Urology Department, Henri Mondor Teaching Hospital, 51 av du Maréchal de Lattre de Tassigny, Créteil, France.
J Sex Med. 2011 Feb;8(2):575-82. doi: 10.1111/j.1743-6109.2010.02002.x. Epub 2010 Aug 30.
Intracavernous alprostadil injection (IAI) is widely used for sexual rehabilitation (SR) after radical prostatectomy (RP). However, the rate of spontaneous erection recovery with IAI remains unclear, and IAI causes pain that may hinder SR.
To assess SR in IAI users after RP and to evaluate the course and impact on SR of postinjection penile pain.
We prospectively studied 87 patients who underwent nerve-sparing laparoscopic RP, reported normal preoperative erectile function, and used IAI for 12 months. Patients started with 2.5 µg alprostadil and were advised to increase the dose gradually until erection hardness allowed vaginal penetration.
At 6 and 12 months, the International Index of Erectile Function (IIEF-15) and Erection Hardness Score (EHS) were determined with and without IAI, and injection-related penile pain was assessed using a numeric rating scale. Correlations linking penile pain, IIEF-15, and EHS scores were evaluated.
The mean alprostadil dose was 8.1 µg after 6 months and 9.9 µg after 12 months. With/without IAI, mean IIEF-15 scores for erectile and orgasmic function and mean EHS score were 14.6/4.6, 4.1/2.1, and 2.5/0.4, respectively, after 6 months; and 17.2/5.4, 4.9/2.6, and 2.7/0.9 after 12 months. Pain scores were 3.2±2.5/10 and 2.5±2.5/10 after 6 and 12 months, respectively. Pain intensity correlated with erectile function (r=-0.23), intercourse satisfaction (r=-0.23), and overall satisfaction (r=-0.24) after 6 months but not after 12 months. Follow-up was short and only patients who used IAI for 12 months were included.
In patients who were willing and able to use IAI, erectile function improved after 1 year but remained below preoperative levels. The adverse impact of pain on SR was significant during the first 6 months and diminished over time. These data may help to counsel IAI users with painful erections.
经海绵体内注射前列地尔（IAI）被广泛应用于根治性前列腺切除术（RP）后的性功能康复（SR）。然而，IAI 引起的自发性勃起恢复率尚不清楚，并且 IAI 引起的疼痛可能会阻碍 SR。
评估 RP 后 IAI 用户的 SR，并评估注射后阴茎疼痛对 SR 的过程和影响。
我们前瞻性研究了 87 例接受神经保留腹腔镜 RP 的患者，这些患者报告术前勃起功能正常，并使用 IAI 进行了 12 个月的治疗。患者起始剂量为 2.5μg 前列地尔，并建议逐渐增加剂量，直到勃起硬度足以进行阴道插入。
在 6 个月和 12 个月时，使用国际勃起功能指数（IIEF-15）和勃起硬度评分（EHS）评估有无 IAI 时的勃起功能，并使用数字评分量表评估与注射相关的阴茎疼痛。评估阴茎疼痛与 IIEF-15 和 EHS 评分之间的相关性。
6 个月后，平均前列地尔剂量为 8.1μg，12 个月后为 9.9μg。无论是否使用 IAI，6 个月时的平均 IIEF-15 评分（勃起和射精功能）和平均 EHS 评分为 14.6/4.6、4.1/2.1 和 2.5/0.4，12 个月时分别为 17.2/5.4、4.9/2.6 和 2.7/0.9。疼痛评分分别为 6 个月时的 3.2±2.5/10 和 12 个月时的 2.5±2.5/10。疼痛强度与勃起功能（r=-0.23）、性交满意度（r=-0.23）和总体满意度（r=-0.24）相关，但与 12 个月时无关。随访时间较短，仅纳入了使用 IAI 12 个月的患者。
在愿意并能够使用 IAI 的患者中，1 年后勃起功能有所改善，但仍低于术前水平。疼痛对 SR 的不良影响在最初 6 个月时显著，并随着时间的推移而减轻。这些数据可能有助于为使用 IAI 治疗伴有勃起疼痛的患者提供咨询。
