Covid 19 induced sildenafil lack efficacy is optimally improved by intra-urethral alprostadil

OBJECTIVES: To find pharmacological options in post-COVID 19 Sildenafil therapy failure in men with before-COVID 19 onset and treated ED, starting from the fact that published studies proves COVID 19 as a risk factor for ED, as well as for Sildenafil loss efficacy in before COVID 19 started ED treatment. METHODS: From prior to 2020 Sildenafil treated ED's we selected 78 ED cases, recently claiming Sildenafil lack efficacy after a COVID 19 episode. According to optional recommendations, 42 cases (gr. A) have chose Avanafil instead to continue the ED therapy, whereas 36 cases (gr. B) preferred intra-urethral Alprostadil. The ED domain of International Index of Erectile Function (ED-IIEF), the erectile hardness score (EHS) and the Sexual Encounter Profile questions 2 (SEP2) and 3 (SEP3) were applied in 4 steps: V1=gr.A1/gr.B1 (first visit, presentation before COVID 19); V2=gr.A2/gr.B2 (second visit, before COVID 19 for Sildenafil benefit assessment); V3 gr.A3/grB3 (third visit, post-COVID 19, medical request for Sildenafil failure); V4=gr.A4/gr.B4 (forth visit, the assessment of the replacing Sildenafil new therapy). RESULTS: ED-IIEF: gr.A1/gr.B1 = 17.32/18.07 (P = 0.22); gr.A2/gr.B2 = 25.33/24.54 (P = 0.15); gr.A3/grB3 = 14.67/14.22 (P = 0.1); gr.A4/gr.B4 = 20.78/26.33 (P = 0.065). EHS: gr.A1/gr.B1 = 1.12/1.7 (P = 0.35); gr.A2/gr.B2 = 3.33/3.54 (P = 0.15); gr.A3/grB3 = 1.67/1.22 (P = 0.5); gr.A4/gr.B4 = 2.4/3.67 (P < 0.05). SEP 2: gr.A1/gr.B1 = 2.2/1.7 (P = 0.3); gr.A2/gr.B2 = 4.53/4.54 (P = 0.9); gr.A3/grB3 = 1.67/1.33 (P = 0.2); gr.A4/gr.B4 = 3.12/4.33 (P < 0.05). SEP 3: gr.A1/gr.B1 = 1.8/2.3 (P = 0.35); gr.A2/gr.B2 = 4.33/4.87 (P = 0.75); gr.A3/grB3 = 1.45/1.54 (P = 0.15); gr.A4/gr.B4 = 3.22/4.66 (P < 0.001). CONCLUSIONS: Sildenafil, as well as other PDE5I's, were already confirmed, as proper for treating ED. However, to correct COVID 19 induced Sildenafil failure, even Avanafil could represent another PDE5I option, the intra-urethral Alprostadil turned out to be a significantly better opportunity. CONFLICTS OF INTEREST: none