Intracavernosal Injection and Intraurethral Therapy for Erectile Dysfunction

Leungwattanakij, Somboon; Flynn, Vincent J.

doi:10.1016/s0094-0143(05)70143-9

Cited by 46 publications

(30 citation statements)

References 57 publications

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“…Padma-Nathan and colleagues 59 reported a response rate of 65.9%. Fulgham and associates 60 noted improvement in 30% of patients; however, this study has been criticized for inadequate dose titration. 61 The most common side effect of intraurethral alprostadil therapy is local penile pain caused by drug-mediated sensitization of nerve fibres.…”

Section: Alternative Treatmentsmentioning

confidence: 73%

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Erectile dysfunction: management update

Fazio

Brock²

2004

Canadian Medical Association Journal

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E rectile dysfunction can be defined as the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. 1 In the face of an aging population, decreasing social stigma associated with erectile dysfunction and an increasing availability of effective oral therapy for its treatment, the number of patients presenting with this complaint has increased dramatically. Current estimates describe 2-3 million Canadian men as having significant recurring erectile difficulties. Recent reports identifying a dramatic increase in rates of diabetes, increased longevity and higher quality-of-life expectations by "baby boomers" are all believed to be factors in a projected continued expansion of the patient population requesting medical help with sexual issues in the near future.2,3 Although historically erectile dysfunction was a problem identified and treated by urologists, today primary care physicians and other specialists write 80% of the prescriptions for sildenafil, the most popular drug used to treat the condition. 4 In this article, we review the epidemiology of erectile dysfunction, the current understanding of its pathophysiology and the evidence for the efficacy of oral therapy with phosphodiesterase type-5 inhibitors, which has become the first-line treatment of erectile dysfunction. Epidemiology of erectile dysfunctionThe Massachusetts Male Aging Study surveyed 1709 men aged 40-70 years in the greater Boston area between 1987 and 1989 and reported a prevalence of erectile dysfunction of 52%, with 9.6% of respondents reporting complete erectile dysfunction. 5 In 2000 the overall prevalence of erectile dysfunction in this study population was reestimated to be 44%. 6 The Massachusetts study is important because it is the first cross-sectional, communitybased, random-sample multidisciplinary survey on the topic and involved a significant cohort followed up for nearly a decade beyond the initial assessment. A survey of 3009 men aged 18-70 years from all regions of Canada revealed a similar prevalence of erectile dysfunction. 7 Physiology of an erectionErection involves the integration of neural and vascular functions. In essence, an erection occurs when blood flow to the penis exceeds flow out of the penis. The cavernosal arteries supply blood to the corpora cavernosa of the penis (through the pudendal artery); the emissary veins running through the tunica albuginea allow drainage. During erection, relaxation of trabecular smooth muscle results in increased blood flow to the corpora cavernosa and expansion of the sinusoids therein. This distension causes mechanical compression of the emissary veins, which impedes their ability to drain blood and thereby results in penile rigidity 8 (Fig. 1).Penile blood flow is controlled by the autonomic erection centre, which provides parasympathetic (S 2 -S 4 ) and sympathetic (T 12 -L 2 ) input to the pelvic plexus, 8 including the cavernous nerves that innervate the cavernosal arteries and trabecular smooth muscle. These nerves are responsible f...

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Section: Alternative Treatmentsmentioning

confidence: 73%

“…61 The most common side effect of intraurethral alprostadil therapy is local penile pain caused by drug-mediated sensitization of nerve fibres. 60 Vasoactive drugs may also be injected intracavernosally. Such therapy represents an important second-line therapy for erectile dysfunction.…”

Section: Alternative Treatmentsmentioning

confidence: 99%

Erectile dysfunction: management update

Fazio

Brock²

2004

Canadian Medical Association Journal

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“…25 It is thought to be of most benefit in men whose ED has a neurogenic aetiology. Some men are unable to tolerate penile injections and compliance can be a problem if adequate support is not made available, with 50 per cent stopping after the first two to three months.…”

Section: Intracavernous Injectionmentioning

confidence: 99%

Management of erectile dysfunction in men treated with androgen deprivation therapy

Wilson

Atkinson

Hughes

2013

Trends Urol & Men's Health

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A 55-year-old man presented to his GP with worsening pain in his left hip. The pain was present during the night as well as in the day. A plain radiograph of the hip demonstrated a sclerotic lesion suspicious of a metastatic deposit. Subsequent investigations revealed a prostate-specific antigen (PSA) of 200ng/ml. Similarly, sclerotic lesions were noted in the right hip and ischium. Prostatic biopsies confirmed Gleason 4+3 adenocarcinoma of the prostate and he was entered into the STAMPEDE trial. He was randomised to receive luteinising hormone-releasing hormone agonist therapy alone, so was commenced on goserelin injections. Bicalutamide was given at the beginning of therapy to prevent tumour flare. Six months later, his PSA had fallen to 0.6ng/ml with a serum testosterone <0.4ng/dl. During a clinic appointment he complained of loss of libido and difficulty maintaining erections adequate for sexual intercourse. He was commenced on tadalafil (Cialis) tablets twice a week as first-line treatment. THE CASEE rectile dysfunction (ED) is the persistent inability to attain and maintain a penile erection satisfactory for sexual intercourse. ED is increasingly common with advancing age, but is even more pronounced in men with prostate cancer who receive androgen deprivation therapy (ADT). Reported rates of impotence in this group range from 50 to 100 per cent.The aetiology of ED in men with prostate cancer is often mixed. Vascular and/or neurological damage at prostatectomy or following radical radiotherapy explains some of the incidence, but even without these treatments, such as in this case, erectile problems are common. Hormonal, neurological, vascular and psychological factors contribute to a greater or lesser degree in different individuals. EFFECTS OF ANDROGEN DEPLETIONAndrogen deprivation therapy, by definition, causes sustained suppression of serum In this series, the authors present cases of men being treated with androgen deprivation therapy, and highlight their management to prevent and treat associated toxicities. This second article will consider the management of erectile dysfunction.

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“…Approved second-line therapies include vacuum-constriction devices, 2 along with intracavernous and intraurethral administration of alprostadil. 3,4 Transcutaneous medications 5 and new oral medications [6][7][8] are under active investigation. Arterial 9,10 and/or venous 11,12 procedures are available for highly selected individuals.…”

Section: Introductionmentioning

confidence: 99%

Inflatable penile prosthesis: site-specific malfunction analysis

Garber

2003

Int J Impot Res

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The purpose of this study was to analyze retrospectively the exact site(s) of device failure of a large series of Mentor Alpha I inflatable penile prostheses. The study consisted of 442 patients implanted over a 12-year period. Only those patients who developed a device malfunction and returned for re-evaluation by the author were included. The exact site(s) of device malfunction were obtained from a review of operative reports. The average length of follow-up in this series was 63 months, ranging from 1 to 138 months. In all, 22 (4.98%) patients developed device malfunction and returned for evaluation, including six (3.9%) of the 154 infrapubic devices and 16 (5.6%) of the 288 scrotal devices. Of these 22 patients, three declined revision and 19 were reoperated on by the author. The exact site of malfunction differed in the infrapubic vs scrotal implants. Most malfunctions of the scrotal device involved tubing fractures at the pump strain reliefs, whereas infrapubic device malfunctions typically involved the cylinders or the reservoir. A review of these malfunction patterns may assist the manufacturer in further improving the reliability of this prosthesis, and may assist implanting surgeons in planning operative procedures.

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Intracavernosal Injection and Intraurethral Therapy for Erectile Dysfunction

Cited by 46 publications

References 57 publications

Erectile dysfunction: management update

Erectile dysfunction: management update

Management of erectile dysfunction in men treated with androgen deprivation therapy

Inflatable penile prosthesis: site-specific malfunction analysis

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