Porst H
Urologische Praxis Hamburg.
Urologe A. 1998 Jul;37(4):410-6. doi: 10.1007/s001200050199.
An analysis of the presently available results concerning transurethral application of Alprostadil with MUSE (Medicated Urethral System for Erection) up to 1000 micrograms indicates a 20-30% lower efficacy if compared to 20 micrograms i.c. injected Alprostadil. Whereas in prospective home-treatment trials only each second MUSE-application was successful in responders 87%-94% of the administrations in self-injection therapy resulted in successful coitus. In an own comparative trial in 73 pts the success rates after MUSE up to 1000 micrograms were 48% compared to 71% after i.c. Alprostadil. Reported side-effects of MUSE in the literature were: Hypotension 3-8%, syncopes 0.4%, penile/urethral pain 29%, urethral bleeding 5%, vaginal irritations 3%, priapisms < 0.1%. After MUSE-applikation the average Alprostadil contents of the ejaculate increased 40%. Whereas in prospective long-term studies of self-injection therapy with Alprostadil the risk of persistent fibrotic alterations of the penis varied between 5-7%, the risk of penile fibrosis after MUSE can not be finally estimated. Also the potential risk for urethral strictures after MUSE is presently not foreseable. The advantage of the technically easy use in confronted with a considerably lower efficacy. Therefore self-injection therapy must be further on considered the "golden standard" in Alprostadil administration.
对目前有关经尿道应用前列地尔（Alprostadil）与MUSE（勃起用药尿道系统）达1000微克的现有结果分析表明，与20微克阴茎海绵体内注射前列地尔相比，其疗效低20%-30%。在前瞻性家庭治疗试验中，MUSE治疗只有约半数成功，而在自我注射治疗中87%-94%的给药可成功性交。在我们自己对73例患者的对比试验中，使用达1000微克MUSE后的成功率为48%，而阴茎海绵体内注射前列地尔后的成功率为71%。文献报道的MUSE副作用有：低血压3%-8%，晕厥0.4%，阴茎/尿道疼痛29%，尿道出血5%，阴道刺激3%，阴茎异常勃起<0.1%。使用MUSE后，射精液中前列地尔平均含量增加40%。在前列地尔自我注射治疗的前瞻性长期研究中，阴茎持续性纤维化改变的风险为5%-7%，而MUSE后阴茎纤维化的风险尚无法最终评估。目前也无法预见MUSE后尿道狭窄的潜在风险。MUSE在技术上易于使用，但疗效却低得多。因此，自我注射疗法仍应被视为前列地尔给药的“金标准”。
