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Intraurethral Alprostadil

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1. Intraurethral Alprostadil

Intraurethral Alprostadil Intraurethral Alprostadil Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Intraurethral Alprostadil (...) Intraurethral Alprostadil Aka: Intraurethral Alprostadil , MUSE II. Indications Psychogenic Neurogenic Vasculogenic III. Contraindications Penile deformity (e.g ) Sexual intercourse with pregnant women Risk of risk or use IV. Preparation Transurethral preparation Inserted 3 cm into with plastic applicator Semi-solid pellet Diameter: 1.4 mm Length: 3-6 mm V. Efficacy Successful intercourse in 65% of 1511 tested success rate: 19% Less effective than injectable alprostadil VI. Adverse effects (3%) (2%) Mild

2018 FP Notebook

2. Intraurethral Alprostadil

Intraurethral Alprostadil Intraurethral Alprostadil Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Intraurethral Alprostadil (...) Intraurethral Alprostadil Aka: Intraurethral Alprostadil , MUSE II. Indications Psychogenic Neurogenic Vasculogenic III. Contraindications Penile deformity (e.g ) Sexual intercourse with pregnant women Risk of risk or use IV. Preparation Transurethral preparation Inserted 3 cm into with plastic applicator Semi-solid pellet Diameter: 1.4 mm Length: 3-6 mm V. Efficacy Successful intercourse in 65% of 1511 tested success rate: 19% Less effective than injectable alprostadil VI. Adverse effects (3%) (2%) Mild

2015 FP Notebook

3. Erectile dysfunction: Alprostadil cream

alprostadil formulations. The topical application route may be preferred to the intraurethral or intracavernosal route by some men. The licensed maximum frequency of use is no more than 2–3 times per week and only once per 24-hour period. Resource implications Resource implications Alprostadil cream costs £10 per dose, which is significantly more than generic sildenafil but is slightly less costly than other alprostadil products, at usual therapeutic dose. Department of Health amended regulations allow (...) of Evidence review. Context Alprostadil (prostaglandin E 1 ) is currently licensed and available in products for intracavernosal (Caverject, Viridal) or intraurethral (MUSE) treatment of erectile dysfunction. Alprostadil is recommended as an alternative therapeutic option for men who cannot tolerate or have contraindications to oral treatment with PDE5 inhibitors or in whom PDE5 inhibitors are ineffective. Non-pharmacological treatment options for erectile dysfunction, such as vacuum erection devices

2014 National Institute for Health and Clinical Excellence - Advice

4. Recovery of erectile function after nerve sparing radical prostatectomy and penile rehabilitation with nightly intraurethral alprostadil versus sildenafil citrate. (PubMed)

Recovery of erectile function after nerve sparing radical prostatectomy and penile rehabilitation with nightly intraurethral alprostadil versus sildenafil citrate. To our knowledge we report the first large, randomized, prospective penile rehabilitation clinical trial to compare the effectiveness of nightly intraurethral alprostadil vs sildenafil citrate after nerve sparing prostatectomy.We performed a prospective, randomized, open label, multicenter American study in men with normal erectile (...) function who underwent bilateral nerve sparing radical prostatectomy. The International Index of Erectile Function erectile function domain was the primary end point. Subjects initiated nightly treatment within 1 month of surgery with intraurethral alprostadil or oral sildenafil citrate (50 mg) for 9 months. After 1-month washout and before sexual activity subjects self-administered sildenafil citrate (100 mg) for a total of 6 attempts in 1 month. Secondary end points were the global assessment

2010 The Journal of urology Controlled trial quality: uncertain

5. Male Sexual Dysfunction

for Erection (MUSE) Study Group. N Engl J Med, 1997. 336: 1. 230. Costa, P., et al. Intraurethral alprostadil for erectile dysfunction: a review of the literature. Drugs, 2012. 72: 2243. 231. Mulhall, J.P., et al. Analysis of the consistency of intraurethral prostaglandin E(1) (MUSE) during at-home use. Urology, 2001. 58: 262. 232. Shabsigh, R., et al. Intracavernous alprostadil alfadex is more efficacious, better tolerated, and preferred over intraurethral alprostadil plus optional actis: a comparative (...) nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J Urol, 1997. 158: 1408. 136. Raina, R., et al. The early use of transurethral alprostadil after radical prostatectomy potentially facilitates an earlier return of erectile function and successful sexual activity. BJU Int, 2007. 100: 1317. 137. Raina, R., et al. Early use of vacuum constriction device following radical prostatectomy facilitates

2019 European Association of Urology

6. Neuro-urology

. Arch Phys Med Rehabil, 1994. 75: 297. 255. Bennett, J.K., et al. Collagen injections for intrinsic sphincter deficiency in the neuropathic urethra. Paraplegia, 1995. 33: 697. 256. Block, C.A., et al. Long-term efficacy of periurethral collagen injection for the treatment of urinary incontinence secondary to myelomeningocele. J Urol, 2003. 169: 327. 257. Schurch, B., et al. Intraurethral sphincter prosthesis to treat hyporeflexic bladders in women: does it work? BJU Int, 1999. 84: 789. 258. Reuvers (...) . 36: 345. 300. Perkash, I. Use of contact laser crystal tip firing Nd:YAG to relieve urinary outflow obstruction in male neurogenic bladder patients. J Clin Laser Med Surg, 1998. 16: 33. 301. Chancellor, M.B., et al. Long-term followup of the North American multicenter UroLume trial for the treatment of external detrusor-sphincter dyssynergia. J Urol, 1999. 161: 1545. 302. Seoane-Rodriguez, S., et al. Long-term follow-up study of intraurethral stents in spinal cord injured patients with detrusor

2019 European Association of Urology

7. Erectile Dysfunction

of benefits and risks/burdens. (Moderate Recommendation; Evidence Level: Grade C) 14. Men with ED should be informed regarding the treatment option of intraurethral (IU) alprostadil, including discussion of benefits and risks/burdens. (Conditional Recommendation; Evidence Level: Grade C) 15. For men with ED who are considering the use of IU alprostadil, an in-office test should be performed. (Clinical Principle) 16. Men with ED should be informed regarding the treatment option of intracavernosal

2018 American Urological Association

8. Erectile Dysfunction

may be more effective if combined with testosterone therapy. (Moderate Recommendation; Evidence Level: Grade C) 13. Men with ED should be informed regarding the treatment option of a vacuum erection device (VED), including discussion of benefits and risks/burdens. (Moderate Recommendation; Evidence Level: Grade C) 14. Men with ED should be informed regarding the treatment option of intraurethral (IU) alprostadil, including dis- cussion of benefits and risks/burdens. (Conditional Recommendation (...) ; Evidence Level: Grade C) 15. For men with ED who are considering the use of IU alprostadil, an in-office test should be performed. (Clinical Principle) 16. Men with ED should be informed regarding the treatment option of intracavernosal injections (ICI), including dis- cussion of benefits and risks/burdens. (Moderate Recommendation; Evidence Level: Grade C) Erectile Dysfunction 3 American Urological Association (AUA) Erectile Dysfunction 17. For men with ED who are considering ICI therapy, an in-office

2018 American Urological Association

9. Neuro-urology

sphincter deficiency in the neuropathic urethra. Paraplegia, 1995. 33: 697. 256. Block, C.A., et al. Long-term efficacy of periurethral collagen injection for the treatment of urinary incontinence secondary to myelomeningocele. J Urol, 2003. 169: 327. 257. Schurch, B., et al. Intraurethral sphincter prosthesis to treat hyporeflexic bladders in women: does it work? BJU Int, 1999. 84: 789. 258. Reuvers, S.H.M., et al. Heterogeneity in reporting on urinary outcome and cure after surgical interventions (...) neurogenic bladder patients. J Clin Laser Med Surg, 1998. 16: 33. 301. Chancellor, M.B., et al. Long-term followup of the North American multicenter UroLume trial for the treatment of external detrusor-sphincter dyssynergia. J Urol, 1999. 161: 1545. 302. Seoane-Rodriguez, S., et al. Long-term follow-up study of intraurethral stents in spinal cord injured patients with detrusor-sphincter dyssynergia. Spinal Cord, 2007. 45: 621. 303. Gajewski, J.B., et al. Removal of UroLume endoprosthesis: experience

2018 European Association of Urology

10. Male Sexual Dysfunction

for Erection (MUSE) Study Group. N Engl J Med, 1997. 336: 1. 230. Costa, P., et al. Intraurethral alprostadil for erectile dysfunction: a review of the literature. Drugs, 2012. 72: 2243. 231. Mulhall, J.P., et al. Analysis of the consistency of intraurethral prostaglandin E(1) (MUSE) during at-home use. Urology, 2001. 58: 262. 232. Shabsigh, R., et al. Intracavernous alprostadil alfadex is more efficacious, better tolerated, and preferred over intraurethral alprostadil plus optional actis: a comparative (...) nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J Urol, 1997. 158: 1408. 136. Raina, R., et al. The early use of transurethral alprostadil after radical prostatectomy potentially facilitates an earlier return of erectile function and successful sexual activity. BJU Int, 2007. 100: 1317. 137. Raina, R., et al. Early use of vacuum constriction device following radical prostatectomy facilitates

2018 European Association of Urology

11. Erectile dysfunction

-informed older men with infrequent sexual intercourse and comorbidity requiring non-invasive, drug-free management of erectile dysfunction. They are reported to be highly effective with variable satisfaction. Second line treatments include alprostadil, available in the UK as an intracavernous injection (Caverject ® , Viridal ® ), an intraurethral application (MUSE ® ), and a topical cream (Vitaros ® ). These can be effective treatments in men with erectile dysfunction following a spinal cord injury

2019 NICE Clinical Knowledge Summaries

12. Treating erectile dysfunction after surgery for pelvic cancers

topical alprostadil, intraurethral alprostadil or intracavernosal injections (ICI) followed by discussion of a penile implant if initial treatment strategies fail. • For non-nerve-sparing surgery, VED is generally the treatment of choice, alone or in combination with ICI or intraurethral alprostadil. • VED is useful alongside medication and facilitates early sexual activity where drugs alone are not effective. Treatment initiation • Initiate treatment preferably as soon as catheter is removed (...) low dose PDE5-I tablets in ED rehabilitation programme. • Consider providing standard dose PDE5-I tablets, as needed, early on in the programme to prevent penile atrophy. • If initial treatment fails, offer alprostadil pellets, injections or topical alprostadil, followed by implants. • Pellets and injections are more useful than tablets in men who have had non-nerve-sparing surgery. • Re-assess erectile function regularly after starting a rehabilitation programme. • Enable access to psychosexual

2014 Prostate Cancer UK

13. Neuro-urology

and pathophysiology 23 3E.2 Diagnostic evaluation 23 3E.3 Disease management 23 3E.3.1 Recurrent UTI 23 3E.3.2 Prevention 23 3E.4 Recommendations for the treatment of UTI 24 3F SEXUAL (DYS)FUNCTION AND FERTILITY 24 3F .1 Erectile dysfunction 24 3F .1.1 Phosphodiesterase type 5 inhibitors 24 3F .1.2 Mechanical devices 25 3F .1.3 Intracavernous injections and intraurethral application 25 3F .1.4 Penile prostheses 25 3F .1.5 Recommendations for erectile dysfunction 25 3F .2 Male fertility 25 3F .2.1 Sperm quality

2015 European Association of Urology

14. Male Sexual Dysfunction

Intraurethral/topical alprostadil 19 3A.4.7 Third-line therapy (penile prostheses) 19 3A.4.7.1 Complications 20 3A.4.7.2 Conclusions third-line therapy 20 3A.4.8 Recommendations for the treatment of ED 20 3A.5 Follow-up 20 3B PREMATURE EJACULATION 21 3B.1 Epidemiology/aetiology/pathophysiology 21 3B.1.1 Epidemiology 21 3B.1.2 Pathophysiology and risk factors 21 3B.1.3 Impact of PE on QoL 21 3B.2 Classification 21 3B.3 Diagnostic evaluation 22 3B.3.1 Intravaginal ejaculatory latency time 22 3B.3.2 PE (...) % of patients. This strategy can be considered in carefully selected patients before proceeding to a penile implant [Level 4]. 3A.4.6.1.3 Intraurethral/topical alprostadil A specific formulation of alprostadil (125-1000 µg) in a medicated pellet (MUSE™) has been approved as a treatment for ED [156]. Erections sufficient for intercourse are achieved in 30-65.9% of patients. In clinical practice, only the higher doses (500 and 1000 µg) have been used with low consistency response rates [156- 158

2015 European Association of Urology

15. Non-invasive Management Options for Erectile Dysfunction When a Phosphodiesterase Type 5 Inhibitor Fails. (PubMed)

an appropriate and full PDE5I clinical trial. True non-responders may be offered intracavernosal injections of erectogenic drugs, intraurethral alprostadil, or surgical insertion of a penile prosthesis. Such options are not discreet and are associated with more adverse effects than PDE5Is. Thus patients may request additional non-invasive medical management options. This review describes published literature on patients who failed to respond to an on-demand PDE5I regimen and were treated with a non-invasive (...) PDEI-based regimen, including switching from one PDE5I to another; increasing the dose of PDE5I above the labeled dosage range; using two PDE5Is concurrently; using a daily PDE5I regimen; or combining a PDE5I with a testosterone supplement, α-adrenergic antagonist, intraurethral or intracavernosal alprostadil, vacuum erection device, or low-intensity shock wave therapy. The limitations of published clinical trials do not allow for sufficient evidence to recommend one option over another. Therefore

2018 Drugs & Aging

16. Erectile dysfunction: avanafil

, and intracavernous, intraurethral and topical alprostadil. Surgical implantation of a penile prosthesis may be considered in men who fail pharmacotherapy or who want a permanent solution (European Association of Urology guidelines on male sexual dysfunction, 2014). Costs of alternativ Costs of alternative treatments e treatments T T able able 3 Costs of PDE5 3 Costs of PDE5 inhibitors inhibitors Dose Dose Directions for use Directions for use a a Estimated cost Estimated cost ( (e ex xcluding V cluding VA AT) T (...) prescribing of generic sildenafil for men with erectile dysfunction. Avanafil tadalafil, vardenafil, branded sildenafil and alprostadil may only be prescribed on the NHS under certain circumstances (see individual preparations in the British National Formulary). Erectile dysfunction: avanafil (ESNM45) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 28 of 35Other treatment options include vacuum erection devices

2014 National Institute for Health and Clinical Excellence - Advice

17. Vacuum Suction Device

with method: 66% V. Adverse Effects cooler to touch (apply warm washcloth) dark pink to blue color with constricting band may bend at base at site of constricting band VI. Monitoring: Follow-up Initial: 1 month after starting method Yearly follow-up VII. Management May be used in combination with PDE-5 Inhibitor (e.g. ) or with Alprostadil (injection or intraurethral) VIII. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term

2018 FP Notebook

18. Mirabegron For Erectile Dysfunction

: Mirabegron Phase 1 Phase 2 Detailed Description: ED affects up to 30 million men in the United States. The only class of oral medication approved for ED is PDE5i. These include sildenafil, tadalafil, vardenafil and avanafil. Other pharmacologic options in the treatment of ED are delivered as an intraurethral suppository (alprostadil) or intracavernosal injection (alprostadil, papaverine, phentolamine, atropine). These are more invasive routes of administration. Men who fail to obtain benefit from a PDE5i

2016 Clinical Trials

19. Pharmacologic Therapy in Men’s Health: Hypogonadism, Erectile Dysfunction, and Benign Prostatic Hyperplasia (PubMed)

of intraurethral and intrapenile alprostadil injections for patients who do not respond to oral medications, and the role of alpha1-adrenergic antagonists, 5-alpha-reductase inhibitors, anticholinergic agents, and herbal therapies in the management of BPH. Copyright © 2016 Elsevier Inc. All rights reserved.

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2016 The Medical clinics of North America

20. Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). (PubMed)

with erectile dysfunction who do not have a specific contraindication to their use (LE = 3, GR = C). (iv) Intracavernosal injection therapy with alprostadil is an effective and well-tolerated treatment for men with erectile dysfunction (LE = 1, GR = A). (v) Intracavernosal injection therapy with alprostadil should be offered to patients as second-line therapy for erectile dysfunction (LE = 3, GR = C). (vi) Intraurethral and topical alprostadil are effective and well-tolerated treatments for men (...) with erectile dysfunction (LE = 1, GR = A). (vii) Intraurethral and topical alprostadil should be considered second-line therapy for erectile dysfunction if available (LE = 3, GR = C). (viii) Dose titration of PDE5 inhibitors to the maximum tolerated dose is strongly recommended because it increases efficacy and satisfaction from treatment (LE = 2, GR = A). (ix) Treatment selection and follow-up should address the psychosocial profile and the needs and expectations of a patient for his sexual life. Shared

2016 Journal Of Sexual Medicine

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