EARLY USE OF TRANSURETHRAL ALPROSTADIL (MUSE) FOLLOWING RADICAL PROSTATECTOMY POTENTIALLY FACILITATES EARLIER RETURN OF ERECTILE FUNCTION AND SUCCESSFUL SEXUAL ACTIVITY

Rupesh Raina*, kalyana C Nandipati*, Ashok Agarwal*, Craig D Zippe*
Cleve;and Clinic Foundation, Cleveland, OH

Introduction:
To assess whether early introduction of Medicated Urethral System for Erection (MUSE) following radical prostatectomy (RP) results in a shorter recovery time with respect to return of functional erections and successful sexual activity.
Methods:
In this prospective study of 91 sexually active men who underwent a nerve-sparing RP for prostate cancer. Fifty-six subjects were treated with MUSE (125 or 250 µg, 3/ wks/ 6 mo; starting ~ 3 weeks after surgery) while the remaining 35 patients (control group) did not receive any erectogenic aids except when attempting sexual activity. Treatment efficacy was analyzed with Sexual Health Inventory for Men (SHIM) questionnaire.
Results:
In MUSE group (mean age-59 yrs) after a median follow-up of 6 months, 68% (38/56) continued the treatment and 32% (18/56) discontinued the treatment (9 due to lack of efficacy, 5- reduced sexual interest and 4- urethral burning/bleeding). Patients reported significant improvement in all domains of the SHIM questionnaire after MUSE use. At 6 months, 74% (28/38) of the patients who remained on MUSE were able to have successful vaginal intercourse. Of those patients who were able to have intercourse, 75% (21/28) reported recovery of spontaneous erections with the mean SHIM score of 18.9. In the control group, 37% regained erections sufficient for vaginal intercourse (mean SHIM score of 15.8). However, 71% were dissatisfied with the quality of their erections and using adjuvant erectaid therapy.
Conclusions:
Initiation of MUSE shortly after RP is safe and tolerable and appears to shorten the recovery time of the resultant ED.

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