After the small applicator tip is inserted into the urethra, a suppository about the size of a grain of rice is released. As it dissolves, alprostadil is absorbed and an erection occurs. 8 MUSE appeals to patients because it does not involve the use of a needle, is presumed to be less likely to cause penile scarring than injections, and can be used twice a day. However, in preliminary studies conducted at Metropolitan Urologic Specialists, PA, St Paul, my colleagues and I have found that penile injections work better than MUSE in men with severe or complete impotence. Many patients who have severe or complete impotence do not respond well to other therapies.
Some patients prefer the spontaneity provided by a prosthesis.
Compared with the other options available, penile prosthesis implantation still yields the highest patient and partner satisfaction rates. It is the prosthesis of choice except in some difficult reconstruction cases or when physical handicaps contraindicate its use. Today, penile prosthesis implantation is a very safe procedure that, in many cases, is done as outpatient surgery. The prostheses used do not interfere with ejaculation, urination, or orgasm. After the cylinder is placed over the penis, the pump is used to create a vacuum that draws blood into the penis, which results in an erection.