Archivio Italiano di Urologia e Andrologia 2017; 89, 2146

SHORT COMMUNICATIONS

Alprostadil plus Vacuum (VITARUM) in severe erectile
dysfunction (ED)

Franco Mantovani

Clinica San Giovanni, Milan, Italy.                

Objectives: Severe erectile dysfunction
(ED) is not uncommon, as can be seen

from the epidemiological literature, and there are several
possible causes, which are not always known, or leastways
evident. Having ascertained the ineffectiveness, intolerance
to or rejection of pharmacological aids,  the option of pros-
thetic surgery remains, but before this, it may be wise when
feasible to use Alprostadil cream in association with
Vacuum device.
Material and methods: 12 patients, aged between 55 and 65
years, with severe erectile dysfunction without palpable
 cavernous fibrosis, were instructed to self-insert into the
 urethral meatus, 3 mg of Alprostadil cream,  sufficient to
make it easy to place the Vacuum device over the penis.
Results: In the cases observed, the preliminary use of
Alprostadil cream fast produced an erection with enough
 rigidity to place the Vacuum. A sufficient erection was
maintained, obviously using an elastic ring at the base of
the penis, to achieve penetration. The reproducibility of the
use of Alprostadil cream with Vacuum device was then 
confirmed at home, to the satisfaction of the patients.

KEY WORDS: Erectile dysfunction; Alprostadil cream; 
Vacuum device.

Submitted 14 April 2017; Accepted 23 April 2017

Summary

No conflict of interest declared.

MATERIALS AND METHODS
Twelve patients aged between 55 and 65 years, with
severe erectile dysfunction scored between 15 and 20 by
the International Index of Erectile Function (IIEF-15)
index and an aetiology falling under the categories men-
tioned above (but excluding palpable cavernosal fibrosis
that was a criterium of exclusion for this treatment) (2),
were instructed to self-insert into their own urethral
meatus, 3 mg of Alprostadil, conveyed in a micro solu-
tion gel with dodecyl dimethylammonium propionate
(Vitaros). 
This patented natural surfactant technology allows for a
rapid absorption of the drug, resulting in a penile turgid-
ity, which is initially modest, but adequate to easily place
the Vacuum device onto the penis avoiding repeated
attempts. The Vacuum device is a tool of the andrological
therapeutic armamentarium for many years.

RESULTS
In the cases observed, the preliminary turgidity obtained
with Alprostadil cream (Vitaros) was soon followed by an
erection produced by the Vacuum. A sufficient rigidity for
penetration was maintained by using an elastic ring at
the base of the penis. 
This arose in a very brief time span, in the absence of any
physical discomfort due to the suction, and did not
require any persistent mechanical manoeuvres to
enhance rigidity, even starting with a completely flaccid
penis. 
The reproducibility of the use of Alprostadil cream in
association with Vacuum was then confirmed at home, to
the satisfaction of the patients (3).

DISCUSSION
In severe ED, the simple use of a Vacuum device alone can
lead to discomfort, not only physically, but also due to
the continuous repeated mechanical manoeuvres needed
to produce rigidity, when starting from a completely flac-
cid penis. 
The preliminary insertion of Alprostadil cream in the ure-
thra prepares the penis, to fit, quickly and safely, to the
Vacuum, thanks to adequate tumescence being produced.

DOI: 10.4081/aiua.2017.2.146

INTRODUCTION
Severe erectile dysfunction (ED) is such a relentless
health care problem that often causes an agonising ordeal
to the patient and constitutes a challenge for the dedi-
cated specialist who has to deal with it in daily practice.
It is well-known that this condition is anything but rare,
as is documented in the epidemiological literature, and
that there are several causes, although not always well
known or even clarifiable (1).
In addition to adverse outcomes of radical pelvic surgery,
these include excessive smoking, vasculopathies due to
uncompensated diabetes, and even undiagnosed psy-
choses. Having ascertained the ineffectiveness, intoler-
ance or rejection of pharmacological treatments, pros-
thetic surgery remains an option, but it may be wise and
certainly feasible, to try the use of Alprostadil cream in
association with Vacuum device (VITARUM) first.

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147Archivio Italiano di Urologia e Andrologia 2017; 89, 2

Alprostadil and Vacuum

CONCLUSIONS
When left to choose between the possible inadequacy of
pharmacologic treatment and the prospect of a surgical
prosthesis, treatment with Alprostadil cream in associa-
tion with Vacuum (VITARUM) may constitute an accept-
able bridging treatment, which is feasible with a
favourable cost/benefit ratio, on the arduous pathway of
treating severe erectile dysfunction, where palpable cav-
ernous fibrosis is absent.

REFERENCES
1. Serefoglu EC, Saitz TR, Douglas LM, et al. The incidence and
types of sexual dysfunction among prostate cancer patients. J Sex
Med. 2012; 9(suppl 5):303-335.

2. Osorio Cabello L, Martinez Salamanca FI, Egui Rojo A, et al.
Penile morphometric changes after radical prostatectomy: impact of
a rehabilitation program. J Sex Med. 2012; 9(suppl 5):320.

3. Ljunggren C, Stroberg P. A clinical sexologist appears to play an
important role in a penile and sexual rehabilitation program may
improve the outcome of sexual function one year after prostate can-
cer surgery. A prospective interventional study. J Sex Med. 2012;
9(suppl 5):319-320.

Correspondence

Franco Mantovani, MD
mantovanifranco@yahoo.it  
Clinica San Giovanni
Via Civitali 71, Milano, Italy

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