Abstract
Introduction and Objective: To assess whether early MUSE treatment following radical prostatectomy (RP) facilitate earlier sexual activity and return of natural erections in men with erectile dysfunction (ED) following bilateral nerve-sparing (NS) RP. Methods: A total of 91 patients were included in this prospective study: 56 received early MUSE and 35 (Control group) did not receive any early treatment. Patients in the early MUSE group received 125 micrograms (mcg) 3 times/week for the first 6 weeks. At 6 weeks the MUSE dose was titrated to 250 mcg, 3 times/week for 4 months. Patients who could not tolerate the 250 mcg doses remained at 125 mcg for 4 months. Treatment efficacy was analyzed by the patient’s response to the Sexual Health Inventory for Men (SHIM) questionnaire. Results: In the MUSE Group, 38/56 (68%) continued MUSE treatment. At 6 months, 28/38 (74%) of the patients resumed sexual activity, 15/28 (53%) had natural erections sufficient for vaginal penetration without MUSE, 13/28 (47%) used MUSE as an adjuvant treatment for attempted/successful intercourse. In the Control Group, 13/35 (37%) resumed sexual activity, 4/13 (30.7%) had natural erections sufficient for vaginal penetration, 9/13 (69.3%) were dissatisfied with the erections and used oral therapy/erectaids as adjuvant treatments. The baseline and 6 month SHIM scores for the MUSE group were 21.14 and18.92, respectively (see Table 1), compared to the Control Group; 22.02 and 12.02. The MUSE discontinuation rate was 32% (18/56). Nine of the 18 (50%) discontinued because of inadequate erections, 5 (28%)due to loss of sexual interest, and 4 (22%) due to local pain/burning. Conclusions: Early MUSE therapy following radical prostatectomy increases the incidence of sexual activity, increases the incidence of erections sufficient for intercourse and may shorten the neuropraxia period.
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