Intracavernous Injection of Prostaglandin E1 for the Treatment of Erectile Impotence

The objective of this study is to evaluate the side effects of intracavernous vasoactive agents on clinical and sonographic basis. Two groups of patients were included, group I included 168 ED patients trained on self-injection therapy using one of the three protocols. Protocol A: papaverine; protocol B: PGE1; and protocol C: trimix (papaverine, phentolamine and PGE1). Patients were followed up clinically, sonographically and by laboratory investigations for 6 months to evaluate the occurrence of side effects. Group II included 21 patients presenting to our department for the first time with a complication of intracavernous injection pharmacotherapy (ICI) initiated elsewhere. In all, 168 patients of group I completed the study. Patients on papaverine had the highest incidence of complications concerning prolonged erection, subcutaneous hematoma and penile fibrosis. Postinjection penile pain was observed more with groups B and C than group A. No systemic side effects were reported. Duplex ultrasound was beneficial in detecting mild clinically impalpable fibrosis. In total, 10 patients of group II presented with prolonged erection, seven with penile fibrosis, three with cavernositis and one with intracavernous needle breakage. We conclude that although ICI therapy is an effective second-line treatment option, patients on a self-injection program should be followed up both clinically and sonographically both at the initiation phase and on regular follow-up visits.

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“…1,2 However several complications have been reported. Early complications include pain, hematoma formation, syncope and prolonged erections.…”

Section: Introductionmentioning

confidence: 99%

Clinical and sonographic assessment of the side effects of intracavernous injection of vasoactive substances

et al. 2004

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“…It has been reported in the literature that intracavernous injection of prostaglandin E1 may result in a full erection in 62 ± 80% of men injecting a dose of 20 mcg or less, 13,14 but in only 41.1% with lower doses. 14 The average age of men in these studies was 47.7 and 55.8 y, respectively.…”

Section: Discussionmentioning

confidence: 99%

Intracavernous injections: still the gold standard for treatment of erectile dysfunction in elderly men

et al. 2001

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The objective of this work was to determine the effectiveness of intracavernous injections (ICI) of vasoactive drugs in elderly men with erectile dysfunction and to compare the results obtained with the injection of two different drug combinations. It was a case control study. The sample consisted of 300 men, 63 ± 85 y of age (mean 67.1) with erectile dysfunction of organic origin. Among the patients 180 underwent ®rst trial with injection of prostaglandin E1 (PE). Further on these 180 patients and another 120 (in total 300 patients) were treated with a triple combination of papaverine hydrochlorate, phentolamine messylate and prostaglandin E1 (PPR). The number of responders to the injection of either PE alone or the drug combination was recorded. The quality of the erections was evaluated in the outpatient clinic by the medical staff and through patient's report after home trial. The average volume of either PE or PPR necessary to obtain a functional erection was measured. We observed a statistically signi®cant association between the results obtained after the injection of PPR as compared to PE (w 2 with 2 d.f.: 34.666; P `0.001). A functional erection was obtained in 224a300 (74.7%) after the injection of PPR as compared to 87a180 men (48.3%) treated with PE. The average volume of PPR necessary to obtain a functional erection was 0.35 AE 0.14 ml whereas that of PE was 1.3 AE 0.3 ml. intracavernous injection of vasoactive drugs is still one of the most successful therapies for patients suffering from organic impotence. It is less effective in the older age group as compared to younger. However, if this form of therapy is chosen for aged men the triple combination therapy (PPR) yields a higher response rate than that obtained with prostaglandin alone.

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“…In 1984, at the beginning of our experience, only psychological, hormonal and surgical (prostheses) solutions could be offered to patients with ED. In 1987 we started offering self-injections of vasoactive drugs (7,8). Between 1988 and 1998 we performed 86 venous surgical procedures (5, 6).…”

Section: Methodsmentioning

confidence: 99%

“…Over the last century, efforts to treat ED have led to the development and use of psychological treatment (early 1900s), hormonal therapies (1960) (1, 2), prosthetic surgery (1971) (3,4), arteriovenous surgery (1981) (5,6), vasoactive intracavernosal self-injection (1982) (7,8), vacuum pumps (1986) (9), intraurethral PGE1-medicated urethral system for erections (MUSE) (1994) (10) and 5-phosphodiesterases inhibitors (5PDHEi) (1997) (11).…”

Section: Introductionmentioning

confidence: 99%

500 penile prostheses implanted by a surgeon in Italy in the last 30 years

Pozza¹,

Pozza²,

Musy³

et al. 2015

Arch Ital Urol Androl

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Objectives: The aim of our study was to report our experience with patients affected by Erectile Dysfunction (ED) and undergoing penile prosthetic implantation (PPI) in a single center by a single surgeon. Material and Methods: We retrospectively evaluated the clinical outcome of 500 patients (mean age: 51.5 years, range: 20-86 years) affected by ED and referred to our private andrological center from January 1984 to December 2013 who underwent penile prosthesis implantation, including the reported level of patient satisfaction. Results: 182 silicone, 180 malleable, 18 monocomponent hydraulic and 120 multicomponents hydraulic prostheses were implanted by the same experienced surgeon. All patients were hospitalized for the procedure. All patients were evaluated immediately, 1 month (496 patients) and, for the great majority, every year after implantation. One hundred twenty five patients were lost to follow-up. Twenty two patients underwent revision surgery for complications in the postoperative period. The most serious postoperative complications were mechanical problems (45 patients, 9.0%) and infection (15 patients, 3%). Forty two (8.4%) prostheses were explanted. Overall, 80% (400/500) of patients were able to have sexual intercourse and were fully satisfied with the results. Conclusions: In our experience prosthetic surgery should be considered a good solution for men affected by ED and not responsive to other therapeutic solutions. Prosthetic surgery can be performed not only in large public hospitals but also in smaller private facilities.

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Intracavernous Injection of Prostaglandin E1 for the Treatment of Erectile Impotence

Cited by 122 publications

References 9 publications

Clinical and sonographic assessment of the side effects of intracavernous injection of vasoactive substances

Clinical and sonographic assessment of the side effects of intracavernous injection of vasoactive substances

Intracavernous injections: still the gold standard for treatment of erectile dysfunction in elderly men

500 penile prostheses implanted by a surgeon in Italy in the last 30 years

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