Satisfaction Profiles in Men Using Intracavernosal Injection Therapy

Abstract

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.

Long-Term Satisfaction and Predictors of Use of Intracorporeal Injections for Post-Prostatectomy Erectile Dysfunction

“…Hsiao et al observed that older age, younger partner age, clinically significant increase in erectile function domain score, and attainment of “fully rigid erection” were significant predictors of satisfaction with ICI. 25 Since only 60 men in our study were satisfied with ICI, it was difficult to assess the determinants of satisfaction.…”

“…8,10,13–22,25–27 This variability may be attributed to differences in: duration of follow-up, etiology for ED, timing of initiating treatment for PPED, physician comfort administering ICI, the degree of counseling or education received prior to initiating therapy, and number and structure of follow-up visits. While it has been suggested that high dropout rates associated with ICI may be improved with comprehensive training and education as well as regular follow-up, 8,10 the results of a recent randomized trial evaluating the use of extra counseling suggest otherwise.…”

Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)

“…It also is noteworthy that when poor responders to PDE5 inhibitors were switched to IC injections, 65% satisfactorily continued with selfinjection at the end of a long-term follow-up (25 months), of whom 85% were tri-mix candidates. 287 Currently, tri-mix is an option for severe veno-occlusive dysfunction or in the aftermath of radical pelvic surgery. 274,288 Pain or tenderness after PGE 1 is accentuated by an underlying cavernous nerve injury; therefore, bi-mix or tri-mix would be more suitable in such patients.…”

Penile revascularization—contemporary update

“…[23][24][25] Other therapies for erectile dysfunction include a vacuum erection device or even penile prosthesis. It is our experience, however, that many of these young men with arteriogenic erectile dysfunction are not enthusiastic regarding a lifetime of medically or prosthetic assisted erections and prefer an opportunity to regain physiological penile erectile function whenever possible.…”