Titre du document / Document title

Apomorphine sublingual as primary or secondary treatment for erectile dysfunction in patients with spinal cord injury

Auteur(s) / Author(s)

STREBEL R. T. ^{(1 2)} ; REITZ A. ⁽¹⁾ ; TENTI G. ^{(1 2)} ; CURT A. ⁽¹⁾ ; HAURI D. ⁽²⁾ ; SCHURCH B. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Swiss Paraplegic Centre, University Hospital Balgrist, Zurich, SUISSE
⁽²⁾ Department of Urology University Hospital, Zurich, SUISSE

Résumé / Abstract

OBJECTIVES To evaluate the effectiveness ofapomorphine sublingual (SL) 3 mg, as a primary or secondary treatment for erectile dysfunction (ED) in patients with spinal cord injury (SCI), and to determine possible differences in efficacy considering clinical, urodynamic and neurophysiological findings. PATIENTS AND METHODS The study included 22 patients with chronic SCI and neurogenic ED who were examined physically and by a video-urodynamic evaluation. A neurophysiological evaluation included somatosensory evoked potentials of the pudendal nerve, palmar and plantar sympathetic skin responses and bulbocavernous reflex recordings. Thereafter the patients received 8 tablets of apomorphine SL 3 mg and were asked to complete the International Index of Erectile Function questionnaire before and after treatment. Side-effects, subjective efficacy compared with other treatments and satisfaction with the SL administration were recorded. RESULTS Of the 22 men, 11 had upper motor neurone lesions (six complete, five incomplete), eight lower motor neurone lesions (seven complete, one incomplete) and three had mixed lesions. In all, 12 patients took sildenafil citrate and five alprostadil intracavernosally beforehand, and five had used nothing to treat their ED. Seven patients had some response and reported that the drug helped them to obtain an erection, but only two reported erections sufficient for intercourse and would agree to continue apomorphine SL as their standard treatment; all the others reported being disappointed. Nine patients reported side-effects. There were no significant correlations for electrophysiological or urodynamic findings and treatment success. Of the 22 patients 20 preferred SL rather than the normal administration. CONCLUSIONS Apomorphine SL, a D1/D2 dopamine agonist, facilitates erectile function in a heterogeneous group of patients with no significant relationship with any of the assessed urodynamic or electrophysiological variables. The overall low rates of response either for primary or secondary treatment suggests that apomorphine will have limited applicability in patients with SCI.

Revue / Journal Title

BJU international   ISSN 1464-4096 

Source / Source

2004, vol. 93, n^o1, pp. 100-104 [5 page(s) (article)] (25 ref.)

Langue / Language

Anglais

Editeur / Publisher

Blackwell, Oxford, ROYAUME-UNI  (1999) (Revue)

Mots-clés anglais / English Keywords

Nervous system diseases ; Central nervous system disease ; Spinal cord disease ; Male genital diseases ; Second line treatment ; First line treatment ; Human ; Treatment ; Spinal cord ; Lesion ; Dopamine agonist ; Catecholamine ; Dopamine ; Agonist ; Chemotherapy ; Sublingual administration ; Erection disorders ;

Mots-clés français / French Keywords

Système nerveux pathologie ; Système nerveux central pathologie ; Moelle épinière pathologie ; Appareil génital mâle pathologie ; Traitement deuxième intention ; Traitement première intention ; Homme ; Traitement ; Moelle épinière ; Lésion ; Stimulant dopaminergique ; Catécholamine ; Dopamine ; Agoniste ; Apomorphine ; Chimiothérapie ; Voie sublinguale ; Erection pathologie ;

Mots-clés espagnols / Spanish Keywords

Sistema nervioso patología ; Sistema nervosio central patología ; Médula espinal patología ; Aparato genital macho patología ; Nefrología ; Hombre ; Tratamiento ; Médula espinal ; Lesión ; Estimulante dopaminérgico ; Catecolamina ; Dopamina ; Agonista ; Quimioterapia ; Vía sublingual ; Erección patología ;

Mots-clés d'auteur / Author Keywords

receptors ; dopamine D2 ; apomorphine ; erectile dysfunction ; spinal cord injury ;

Localisation / Location

INIST-CNRS, Cote INIST : 1050, 35400011695534.0250