The aim of this study was to evaluate the glans penile response to Alprostadil cream in patients with a well-functioning penile prosthesis (malleable or three-piece inflatable) who presented symptoms consistent with cold glans syndrome.

The study was conducted on patients with penile prostheses implanted at our center between 2000 and 2022. The initial number of patients was 76. They were contacted by phone, and 47 of them who regularly used the device were selected.

Patients were interviewed to identify those who were dissatisfied with the prosthesis despite its proper functioning, based on their subjective perception of glans sensitivity and tumescence during sexual intercourse. This was assessed on a scale from 1 to 10. Patients with a score lower than 5 in both categories were selected. Additionally, they completed the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire to evaluate satisfaction with the prosthesis, rated on a percentage scale from 0 to 100%. Those with a score below 60% on the questionnaire were selected. 18 patients met both criteria and were included in the study.

The treatment regimen included 3 mg/g of Alprostadil cream (Virirec®) to be applied 45 minutes before activating the prosthesis and initiating sexual intercourse. After using the medication for at least three occasions, patients were re-interviewed regarding their symptoms and completed the questionnaire EDITS again.

All patients adhered to the treatment appropriately. The average glans sensitivity score was 3.7 before treatment and 6.4 after treatment. Regarding glans tumescence, the score was 3 before the drug was used and 5.7 afterward. In relation to the EDITS questionnaire, the satisfaction with treatment using the penile prosthesis alone in the selected patients was 52.8%, reaching 66.3% after adding Alprostadil cream. As an adverse effect, 5 of the 18 patients reported mild itching or pain in the glans. Of the total, 9 patients requested to extend the treatment.

Topical Alprostadil cream may be an option for patients who report issues with glans response during the use of a penile prosthesis. It appears to increase sensitivity and tumescence of the glans during sexual intercourse. Furthermore, when combined with the prosthesis, it improves the overall satisfaction rate with the treatment, with few adverse effects reported.

Topical Alprostadil cream may be effective in enhancing the functional outcomes of penile prostheses in patients with cold glans syndrome and appears to boost satisfaction  during sexual intercourse.