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Midodrine, un traitement oral des érections prolongées induites par injection intracaverneuse de substances vasoactives chez le blessé médullaire

Oral midodrine in the treatment of prostaglandin E1-induced priapism in spinal cord injured patients

  • Article Original / Original Article
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Pelvi-périnéologie

Résumé

Introduction

Les blessés médullaires ont un dysfonctionnement érectile. Le rétablissement de l’érection nécessite habituellement un traitement pharmacologique. Les injections intracaverneuses (IIC) de substances vasoactives peuvent induire une érection prolongée pour un priapisme. Le traitement recommandé des priapismes est une ponction du corps caverneux et/ou une IIC de substance alphamimétique. Nous proposons un traitement des érections prolongées et des priapismes par midodrine per os (alphamimétique).

Matériel et méthodes

Notre étude concerne 354 blessés médullaires présentant un dysfonctionnement érectile et traités par IIC de substances vasoactives (prostaglandine et/ou Papavérine®). Quatorze blessés médullaires ont présenté un priapisme traité par midodrine per os. Une évaluation de la détumescence et une surveillance de la tension et du pouls ont été réalisées pour tous les patients.

Résultats

Pour les 14 patients, le traitement a entraîné une détumescence 30 à 45 minutes après la prise de 15 mg de midodrine per os, sans effet secondaire gênant.

Discussion

Le traitement des dysfonctionnements érectiles du blessé médullaire par IIC de substances vasoactives a considérablement augmenté l’incidence des érections prolongées et des priapismes. Le traitement recommandé des priapismes consiste à réaliser une ponction des corps caverneux et/ou une injection de substance alphamimétique intracaverneuse. Ces traitements sont efficaces, mais peuvent entraîner des troubles de l’érection définitifs. Les traitements per os des priapismes ne sont pas recommandés. Le traitement par midodrine per os des priapismes induits par IIC de substances vasoactives chez le blessé médullaire est efficace, non invasif et n’entraîne pas d’effet secondaire gênant.

Conclusion

La midodrine per os est un nouveau traitement efficace non invasif des érections prolongées et des priapismes induits par IIC de substances vasoactives chez le blessé médullaire. Il pourrait être proposé comme traitement de première intention des priapismes ischémiques.

Abstract

Introduction

Erectile dysfunction is a frequent finding in spinal cord injured patients, and is effectively managed with pharmacological treatments in most cases. Intracavernosal injection (ICI) of prostaglandins (PGE1), which is considered first- or second-line treatment, can induce prolonged erection or priapism. An invasive therapy, cavernosous blood aspiration and intracavernosal irrigation of alphamimetic drugs, is recommended in such cases.We propose to evaluate midodrine as an oral treatment for pharmacologicalinduced priapism in spinal cord injured patients.

Materials and methods

From 2004 to 2007, 354 spinal cord injured patients were treated with ICI of PGE1 to induce erection. A prolonged erection or priapism happened in 14 cases. High blood pressure and bradycardia (autonomic dysreflexia) were noticed in two tetraplegic patients. Except for two patients, oral midodrine was used as the only therapeutic approach to this event, because of its alphastimulant properties.

Results

All patients returned to the flaccid penile state within 30 to 45 minutes after administration of midodrine. Oral midodrine was well tolerated with few side effects, without increasing the incidence of autonomic dysreflexia. At six months, a complete erection could be again induced with ICI in all treated patients.

Conclusion

Midodrine administered orally is a simple and efficient treatment for priapism induced by ICI of PGE1. It could be the first-line therapeutic approach before more aggressive procedures.

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Authors and Affiliations

  1. Laboratoire d’urodynamique et de sexologie, centre Docteur-Bouffard-vercelli, Cap Peyrefite, F-66290, Cerbere, France

    J. -M. Soler

  2. Département médullaire, Fondation Hopale, centre Calvé, esplanade Parmentier, F-62608, Berck-sur-Mer cedex, France

    J. -G. Prévinaire

  3. Centre de stérilité masculine, hôpital Paule-de-Viguier, TSA 70034, F-31059, Toulouse cedex, France

    R. Mieusset

  4. Service d’urologie, CHU de Toulouse, F-31509, Toulouse, cedex 09, France

    P. Plante

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  1. J. -M. Soler
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  2. J. -G. Prévinaire
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  3. R. Mieusset
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  4. P. Plante
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Correspondence to J. -M. Soler.

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Public/Intérêt: Chercheurs/Élevé. Cliniciens/Majeur. Enseignants/Élevé. Étudiants/Élevé. Autres professions de santé/Faible. Cadres santé publique/Faible.

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Soler, J.M., Prévinaire, J.G., Mieusset, R. et al. Midodrine, un traitement oral des érections prolongées induites par injection intracaverneuse de substances vasoactives chez le blessé médullaire. Pelv Perineol 6, 97–102 (2011). https://doi.org/10.1007/s11608-010-0345-7

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  • DOI: https://doi.org/10.1007/s11608-010-0345-7

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