Self Injection therapy and transurethral therapy

Phase 5 of the POC guidelines recommends the second-line treatments of self-injection therapy and transurethral therapy. Of the three medications commonly used for self-injection therapy (papaverine hydrochloride, phentolamine, and prostaglandin E -,), only prostaglandin E-, has received the United States Food and Drugs Administration approval for this indication. The two commercial preparations of prostaglandin E used most frequently by the majority of clinicians are Edex™ (Schwarz Pharma) and Caverjet™ (Pharmacia-Upjohn).

Transurethral therapy allows prostaglandin E to be applied directly to the urethral mucosa through an innovative, drug-delivery system developed by the Vivus Corporation. Known as MUSE™ (medicated urethral system for erection), a pellet of prostaglandin E is placed on to the urethral mucosa and transferred to the corpora cavernosum through vascular channels resulting in an erection. The major advantage of this treatment method is that it obviates the need to inject the penis.

Only one intervention, the implantation of a penile prosthesis, comprises phase 6 of the POC model and is viewed as a third-line treatment for erectile dysfunction. Details about this intervention are also beyond the scope of this chapter.

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