Intracavernosal therapy for erectile failure—Impact of treatment and reasons for drop-out and dissatisfaction

Abstract

Objectives: To examine the impact of intracavernosal therapy on libido, ejaculatory control, quality of life and treatment dependency in men with erectile failure. Furthermore to assess the drop-out rate and reasons for dissatisfaction with the technique. Subjects and methods: Questionnaires were sent to 1116 subjects with erectile failure who had previously elected to use intracavernosal therapy in the period 1995 ± 1997. Results: The response rate was 72.5%. The majority of erections lasted 30 ± 60 min, 10 ± 20% of the erections were considered unsatisfactory for intercourse and 15% of subjects reported erections lasting longer than 5 h on at least 10% of the occasions. Bleeding at the injection site occurred in 60% on at least 10% of the occasions and various degrees of deformation of the penis shaft were reported by 10%. The latter was related to the age of the subject and not the type of medication employed. Forty percent experienced at least partially improved control over ejaculation and almost 50% experienced some degree of increase in libido. One quarter retained penile rigidity after ejaculation but this was age-dependent. In those satis®ed with intracavernosal treatment, 80% admitted that it had improved the quality of their lives. Sixty percent did not feel that their dependency on intracavernosal treatment had lessened during the treatment period.Approximately 40% of subjects admitted to dropping out of the programme, the majority within the ®rst six months. The age of the subject did not in¯uence the decision and the type of medication or the mode of injection had only a minor impact on drop-out rate. Of those currently using IC therapy, 87% were either fully or partly satis®ed with this form of treatment. The corresponding ®gure for those discontinuing treatment was 58%. Dissatisfaction was higher in the younger age groups and could not be clearly related to the mode of injection. The major reasons for drop out or dissatisfaction were inadequate penile rigidity, the expense of the treatment, penile discomfort and the lack of spontaneity it necessitated. Penile discomfort was more associated with younger age groups, whilst an inadequate response to medication was more often experienced by men over 60 y. Deformation of the penile shaft was observed in 5% of those dissatis®ed with IC therapy and was four times more often reported by those over 70 compared to subjects younger than 40 y. In 6% of cases, a return of spontaneous erections was given as reason for drop-out. This was more often associated with younger subjects. In 16% of the subjects, the partner had expressed dissatisfaction with the technique primarily because of inadequate rigidity, lack of spontaneity or the complicated nature of the treatment.Conclusions:Intracavernosal treatment for erection failure is associated with side-effects such as penile ®brosis and bleeding at the injection site but has advantages including increased libido, an increase in the quality of life and ejaculatory control. Only a small proportion of men reduce thei...

Long-term efficacy and compliance of intracorporeal (IC) injection for erectile dysfunction following radical prostatectomy: SHIM (IIEF-5) analysis

“…However, our satisfaction and compliance rates are similar to those of Mulhall et al 3 and Purvis et al 6 Using an institutional questionnaire, Mulhall et al found a good response in 75% of their patient group using PGE1, which included patients with ED of all etiologies. 3 They reported an attrition rate of 31% over a 38-month period.…”

“…4 Patients who had non-nerve-sparing (non-NS) procedures and those who have failed oral therapy will require other options such as IC injections. [5][6][7] Dennis and McDougal 8 were the first to document the use of IC (PGE 1) therapy in previously potent RP patients with success rates of 85%. A study by Rodriquez Vela et al 9 in 1999 found that IC PGE1 injection provided adequate rigidity in 95% of their patients.…”

“…Studies show that compliance rates are poor, ranging from 11 to 70%. 1,3,5,6,[10][11][12] Dropout rates in many series exceed 40%. 13 Factors that compromise the success of therapy include: pain associated with the injection, difficulty in reproducing a successful injection, and penile fibrosis.…”

Experience with intracavernous injection in the treatment of erectile dysfunction after radical prostatectomy: dose considerations

“…14 Nevertheless, patients who have undergone a non-NS procedure and those in whom oral therapy has failed or is contraindicated require other options such as IC injections. [15][16][17] PGE1 (alprostadil) induces erections by directly stimulating the production of cyclic AMP within the smooth muscle cell and therefore does not require a functioning nerve to induce SM relaxation. The fact that PGE1 has a direct vasodilatory effect on smooth muscle in the penis is the basis for its efficacy in the treatment of non-NS or NS post-RP ED.…”

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

“…4 -8 However, many patients find the idea of penile injection unacceptable. In addition, side effects, including bleeding on injection, bruising, penile pain and fibrosis, 5,8 contribute to patient dissatisfaction. Intra-urethral alprostadil delivery is a putative alternative, although the higher doses of drug needed to elicit a response results in lower tolerability amongst patients and this route is less efficacious than direct injection into the erectile bodies.…”