burning. This placebo-controlled study supported the use of a less invasive treatment modality in men who might not otherwise respond to PDE-5 inhibitors. More recently, Raina and coworkers31 reported the results of a study in 54 prostatectomized men who used transurethral PGE1 (250, 500, or 1000 µg). Subjects those experienced ED for at least 6 months after surgery before initiating treatment. Fifty-five percent of the subjects were able to achieve and maintain erections sufficient for intercourse while on treatment, and 48% continued long-term therapy with a mean use of 2.3 years. There were no significant differences in responses between those subjects who had a nerve-sparing surgery (34 patients) and those who had a NNSRRP procedure (20 subjects).