All patients experienced ED for at least 6 months
after their RP before starting MUSE therapy. Overall, 55% of patients achieved and maintained erections sufficient for intercourse, 48% continued long-term therapy with an average usage of four times per month, and there was a 61% spousal satisfaction rate. The most common reasons for discontinuation of MUSE are insufficient erections, switch to other ED therapies, natural return of erections, and urethral pain and burning.41 MUSE has been shown to be an effective therapy for post-RP ED with a compliance rate of 63% Inhibitors,research,lifescience,medical to 68% shown in some series.14,41 Like ICI therapy, intraurethral PGE-1 has been shown to increase intracorporal oxygenation by 37% to 57%.14 PGE-1 has been shown in rat models to rescue dorsal root ganglion Inhibitors,research,lifescience,medical neurons from apoptosis and improve axonal regeneration in diabetic rats. These mechanisms of action will further help prevent post-RP fibrosis and stimulate neurovascular bundle regeneration after RP. Combination Therapy Combination therapy can include ICI with PDE5-I, or VED and PDE5-I. Montorsi and coauthors randomized patients to receive ICI of alprostadil three times per week for 3 months with on-demand sildenafil for 3 months versus monotherapy with sildenafil on demand starting 3 months after RP.25 Patients in the combination
arm had an 82% response rate to sildenafil Inhibitors,research,lifescience,medical versus 52% in the monotherapy Inhibitors,research,lifescience,medical group.25 Mydlo and colleagues retrospectively looked at 34 men after RP with subsequent ED.42 The patients were then this website titrated on either sildenafil or vardenafil to their maximum doses. All patients had suboptimal responses after a maximum of eight doses as assessed by the SHIM score. These patients were then started on ICI therapy with alprostadil in addition to their oral therapy with 68% reporting a much better erection with combination therapy. Nandipati and associates evaluated early combination Inhibitors,research,lifescience,medical therapy with ICI therapy with alprostadil and oral sildenafil versus low-dose TriMix (papaverine, phentolomine
and PGE-1) versus low-dose PGE-1 after RP.23 Sildenafil, 50 mg, was started daily at discharge isothipendyl from the hospital, and ICI therapy with alprostadil or low-dose TriMix was started within 3 weeks or at catheter removal. This therapy was to be attempted two to three times weekly. Their results were compiled using the abridged version of the IIEF-5 questionnaire. The patients were followed every 3 months for a 12-month period. At a mean follow-up of 6 months, 96% were sexually active. Approximately 45% were sexually active in the injection-only group versus 50% with combination therapy. Doppler studies showed that peak systolic velocities were higher in the low-dose TriMix population compared with the low-dose PGE-1 alone group. These data support a stronger response of penile vasculature with TriMix.