Michael Godschalk

Testosterone improves rehabilitation outcomes in ill older men.

OBJECTIVES: To determine whether testosterone supplementation improves rehabilitation outcomes in ill older men.

Quality of Life in Patients Using Self-Administered Intracavernous Injections of Prostaglandin E1 for Erectile Dysfunction

PURPOSE We assessed changes in quality of life after 6 months of self-injections of prostaglandin E1 for the treatment of erectile dysfunction. MATERIALS AND METHODS A prospective study was done at a university affiliated Veterans Affairs medical center of patients using prostaglandin E1 at home. Quality of life was assessed with the Case Western Reserve University sexual functioning questionnaire and the Duke health profile. These questionnaires were administered before initiation and after 6 months of prostaglandin E1 therapy. RESULTS Of 16 subjects injecting prostaglandin E1 at home 15 completed 6 months of therapy, and 13 of them completed both questionnaires. While using prostaglandin E1 we found an increase in the frequency of sexual activity from 2.9 to 5.5 times during the prior month (p = 0.01), rigidity of erection scores from 3.8 to 7.6 (p = 0.002, score 0-no erection to 8-full erection) and sexual satisfaction scores from 2.5 to 4.1 (p = 0.03, score 0-extremely unsatisfied to 5-extremely satisfied). We also found improvements in mental health scores from 80.0 to 92.3 (p = 0.007), social health scores from 61.5 to 80.8 (p = 0.004) and self-esteem scores from 72.3 to 86.9 (p = 0.01) on a scale of 0 to 100, where a higher score indicates better health. CONCLUSIONS Self-injection of prostaglandin E1 improves sexual satisfaction and quality of life in men with erectile dysfunction.

Combining Intracavernous Injection and External Vacuum as Treatment for Erectile Dysfunction

We studied the effect of combining intracavernous injection and an external vacuum in 10 men with erectile dysfunction who previously failed attempts at treatment with either method as single therapy. We measured the length, circumference and buckling pressure of the penis at baseline, after applying negative pressure (250 mm. Hg for 2 minutes), 15 minutes after intracavernous injection of 60 mg. papaverine or 30 micrograms prostaglandin E1 and after combining both modalities. No patient achieved adequate rigidity (defined as a penile buckle pressure greater than 450 gm.) with single therapy. The mean buckle pressure using vacuum alone was 125.0 +/- 53.6 gm. After intracavernous injection the mean buckle pressure was 117.0 +/- 38.3 gm. In contrast, all 10 subjects responded to combination therapy with a mean buckle pressure of 565.0 +/- 56.8 gm. (p < 0.0001). After 10 months of followup 3 subjects were still using the combination and were satisfied with the erectile response, 1 found that he no longer needed the addition of external vacuum after using combination therapy for 3 months, 1 used the combination for 9 months and then stopped because of an intervening acute illness, 1 lost the partner due to death, 2 found combination therapy to be too cumbersome and 2 were lost to followup. We conclude that external vacuum devices can augment a partial response to intracavernous injection and the combination may be an alternative treatment before intrapenile prosthesis implantation.

Treatment of Erectile Failure with Prostaglandin E1: A Double-Blind, Placebo-Controlled, Dose-Response Study

We report a double-blind, randomized, placebo-controlled, dose-response study of prostaglandin E1 as treatment for erectile failure. A total of 15 men 55.8 +/- 9.2 years old with a mean duration of erectile dysfunction of 7.6 years participated. During phase 1 (double-blind) subjects received injections of prostaglandin E1 twice weekly at doses of 0 micrograms. (placebo), 2.5 micrograms., 5.0 micrograms., 7.5 micrograms. and 10 micrograms. During phase 2 (nonblind) the dose was increased until a full erection or intolerance developed. Response was measured using a RigiScan monitor. During phase 3 the subjects injected prostaglandin E1 at home. Of the subjects 66% achieved an erection adequate for intercourse, with an average rigidity of 59%. The dose-response curve reached a plateau at 5 to 10 micrograms. Among those responding to prostaglandin E1 intercourse was rated satisfactory by 81% of the subjects and by 90% of the partners. There were no prolonged erections requiring reversal and pain was reported with only 10% of the injections. In summary, intracavernous prostaglandin E1 is an efficacious and effective treatment for erectile failure.

Oncogenic osteomalacia associated with metastatic prostate carcinoma : case report and review of the literature

umor-induced osteomalacia is a disorder of mineralization caused by neoplasm-induced phosT phaturia. Laboratory features include low serum 1,25(OH)’D, hypophosphatemia, and phosphaturia. Although almost exclusively associated with mesenchymal tumors, an association between prostate cancer and osteomalacia has been described in at least six subjects.’,’ These six subjects together with the subject of this report, the oldest reported case, represent approximately 10% of all cases.

Alkalization Does Not Alleviate Penile Pain Induced By Intracavernous Injection of Prostaglandin E1

PURPOSE A prospective, randomized, double-blind study was done to determine whether alkalization of prostaglandin E1 decreases pain associated with intracavernous injection. MATERIALS AND METHODS Ten subjects with a history of pain following at least 70% of injections of prostaglandin E1 received 2 injections of prostaglandin E1, 1 with and 1 without sodium bicarbonate. Patients reported the duration and intensity of pain following each injection. RESULTS Comparing injections of prostaglandin E1 with and without bicarbonate, there were no significant differences in number of subjects reporting pain, or duration and intensity of pain. CONCLUSIONS Addition of sodium bicarbonate does not alleviate penile pain associated with injection of prostaglandin E1.

Management of erectile dysfunction by the geriatrician

Erectile dysfunction (ED) is the most common health disorder to afflict elderly men. Although 67% of men aged 70 years have ED, and their interest in sexual intercourse remains high, less than 5% receive adequate treatment. In this report, we review recent developments in our understanding of the pathophysiology of ED, how geriatricians can perform an office‐based evaluation, and rational (evidence‐based) treatment of this important disorder.

Slow injection of prostaglandin E1 decreases associated penile pain

OBJECTIVES A randomized, double-blind study to determine whether speed of intracavernous injection of prostaglandin E1 (PGE1) is associated with pain. METHODS On two separate occasions, using two different speeds of injection (5 versus 60 seconds), 11 subjects received the same dose of PGE1 that they used at home. The presence, duration, and intensity of pain were recorded. RESULTS We found that fast penile injection of PGE1 was associated with a greater intensity of pain (P = 0.04). CONCLUSIONS Slow injection of PGE1 is less often associated with penile pain, the most common adverse effect of this treatment.

Long-term Efficacy of a New Formulation of Prostaglandin E1 as Treatment for Erectile Failure

PURPOSE We determined the long-term efficacy of intracavernous injection of a new formulation of prostaglandin E1 (Caverject) as treatment for erectile failure. MATERIALS AND METHODS A prospective study was done at a university affiliated Veterans Affairs medical center. Subjects with erectile failure received injections of prostaglandin E1 at the office and self-administered injections at home for up to 18 months. RESULTS Of 16 patients who performed home injections 15 completed 6 months and 10 completed 18 months of therapy. Patient and spousal satisfaction with intercourse was 90% for months 1 to 6, and patient satisfaction was 95% for months 7 to 18. CONCLUSIONS Prostaglandin E1 was highly effective at producing penile rigidity and an erection with satisfactory vaginal intercourse.

Incidence of Penile Pain After Injection of a New Formulation of Prostaglandin E1

PURPOSE We determined the incidence of pain with injection of a new formulation of prostaglandin E1. MATERIALS AND METHODS A total of 63 subjects with erectile dysfunction underwent treatment with the new formulation of prostaglandin E1. Evidence of pain associated with injection was obtained by questionnaire and through questioning. RESULTS A total of 451 injections was given to 63 subjects in the office, with 16 episodes (3.5%) of pain in 10 (15.9%). Then, 680 injections were performed by 38 subjects at home, with 15 episodes (2.2%) of pain in 8 (21%). Pain was not dose related. CONCLUSIONS The new formulation of prostaglandin E1 is less likely to be associated with pain compared with alcohol based formulations.