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Diabetes mellitus is a risk factor for many urological complications, with the most frequent one in men, erectile dysfunction, occurring in patients with diabetes three times more often than in men with normal glucose tolerance. Diabetes contributes to erectile dysfunction through endothelial dysfunction, neuropathy, structural and functional dysfunction of cavernous bodies’ smooth muscles and hormonal disorders. Alprostadil is a synthetic form of Prostaglandin E1, which directly affects arterial smooth muscles and causes vasodilatation. Besides being administrated deeply into the urethra and via injections into cavernous bodies, it might be used as a cream, which is rapidly and almost entirely absorbed into corpus spongiosum and cavernous bodies. It might be used as a first-line treatment for patients who have contraindications for PDE5 inhibitors or prefer topical application of the drug and as a second-line treatment in case of intolerance or no response to PDE5i, also for more complicated clinical cases, often occurring in diabetes. Alprostadil is administrated into the external urethral meatus 5–30 minutes before sexual intercourse; a complete erection appears in 10–12 minutes and lasts 1–2 hours. Due to lack of systemic effects, alprostadil in cream is safe and well tolerated, moreover, it does not interact with intake of food and alcohol. The advanced and effective therapy of erectile dysfunctions, which is alprostadil, helps to improve the quality of life in patients with diabetes.

Alprostadil in cream — a new option of treating erectile dysfunctions in diabetic patients