Brock G, Tu L M, Linet O I
Urology Clinic, St. Joseph's Health Center, London, Ontario, Canada
Urology. 2001 Mar;57(3):536-41. doi: 10.1016/s0090-4295(00)01027-x.
To investigate the effect of long-term intracavernosal self-injection of alprostadil (Caverject) on the penile circulation and return of spontaneous erection in men with arteriogenic erectile dysfunction.
Seventy men with a stable heterosexual partner entered the titration phase of this open-label, flexible-dose study. The effective alprostadil dose (ie, the dose producing penile rigidity adequate for intercourse and lasting up to 60 minutes) was determined before entry into the 12-month self-treatment home phase. Duplex ultrasonography was used to measure the peak systolic velocity and diameter of the cavernosal arteries at the end of the titration phase and after 4, 8, and 12 months of the home phase. The efficacy, tolerability, and return of spontaneous erections were assessed from the patients' diaries and by interview at each clinic visit. Sixty-three men entered the home phase; 49 of them filled out the diaries and 42 completed the study.
An effective dose was established for 67 (96%) of the 70 men (median dose 15 microg). During the home phase, 94% of men responded to alprostadil, and the median dose remained unchanged. Complete duplex ultrasound data were obtained in 38 men and showed significant increases in postinjection peak systolic velocity in both cavernosal arteries (P <0.001 at 12 months) and between the preinjection and postinjection cavernosal arterial diameters (P = 0.0001) compared with baseline. Reports of a return of spontaneous erections increased throughout the study compared with baseline (37%, 26 of 70) and were confirmed by interview for 46 (85%) of 54 men with available data overall. Treatment was generally well accepted, with low incidences of penile pain (23%), prolonged erection, which resolved spontaneously (6%), and fibrosis (1%).
Intracavernosal alprostadil was effective, acceptable, and generally well tolerated in men with arteriogenic erectile dysfunction. Long-term treatment improved the penile circulation, and most men reported an increase in return of spontaneous erections.
研究长期阴茎海绵体内自我注射前列地尔（凯威捷）对动脉性勃起功能障碍男性阴茎血液循环及自发勃起恢复情况的影响。
70名有稳定异性伴侣的男性进入了这项开放标签、灵活剂量研究的滴定阶段。在进入为期12个月的自我治疗居家阶段之前，确定有效前列地尔剂量（即产生足以进行性交且持续长达60分钟的阴茎硬度的剂量）。在滴定阶段结束时以及居家阶段的4个月、8个月和12个月后，使用双功能超声测量海绵体动脉的收缩期峰值流速和直径。通过患者日记以及每次门诊就诊时的访谈来评估自发勃起的疗效、耐受性和恢复情况。63名男性进入居家阶段；其中49人填写了日记，42人完成了研究。
70名男性中有67名（96%）确定了有效剂量（中位剂量15微克）。在居家阶段，94%的男性对前列地尔有反应，且中位剂量保持不变。38名男性获得了完整的双功能超声数据，结果显示与基线相比，注射后两侧海绵体动脉的收缩期峰值流速均显著增加（12个月时P<0.001），且注射前和注射后海绵体动脉直径之间也有显著增加（P = 0.0001）。与基线相比，在整个研究过程中自发勃起恢复的报告有所增加（37%，70人中的26人），在有可用数据的54名男性中，有46名（85%）通过访谈得到证实。治疗总体上被很好地接受，阴茎疼痛发生率较低（23%），勃起延长且能自发缓解（6%），纤维化发生率为（1%）。
阴茎海绵体内注射前列地尔对动脉性勃起功能障碍男性有效、可接受且耐受性良好。长期治疗改善了阴茎血液循环，大多数男性报告自发勃起恢复有所增加。
