Costabile R A, Spevak M, Fishman I J, Govier F E, Hellstrom W J, Shabsigh R, Nemo K J, Rapport J L, Tam P Y, Weldon K L, Gesundheit N
Department of Surgery, Military Andrology Research Center, Walter Reed Army Medical Center, Washington, DC, USA.
J Urol. 1998 Oct;160(4):1325-8.
A retrospective analysis of the MUSE clinical trial was performed to evaluate the efficacy and safety of transurethral alprostadil in patients with erectile dysfunction after radical prostatectomy.
Patients received doses of transurethral alprostadil in the clinic and those for whom a suitable dose was determined were treated at home with active drug or placebo for 3 months. Patients had undergone radical prostatectomy no less than 3 months before study entry.
Of the 384 patients in whom radical prostatectomy was identified as a cause of erectile dysfunction 70.3% had an erection believed sufficient for intercourse in the clinic and 57.1% on active medication had sexual intercourse at least once at home. The product of clinic and home success rates (70.3 x 57.1%) was an overall success rate (the likelihood of active treatment to lead to intercourse at home) of 40.1%. The frequency of most adverse effects of radical prostatectomy was comparable to that of other organic etiologies of erectile dysfunction (1,127 patients). The percentage of patients with hypotension in the clinic was lower after radical prostatectomy compared to other erectile dysfunction etiologies (0.8 versus 4.2%, p < 0.001) but the percentage of patients with urethral pain/burning was higher (18.3 versus 10.4%, p = 0.027). No urinary tract infection, fibrosis or priapism occurred in the post-radical prostatectomy patients.
Transurethral alprostadil is a well tolerated and efficacious method of treating erectile dysfunction after radical prostatectomy, although psychological changes associated with cancer and surgery may limit home response. The severe neurovascular deficit associated with prostatectomy neither limits the efficacy of transurethral alprostadil nor increases the risks.
对MUSE临床试验进行回顾性分析，以评估经尿道前列地尔对根治性前列腺切除术后勃起功能障碍患者的疗效和安全性。
患者在诊所接受经尿道前列地尔给药，确定合适剂量的患者在家中接受活性药物或安慰剂治疗3个月。患者在入组研究前至少3个月接受了根治性前列腺切除术。
在384例被确定为勃起功能障碍病因是根治性前列腺切除术的患者中，70.3%的患者在诊所的勃起被认为足以进行性交，57.1%接受活性药物治疗的患者在家中至少有一次性交。诊所成功率与家中成功率的乘积（70.3×57.1%）为总体成功率（活性治疗导致在家中进行性交成功的可能性）40.1%。根治性前列腺切除术的大多数不良反应发生率与其他器质性勃起功能障碍病因（1127例患者）相当。与其他勃起功能障碍病因相比，根治性前列腺切除术后诊所中低血压患者的百分比更低（0.8%对4.2%，p<0.001），但尿道疼痛/烧灼感患者的百分比更高（18.3%对10.4%，p = 0.027）。根治性前列腺切除术后患者未发生尿路感染、纤维化或阴茎异常勃起。
经尿道前列地尔是治疗根治性前列腺切除术后勃起功能障碍耐受性良好且有效的方法，尽管与癌症和手术相关的心理变化可能会限制在家中的反应。与前列腺切除术相关的严重神经血管缺损既不限制经尿道前列地尔的疗效，也不增加风险。
