Intracavernous injections for erectile dysfunction in patients with cardiovascular diseases and failure or contraindications for sildenafil citrate

Abstract

The aim of this study was to evaluate the effectiveness of a progressive program for the treatment of erectile dysfunction in patients with cardiovascular disease in whom sildenafil citrate (Viagra) was not an option. The study population included 106 patients selected from 267 with cardiovascular disease. The intracavernous injection program consisted of three protocols of increasingly complex combinations of vasoactive drugs, papaverine, phentolamine, prostaglandin E1 and atropine sulfate. Patients who failed the first protocol were switched to the second, and those who failed the second were switched to the third. A positive response was defined as an erection sufficient for vaginal penetration. A positive response was achieved on protocol I in 61 of the 106 patients (57.5%); protocol II in 32 of the remaining 45 patients (71.1%); and protocol III in seven of the remaining 13 patients (53.8%); the total success rate was 94.3%. These 100 patients were included in the 1-year follow-up, and 90 reported successful coitus at the end of that period: 79 patients (87.8%) with intracavernous injection and 11 (12.2%) without injection. The remaining 10 patients (10%) dropped out of the program, seven (7.0%) for health or marital reasons and three (3.0%) because of treatment failure. We conclude that a progressive program of intracavernous injections of vasoactive drugs may be a good alternative for the treatment of erectile dysfunction in patients with cardiovascular disease.

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

“…This is in contrast to the reported incidence of pain in some studies (3.5%) 7 and on the other hand is comparable with or even lower than others (12.5-34.4%). 6,12 A probable explanation for the high incidence of pain in our study is that apprehension of the needle aggravates pain. As the process of titration and home injection is continued, the patient's fears decrease and the actual pain related to the drug and not to the injection becomes apparent.…”

“…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 .…”

“…Several investigators have devised their own dose combinations (Table 1). [6][7][8][9][10][11][12] The real value of Tx is in salvaging those patients who respond poorly or painfully to PgE 1 alone, or need an economic yet effective treatment for ED. Standardization of the dosage and correlation of efficacy with patient response and satisfaction is lacking.…”

Triple Threat: Myocardial Ischemia Following Intracavernous Injection

“…2 Other side effects of intracavernous combination therapy include injection site bruising, subcutaneous hemorrhage, and prolonged erection. [2][3][4][5][6] Dose-dependent fibrotic reactions presenting as penile nodules, plaques, or induration may also occur. [2][3][4][5][6] The only reported systemic side effects are elevated liver enzymes, arterial hypotension, and headache.…”

“…[2][3][4][5][6] Dose-dependent fibrotic reactions presenting as penile nodules, plaques, or induration may also occur. [2][3][4][5][6] The only reported systemic side effects are elevated liver enzymes, arterial hypotension, and headache. [2][3][4][5][6]11 Since side effects are generally mild and infrequent, intracavernous injection therapy has been deemed safe and effective in the treatment of erectile dysfunction.…”