Till now the first line treatment of neurogenic erectile dysfunction is the use of PDE5 inhibitors. Our aim was to evaluate the efficacy and safety of  intraurethral alprostadil (Vitaros©)  on-demand in men with neurogenic ED due to SCI or MS as a viable alternative.

We prospectively collected data of 54 men suffering from SCI and 50 from MS who used Vitaros© for ED. The treatment protocol required a minimum administration of intraurethral alprostadil for at least twice a week, even without a subsequent sexual intercourse for a period of 6 weeks. Inclusion criteria included absence of ED prior the accident or the onset of the disease (IIEF-5 score >21, Erection Hardness Score-EHS ≥3, affirmatively answers to Sexual Encounter Profile Questions 2 and 3 -SEP2 & SEP3) and absence of moderate/severe cardiovascular disease, diabetes mellitus and metabolic syndrome. All men with SCI were performing intermittent catheterizations (ICs) and 75% of MS group (35 patients) respectively. Average age was 43.5 and 38.5 respectively, mean IIEF score prior the therapy 15 and 16 and EHS score 1.7 and 1.9.

After 6 weeks, 6 patients dropped out from the group of SCI due to hypotension or urethral pain and 3 from MS group due to urethral pain. Vitaros© implied an improvement of 4.4 points for the IIEF-5 score and 1.1 for the EHS score in the SCI group, while the improvement for the MS group was 4.1 points and 1.3 points respectively. The subgroup of MS patients who did not perform ICs seems to have benefited the most in comparison with the other patients and none of them discontinued the treatment. At the end of the study, 23 SCI patients, and 27 MS patients selected Vitaros© to be added in their treatment agents of choice, as an alternative.

It seems that Vitaros© is an alternative treatment for neurogenic patients suffering from SCI and MS, less effective though in ICs users, and the most apparent reason of failure might be the alteration of urethral epithelium to squamous one, due to repetitive injuries as catheters pass through, making the agent less absorbable through it.

It seems that Vitaros© is an alternative treatment for neurogenic patients suffering from SCI and MS, less effective though in ICs users, and the most apparent reason of failure might be the alteration of urethral epithelium to squamous due to repetitive injuries as catheters pass through, making the agent less absorbable through it.

Bodner DR, Haas CA, Krueger B, Seftel AD. Intraurethral alprostadil for treatment of erectile dysfunction in patients with spinal cord injury. Urology. 1999 Jan;53(1):199-202. doi: 10.1016/s0090-4295(98)00435-x. PMID: 9886612.
Biering-Sørensen F, Sønksen J. Sexual function in spinal cord lesioned men. Spinal Cord. 2001 Sep;39(9):455-70. doi: 10.1038/sj.sc.3101198. PMID: 11571657.
Thomas C, Konstantinidis C. Neurogenic Erectile Dysfunction. Where Do We Stand? Medicines (Basel). 2021 Jan 7;8(1):3. doi: 10.3390/medicines8010003. PMID: 33430218; PMCID: PMC7825654

Continence 7S1 (2023) 101032
DOI: 10.1016/j.cont.2023.101032