Title
Treatments for erectile dysfunction in spinal cord patients: alternatives to phosphodiesterase type 5 inhibitors? A review study Treatments for erectile dysfunction in spinal cord patients: alternatives to phosphodiesterase type 5 inhibitors? A review study
Author
Faculty/Department
Faculty of Medicine and Health Sciences
Publication type
article
Publication
London :Nature publishing group ,
Subject
Human medicine
Source (journal)
Spinal cord. - Edinburgh
Volume/pages
53(2015) :12 , p. 849-854
ISSN
1362-4393
ISI
000366488200003
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
Study design: Review study. Objectives: Alternative treatments to oral phosphodiesterase type 5 inhibitors (PDE5Is) in individuals with spinal cord lesions (SCLs) and erectile dysfunction (ED). Setting: Italy. Methods: Research clinical trials (1999-2014). Results: Twelve studies were selected. One article documented that 76% of subjects reached satisfactory sexual intercourse (SI) using intracavernosal injection of vasoactive medications (papaverine and prostaglandin E1). One study regarding perineal training showed a significant increase (Po0.05) in penile tumescence in 10 individuals with preserved sacral segment. Two studies reported contrasting results on erectile function (EF) using various dosages of oral fampridine (25-40 mg). Furthermore, 95.1% of patients on fampridine 25mg experienced drawbacks. Disappointing findings were found with intraurethral alprostadil (125-1000 mu g) and sublingual apomorphine 3mg. Two studies concerning penile prosthesis reported valid SI more than 75% of the time with a mean follow-up of 11 years, although around 15% of individuals showed side effects. As for surgical treatments, 88% of males submitted to Brindley sacral anterior root stimulator after sacral dorsal rhizotomy achieved valid erection up to 8 years following the procedure. Three studies documented the impact of definitive sacral neuromodulation implant (Medtronic, Minneapolis, MN, USA) also on EF. After surgery, 20-37.5% of patients with ED recovered normal EF. Conclusions: Data are scant on the efficacy of ED treatments for SCL subjects who did not respond to PDE5Is. Further research should investigate the effects of any SCL treatments even when they are not strictly used for neurogenic sexual dysfunction.
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