Local treatments

Apart from oral medications, there are treatment to be applied directly to the penis cream, mini-urethral suppository and intracavernous injections, constituting local treatments.

Treatment cream form: alprostadil – (Vitaros)

vitaros

Alprostadil: the active substance

The active ingredient in Vitaros cream is alprostadil, a derivative of prostaglandin E1, which works by  blood vessels vasodilation of the erectile tissue of the corpora cavernosa and increased flow of cavernous arteries, causing penile rigidity.

How to use it?

Administered at the very top of the penis, using a single dose. Its effect appears in a few minutes can last between 1-2 hours.

Side effects

The most frequently reported events were :

  • sensation of warmth or burning in the penis, penile pain or redness
  • a local vaginal reaction from the partner , mainly type of vaginal burns mild to moderate
  • Some cases of dizziness and fainting have been observed
  • A priapism has also been reportedThis drug must be prescribed, and most of the time not reimbursed by medical insurances . The drug is not recommended for men with myocardial infarction, postural hypotension or who are at risk of venous thrombosis.

Caution

If the erection lasts more than 2 hours: consult immediately the emergency service. It could be a case of priapism (prolonged and painful erection, must be treated).

Intra-urethral pellet: alprostadil – MUSE®

muse
Alprostadil: the active substance

The active substance in Muse is alprostadil, a derivative of prostaglandin E1, which works by blood vessels vasodilation of the erectile tissue of the corpora cavernosa and increased flow of cavernous arteries, causing penile rigidity.

How to use it?

Alprostadil (Muse) is a mini-urethral suppository or pellet. It is administered using a small disposable applicator inserted in the urinary meatus. The active substance (alprostadil) is then released inside the urethra and goes inside the corpora cavernosa, promoting increased blood flow.
The erection occurs 5 to 10 minutes after administration and persists for 30 to 60 minutes.

Dosage

The recommended starting dose is 500 micrograms.
This may be increased stepwise (1000 mcg) or less (at 250 or 125 micrograms) under medical supervision until a satisfactory effect.
It is recommended not to exceed two doses in 24 hours, and do not use more than seven doses per seven days. The prescribed dose should not be exceeded.

Method of administration

After checking mastering the technique of administration by the patient, the chosen dose may be prescribed for home self-administration.
The patient must urinate before the introduction of the product because the urethral humidification makes administration of alprostadil (Muse) and is critical to the dissolution of the active ingredient.
For administration, remove the applicator protective cap, completely stretch the penis to its full length upwards and insert the applicator stem into the urethra.
Press the push button to release the product from the applicator and remove it from the urethra (before removing the applicator, perform a lateral back and forth movement to ensure that the product has been released the administration rod).
Roll the penis between the palms for at least 10 seconds to ensure a homogeneous distribution of the drug on the wall of the urethra.

Side effects

The most frequently reported events were:

  • sensation of warmth or burning in the penis, penile pain or redness
  • pain in the tip of the penisMuse is issued on prescription, and most of the unpaid time.The drug is not recommended for men with myocardial infarction, postural hypotension or who are at risk of venous thrombosis.

Caution

If the erection of more than 2 hours consult immediately the emergencies. This could be a case of priapism (painful and prolonged erection, must be treated) .

Injections Intracavernous: alprostadil –
(Edex®, Caverject®, Caverject-Dual®)

edex
They are delivered on prescription and reimbursed only when disorders are related to:

  • paraplegia / quadriplegia,
  • advanced diabetic neuropathy,
  • multiple sclerosis,
  • surgical scars of (radical prostatectomy eg),
  • pelvic trauma with urinary disorders,
  • sequels radiotherapy
  • sequels to priapism.The injected substance (synthetic derivative of prostaglandin E1 in the name of alprostadil) remains locally and dilates the blood vessels of the penis to promote the accumulation of blood inside the penis and allow an erection. These drugs are inducers of erection. They are effective even in the absence of sexual stimulation.

    Dosage

     

  • Dosage is strictly individual and must be determined in advance by a test performed by a physician.
  • The first injection must be carried out in medical settings .
    – In general, the initial dose is 5 mcg.
    – In case of insufficient erection that dose will then be increased by increments of 5 mcg to 20 mcg in subsequent administrations. The dose should be adjusted to allow the patient to be in full erection 5 to 10 minutes after injection. The erection should not last more than an hour .

 

– Do not administer more than one injection per day, the maximum injection rate is two per week with an interval of at least 24 hours between injections. The maximum individual dose injection of 20 micrograms.

– The self-injected into the corpus cavernosum will be made only after learning of the injection technique, once the optimal dose was determined. The patient should inject the individual optimal dose determined for him.

– Never increase its individual dose of his own.

How to inject?

  • The injection is on the side of the penis. At this point there are no seams and therefore no risk of injury.
  • The injection site is cleaned with antiseptic solution.
  • The injection is then performed quickly (5 to 10 seconds) and manual compression must be made on the injection site for 2 to 3 minutes to prevent the formation of an hematoma.
  • Any unused solution should be discarded.

Side-effects

  • penile pain at the injection site, mild to moderate
  • hematoma, bruising at the injection site, penile fibrosis
  • Prolonged erection. Beyond 2H it is imperative to seek medical attention (risk of priapism)
  • headaches