Prostaglandin E1 and the Nitric Oxide Donor Linsidomine for Erectile Failure: A Diagnostic Comparative Study of 40 Patients

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Abstract
A total of 40 patients (average age 55.9 years, range 23 to 78 years) with erectile failure was enrolled in a study to compare 1 mg. of the nitric oxide donor linsidomine to 20 micrograms prostaglandin E1 administered for diagnostic purposes. Prostaglandin E1 was considered comparable to linsidomine by 10% of the patients, slightly superior by 15%, moderately superior by 20% and much superior by 55%. No patient rated linsidomine superior to prostaglandin E1. Objective evaluation of erectile response to linsidomine versus prostaglandin E1 by the investigator revealed no response in 7.5% versus 0% of the cases, tumescence in 57.5% versus 17.5%, semirigid erection in 22.5% versus 17.5% and full erection in 12.5% versus 65%, respectively. Duplex sonography after linsidomine and prostaglandin E1 with evaluation of peak flow velocities (centimeters per second) showed that the increase in peak flow velocity after linsidomine was at least a third less than the increase after prostaglandin E1. The appearance after linsidomine often resembled arterial insufficiency, whereas after prostaglandin E1 there was no evidence of arterial insufficiency. The erectile and hemodynamic response to the nitric oxide donor linsidomine was modest compared to that of prostaglandin E1. Therefore, linsidomine is not a genuine alternative to prostaglandin E1 for the diagnosis and treatment of male impotence.