Comparison of a needle-free high-pressure injection system with needle-tipped injection of intracavernosal alprostadil for erectile dysfunction

Abstract

Patients identified from hospital records as using alprostadil injections for erectile dysfunction were invited to take part in this open crossover study. On alternate weeks eight patients were given intracavernosal needle injections and transdermal needle-free injection of alprostadil in a randomized order. Efficacy of injection and associated pain were assessed and compared for the two methods. Pain produced during injection was significantly greater with the needle-free system than with the needle-tipped injection whilst efficacy was significantly less. Bruising was reported in all except one patient following needle-free injection only. Patient ratings of the needle-free injector were significantly lower than ratings for needle-tipped alprostadil delivery and when asked to express a preference, every patient chose the needle-tipped injection over the needle-free device.

Current trends in needle-free jet injection: an update

“…Larger volumes per spurt increase the depth penetration level 36 and also increase pain perception. 37 Gaylarde et al demonstrated that the volume of liquid entering the skin is less than the volume the injector is set to deliver. The discrepancy between the volume set on the injector and the actual volume that penetrates the skin is due to the liquid lost in the splash back during jet injection.…”

Pathophysiological role of the renin–angiotensin system on erectile dysfunction

“…The PDE‐5 inhibitor effect is dependent on NO release by cavernosal nerves; thus, it is not effective unless the neuronal stimulus has been initiated and becomes functional . Patients, who cannot be treated with PDE‐5 inhibitors or find them ineffective, may achieve the erection using intrapenial injection of vasodilators . Alprostadil (Prostaglandin E1, PGE1) is the most common vasodilator used for ED .…”

“…Patients, who cannot be treated with PDE‐5 inhibitors or find them ineffective, may achieve the erection using intrapenial injection of vasodilators . Alprostadil (Prostaglandin E1, PGE1) is the most common vasodilator used for ED . It can be administered by direct injection into the corpus cavernosum with a needle or inserted into the urethra in pellet form through a delivery system .…”

Peak systolic velocity thresholds of cavernosal penile arteries in patients with and without risk factors for arterial erectile deficiency

“…The authors tested pharmacologically naïve patients with no erectile dysfunction and chose a low alprostadil dose because of the increased theoretical risk of prolonged erection/priapism (Patel et al ., ). After injection, the site of the injected alprostadil was gently massaged to avoid hematoma formation at the level of the injection site as much as possible (Harding et al ., ; Patel et al ., ). The standard approach of the authors for the duplex examination was dorsal.…”