Vitaros®: Efficiency, tolerance and satisfaction in a population of spinal cord-injured (SCI) men and comparison to usual treatments

Abstract

Listen

Translate article

According to European guidelines, phosphodiesterase-5 inhibitors (PDE5I) are recommended as first-line treatment in erectile dysfunction after spinal cord injury (SCI), and intracavernous injections (ICI) as second choice. Vitaros ® (alprostadil) is a new treatment with intra-urethral administration; several studies have already proved its efficacy in general population. The aim of this monocentric retrospective study was to evaluate Vitaros ® ’s efficacy in SCI men. Side effects and benefits were also studied, and the whole results were compared with those obtained with PDE5I and ICI. Eighteen to 60-years-old SCI patients were included if they suffered from erectile dysfunction secondary to the injury for which Vitaros ® had been prescribed. Self-evaluations were used to assess each treatment (Vitaros ® , PDE5I and ICI) and the baseline (without treatment); it included the Erection Hardness Score (EHS) and IIEF5 (abbreviated score from the International Index of Erectile Function), time duration, side effects, global satisfaction score and the preferred treatment for further use. The Wilcoxon test was used for statistical analysis. Forty patients were included, among whom 29 had completed all of the self-evaluations. The average age was 42.3 ± 10.4 years-old; 8 were tetraplegics and 21 were paraplegics. Vitaros ® implied an improvement of 3.9 points for the IIEF5 score from the baseline ( P = 0.0005). Seven of the 29 patients reported side effects with Vitaros ® , moderate and transitory. When Vitaros ® was compared to ICI, a significant difference to the benefit of ICI was found for the IIEF5 score (9.4 points, P = 0.0015), for the EHS score (2.21 points, P = 0.0010) and for time duration (90 min, P = 0.0020). When Vitaros ® was compared to PDE5I, a significant difference to the benefit of PDE5I was found for the IIEF5 score (3.03 points, P = 0.0288) and for the EHS score (1.04, P = 0.0040). Nine of the 29 patients had finally selected Vitaros ® for future use. As Vitaros ® may be an effective treatment of erectile dysfunction in SCI men, it seems to be less efficient than ICI and PDE5I; however, some patients choose it for future use.