Why alprostadil
Prostaglandin E1 relaxes the smooth muscles of the corpora cavernosa directly and is quickly metabolized in the tissues of the penis, therefore it gives a dose-dependent, predictable erection with a low risk of priapism - it is the drug of choice for diagnostic pharmacological tests and long-term therapy. A side effect is a burning sensation or pain in the penis in 10–30% of men in the first minutes, which decreases with a decrease in dose or combination with papaverine. The doctor selects the dose (5–20 mcg) at the first visit and teaches self-injections. Efficiency lasts for years; the drug is safe for heart diseases, when tablets are contraindicated.
Erectile dysfunction treatment ladder
The first line is PDE-5 inhibitors (tablets) and correction of the causes: testosterone, diabetes, blood pressure, smoking. The second is intracavernosal injections of vasoactive drugs and vacuum devices, which give an erection in 80-90% of men, including those for whom pills do not help. The third is surgery: in case of proven venous leakage in young patients - ligation of the veins, in all other cases - penile prosthesis. Diagnosis begins with ultrasound with Doppler against the background of a pharmacological test, which distinguishes between arterial, venous and psychogenic ED.
Intracavernous therapy
Injection of a drug (papaverine, phentolamine, alprostadil/vasaprostan) into the corpus cavernosum causes an erection within 5–15 minutes, regardless of arousal. The first injection is performed in the clinic as a dose titration test, then the patient is taught self-administration before sexual intercourse (up to 2-3 times a week). The risk is a prolonged erection (priapism) in case of an overdose, so the doctor selects the dose.
