ABSTRACT
OBJECTIVE: To study the erectile response to intracavernosal injection of prostaglandin E1 in 33 spinal cord injured men with neurogenic erectile dysfunction. METHOD: The erectile response was assessed by the penile palpation. Thirty three subjects (mean age, 35.5 years) were studied. They received a testing dosage starting from 2.5 microgram with increasing dosage (maximum 40 microgram) to achieve an erection. The positive response accounts for the sufficient erection lasting for more than 30 minutes. RESULTS: After the injection, 30 subjects (90.9%) achieved the positive response and the mean duration of erection was 59.2 minutes. Of the 30 positive responders, the mean dosage needed to induce positive response was 5.8 microgram in the patients with cervical cord injury (12 subjects), 13.1 microgram in the patients with thoracic cord injury (12 subjects), and 33.3 microgram in the patients with lumbar cord injury (6 subjects). The mean dosage required for the positive response was different according to the pre-injection erectile function of the subjects. For the positive response, it required 7.7 microgram in a full erection with short duration group (14 subjects), 9.4 microgram in a partial erection group (8 subjects), and 30.6 microgram in no erection group (8 subjects). No systemic side effect or complication was noted except for the prolonged erection in 1 subject. CONCLUSION: The intracavernosal injection of prostaglandin E1 appears to be a safe and effective treatment for the treatment of erectile dysfunction in spinal cord injured men. The dosage depends on the level of spinal cord injury and pre-injection erectile function.
Subject(s)
Humans , Male , Alprostadil , Erectile Dysfunction , Palpation , Spinal Cord Injuries , Spinal CordABSTRACT
OBJECTIVE: The purposes of this study were 1) to evaluate the effectiveness of follow-up urologic evaluation of neurogenic bladder in patients with spinal cord injury, 2) to define risk factors causing upper urinary tract complications, and 3) to evaluate changes of the vesicoureteral reflux grade on follow-up study. METHOD: Urodynamic studys, ultrasonographys, and voiding cystourethrographys of 90 patients with spinal cord injury who admitted to the bladder clinic of National Rehabilitation Hostpital were evaluated. Of the 90 patients, twenty four patients (27%) had upper urinary tract complication (vesicoureteral reflux or hydronephrosis). The risk factors of upper urinary tract complication were compared. The patients who had vesicoureteral reflux were devided into two main groups: conservative medical treatment group (oxybutynin, atropine intravesical instillation and intermittent catheterization) and primary surgical treatment group, and then the changes of the vesicoureteral reflux grade on follow-up study were evlauated. RESULTS: 1) The incidence of upper urinary tract complication was 27% for all patients. After bladder clinic evaluation, the patients who were recommended the change of the voiding mothods were 24%, and 58% of the patients were need management to decrease maximal detrusor pressure. 2) Maximal bladder capacity by clinical voiding chart recording ( or =trabeculation grade 2), leak point pressure (> or =40 cmH20), and maximal detrusor pressure (> or =90 cmH2O) were significantly different between patients with upper urinary tract complication and patients without that. 3) In the eight vesicoureteral reflux patients, five of six patients were cured or improved with conservative treatment and two patients were cured with surgical treatment. CONCLUSION: The periodic follow-up evaluation of neurogenic bladder of spinal cord injuredpatients was important to prevent upper urinary tract deterioration. The factors related upper urinary tract complication were clinical bladder capacity, leak point pressure, bladder wall deformity (trabeculation) and maximal detrusor pressure.