Drop-out reasons and complications in self-injection therapy with a triple vasoactive drug mixture in sexual erectile dysfunction

Casabé, A.; Bechara, Amado; Chéliz, G.; Romano, Salomón Víctor; Rey, Horacio Manuel; Fredotovich, N.

doi:10.1038/sj.ijir.3900307

Cited by 16 publications

(9 citation statements)

References 14 publications

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“…As demonstrated in this and other studies, 12,13,23,24 some attrition (21%) occurred for a positive reason, namely elimination of the erectile dysfunction through recovery of spontaneous erections. These ex-users reported a high degree of satisfaction.…”

Section: Discussionmentioning

confidence: 71%

Intracavernosal self-injection therapy in men with erectile dysfunction: Satisfaction and attrition in 119 patients

et al. 1999

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This study describes a 12 ± 24 month follow-up on 119 ED patients in an attempt to understand satisfaction with and dropout from ICI use. Results indicate 40% attrition, attributed primarily to a lack of ef®cacy of ICI, but also to spontaneous return of erectile function and to negative reactions surrounding the injection procedure. Multivariate analyses indicated that ICI dropouts were more likely to have co-existing premature ejaculation, low responses during psychophysiological screening, a lack of spontaneous erections prior to ICI, and an etiology that included an organogenic component. These same factors, along with low satisfaction with their sex life, were related to attrition due speci®cally to a lack of drug ef®cacy. In contrast, attrition due to recovery of spontaneous erections was associated with high sexual satisfaction. Among ongoing users, dissatisfaction was associated with higher age, shorter erections during ICI use, and low satisfaction with sex life. These ®ndings identify a number of factors related to attrition and satisfaction, emphasizing the importance of specifying the cause for ICI attrition and, demonstrating that a substantial portion of patients who dropout do so for positive reasons.

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Section: Discussionmentioning

confidence: 71%

Intracavernosal self-injection therapy in men with erectile dysfunction: Satisfaction and attrition in 119 patients

et al. 1999

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“…Its advantages include its high degree of efficacy, its reproducibility, its speed of onset, and duration of erection. Despite this, dropout rates are significant with estimates of 30-80% of men dropping out by 2-5 years after commencing treatment [3,5,10,14,20]. While dropout rates are significant, it has been our clinical experience that men who continue ICI have a high level of satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Satisfaction Profiles in Men Using Intracavernosal Injection Therapy

Hsiao

Bennett

Guhring

et al. 2011

The Journal of Sexual Medicine

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Introduction Intracavernosal injection therapy (ICI) is a well-established second-line therapy used in the treatment of erectile dysfunction (ED). Controversy exists as to whether oral phosphodiesterase type 5 inhibitors (PDE5i) or injection therapy lead to higher satisfaction. Aim This study addressed ICI satisfaction in a modern cohort of patients in the PDE5i era. Methods Patients on ICI for at least 6 months were included in our study. Patients were administered the International Index of Erectile Function (IIEF) at the initial visit. On subsequent visits, patients were administered the IIEF and the Erection Hardness Scale (EHS). Main Outcome Measures Study end points were change in baseline scores in the satisfaction domains (SD) of the IIEF, type of injection medication used, and predictors of satisfaction. Multiple logistic regressions were performed for predictors of satisfaction. Results One hundred twenty-two patients met inclusion criterion. Mean time to follow-up was 25 ± 12 months (range 6–106 months). Sixty-five percent of patients continued injections at the time of follow-up. When SD scores were examined, intercourse SD scores increased from 4.8 ± 1.7 at baseline to 12.3 ± 3.1 (P < 0.01); overall SD scores increased from 4.1 ± 1.8 to 7.2 ± 2.0 (P < 0.05). On multivariate analysis, predictors of satisfaction included older age (odds ratio [OR] = 2.1), younger partner age (OR = 2.5), clinically significant increase in the erectile function domain score (OR = 3.1), and attainment of a “fully rigid” erection (EHS 4) (OR = 6.8). Conclusions We have evaluated satisfaction in a modern cohort of ICI patients. While dropout rates are significant, for those patients who continue to inject, we have found high levels of satisfaction using the IIEF, the gold standard for evaluation of erectile function. On multivariate analysis, we found that older age, younger partner age, and fully rigid erections were predictors of increased satisfaction. ICI remains a robust second-line therapy in the treatment of ED even in the era of PDE5i.

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“…20 The incidence of priapism for Tx varies between 0 and 3.7%. 7,12,21 This variability in incidence is expected because of the different doses of papaverine used and different definitions for priapism. With Tx, our study showed that the overall incidence of priapism is 5%, which is significantly higher than PgE 1 .…”

Section: Discussionmentioning

confidence: 99%

A prospective randomized study to optimize the dosage of trimix ingredients and compare its efficacy and safety with prostaglandin E1

et al. 2005

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Intracavernous injection of Trimix (Tx) is indicated for patients unsuitable for prostaglandin E 1 (PgE 1 ) injection due to lack of response, pain or cost. We believe that the ideal ratio of ingredient doses in Tx is yet to be found. We postulated that increasing the doses of individual drug components in an orderly manner would convey important data on penile hemodynamic response. Such information is needed to choose an effective and less costly alternative to PgE 1 with least side effects. We set out to evaluate the impact of varying the ingredient dosage on response and shortterm safety of Tx compared with PgE 1 . We prospectively randomized 180 consecutive patients with erectile dysfunction into nine equal groups and each group received a different dose of Tx, namely phentolamine (1 mg) plus one dose of PgE 1 (2.5, 5 or 10 lg) and one dose of papaverine (5, 10 or 20 mg). Each patient was injected with 20 lg PgE 1 and one dose of Tx in two clinic visits 1 week apart. Following injection, duplex ultrasound of cavernous arteries and axial rigidometry were carried out. Patients ranked the quality of erection, estimated overall satisfaction and reported time to detumescence and side effects. Patients' mean age was 50.5711.7 y with underlying organic condition in 91.1%. There were no significant differences between PgE 1 and Tx with regard to peak cavernous artery flow, time to erection, patients' satisfaction, average axial rigidity and pain. PgE 1 produced higher end diastolic velocity, shorter duration of erection and less priapism. Patients did not show a preference for either drug or any particular dosage. We conclude that even at the smallest dose of ingredients of Tx, there are no significant differences in hemodynamic effects, rigidity, pain and self-satisfaction between the two drugs. However, Tx produces a longer duration of erection and more priapism than PgE 1 .

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Drop-out reasons and complications in self-injection therapy with a triple vasoactive drug mixture in sexual erectile dysfunction

Cited by 16 publications

References 14 publications

Intracavernosal self-injection therapy in men with erectile dysfunction: Satisfaction and attrition in 119 patients

Intracavernosal self-injection therapy in men with erectile dysfunction: Satisfaction and attrition in 119 patients

Satisfaction Profiles in Men Using Intracavernosal Injection Therapy

A prospective randomized study to optimize the dosage of trimix ingredients and compare its efficacy and safety with prostaglandin E1

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