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Combination Therapy: Medicated Urethral System for Erection Enhances Sexual Satisfaction in Sildenafil Citrate Failure Following Nerve-Sparing Radical Prostatectomy

RUPESH RAINA^*,

DAVID MANSOUR

DAVID C. KAELBER

From the ^* Center for Advanced Research in Human Reproduction, Infertility, and Sexual Function, Cleveland Clinic Foundation, Glickman Urological Institute and the Department of Internal Medicine and Pediatrics, Case-Western Reserve University (MHMC), Cleveland, Ohio.

Correspondence to: Dr Rupesh Raina, Department of Internal Medicine and Pediatrics, 2500 Metrohealth Drive, CASE School of Medicine, Cleveland, OH 44105 (e-mail: rraina{at}metrohealth.org).

The objective of our study was to assess the effectiveness of combining medicated urethral system for erection (MUSE) with sildenafil citrate in men unsatisfied with the sildenafil alone. Baseline and follow-up data from 23 patients (mean age, 62.5 ± 5.23 years) unsatisfied with the use of the sildenafil citrate alone for the treatment of erectile dysfunction following nerve-sparing radical prostatectomy (mean use, 4 attempts/100-mg dose) was obtained. All patients started oral sildenafil citrate more than 6 months after radical prostatectomy. Combination therapy was initiated using 100 mg sildenafil citrate orally 1 hour prior to intercourse. Patients used combination therapy for a minimum of 4 attempts prior to assessment with the Sexual Health Inventory of Men (International Index for Erectile Function-5) and visual analog scale to gauge rigidity (0-100). The effect of therapy on the total International Index for Erectile Function (IIEF) score and penile rigidity score was assessed. Of the 23 patients, 4 (17%) had no improvement with the addition of medicated urethral system for erection and discontinued the drug, while 19 (83%) reported improvement with the penile rigidity and sexual satisfaction. The IIEF scores of these 19 patients showed significant improvements in each sexual domain, and the patients reported that erection was sufficient for vaginal penetration 80% of the time. Rigidity scores on a scale of 0-100 with sildenafil alone averaged 38% (23-53) for men and 46% (26-67) for their partners. With the addition of MUSE, scores increased to 76% for men and 62% for their partners. We conclude that the addition of MUSE to sildenafil improved sexual satisfaction and penile rigidity in patients unsatisfied with sildenafil alone.

     Key words: Erectile dysfunction, MUSE, intraurethral alprostadil