Conclusions : This systematic review and meta- analysis indicate that PDE5 inhibitors are effective and well tolerated to treat ED secondary to SCI compared with placebo , as measured by response to GEQ , SEP2 , SEP3 and incidence of adverse events .
PDE5 inhibitors could be considered as the first choice in the treatment of ED patients with SCI
Study design : Systemic review Objective : We carried out a systematic review and meta- analysis to assess the efficacy and safety of phosphodieterase-5 ( PDE5 ) inhibitors on erectile dysfunction ( ED ) secondary to spinal cord injury ( SCI ) .
Intraurethral alprostadil for treatment of erectile dysfunction in patients with spinal cord injury.
OBJECTIVES To assess the efficacy of intraurethral prostagl and in E1 ( alprostadil , MUSE ) in treating  erectile dysfunction in patients with spinal cord injury ( SCI ) . METHODS Intraurethral alprostadil was tested in 15 patients with SCI to evaluate its effectiveness in treating SCI-associated erectile dysfunction . All patients were at least 1 year after injury , and all had previously used intracavernosal injections successfully ( Schramek 's grade 5 erection ) . The intraurethral drug was administered in the office , in the presence of a physician , with monitoring of blood pressure . If effective , the patient was then able to use MUSE at home . The first 3 patients underwent gradual dose escalation starting with 125 microg , without the use of a constriction ring . Because of hypotension , the remaining 12 patients all used a penile constriction ring prior to intraurethral drug administration using 1000 microg . The quality of the erection was compared with that achieved with intracavernosal injections using Schramek 's grading . RESULTS The dose escalation ( titration ) in the first 3 patients demonstrated that the 1000-microg dose was the most effective in creating an erectile response . Transient hypotension was noted in these first 3 patients in whom the constricting b and was not used . The highest dose of MUSE ( 1000 microg ) was , therefore , used in the remaining 12 patients , with the constriction b and . The quality of the erection varied and appeared to be less rigid in all patients ( 12 patients with grade 1 to 3 ; 3 patients with grade 4 ) than that noted with intracavernosal injection therapy ( 1 5 patients with grade 5 ) . There was no incidence of priapism . The 3 patients with grade 4 erections tried the MUSE at home . All 3 patients were dissatisfied with the quality of the erection and did not continue to use the MUSE at home and returned to intracavernosal injection therapy . CONCLUSIONS MUSE appears to be somewhat effective in creating erections ; however , these were less rigid erections than those obtained with intracavernosal therapy and provided less overall satisfaction . It should always be used in the patient with SCI after placement of a constriction ring to prevent hypotension . Its ultimate use depends on the patient 's level of satisfaction with the quality of the erection compared with intracavernosal injections
Conclusions : This systematic review and meta- analysis indicate that PDE5 inhibitors are effective and well tolerated to treat ED secondary to SCI compared with placebo , as measured by response to GEQ , SEP2 , SEP3 and incidence of adverse events .
PDE5 inhibitors could be considered as the first choice in the treatment of ED patients with SCI
Study design : Systemic review Objective : We carried out a systematic review and meta- analysis to assess the efficacy and safety of phosphodieterase-5 ( PDE5 ) inhibitors on erectile dysfunction ( ED ) secondary to spinal cord injury ( SCI ) .