The value of a second injection on the pharmaco induced erection test

Abstract

In order to test the capability of a reinjection to improve an incomplete pharmaco induced erection, we submitted 30 impotent patients, with incomplete erectile responses to 10 mg PGE1 1 mg phentolamine, to a second injection of 15 mg PGE1 1.5 mg phentolamine 30 mg papaverine, ®fteen minutes after the ®rst injection. Twenty-one patients improved their erection including nine who achieved complete rigidity. We conclude that incomplete pharmaco induced erections can frequently be improved by reinjection.

Re-dosing of prostaglandin-E1 versus prostaglandin-E1 plus phentolamine in male erectile dysfunction: a dynamic color power Doppler study

“…31 As expected, none of the venogenic and mixed arterious-venogenic patients (n 90) reached a rigid erection after phase 1 (RI`0.90); however, after phase 2, re-injection caused the appearance of a semirigid erection (RI b 0.90) in a subset of subjects with organic ED further indicating that re-dosing is recommended also when veno-occlusive is suspected. 5,17 Interestingly, in both groups of patients the erectile response as well as Doppler parameters were magni®ed more than 3-fold by re-dosing of PGE 1 plus phentolamine (39% versus 12% and 21% versus 6%, respectively); this suggests that phentolamine improves the diagnostic ef®cacy of dynamic CPD studies possibly by speci®c unmasking a subset of impotent patients with increased adrenergic tone due to concomitant emotional disturbances. 9,32 In these patients, it is likely that the mild corporeal veno-occlusive dysfunction may be suf®ciently and satisfactorily treated with sildena®l 50 ± 100 mg at home.…”

“…Re-dosing of trimix has been shown to be of value in predicting arterial dysfunction; however, it has a limited role in investigating the veno-occlusive mechanism, due to the necessity of using low doses of each single agent in order to prevent prolonged erections and priapism which can occur at high frequency with this mixture. 17,25 This study provides for the ®rst time penile blood¯ow-based evidence that re-dosing of a combination of PGE 1 and phentolamine has a better diagnostic sensitivity than re-dosing of PGE 1 alone with a comparable pro®le of safety. We had no cases of priapism since we decided to interrupt all prolonged erections b2 h by injecting intracavernously the antidote metaraminol.…”

Penile pharmacotesting in diagnosing male erectile dysfunction: evidence for lack of accuracy and specificity

“…We found that up to 20% of pts with a type‐3 response were affected by arterial insufficiency as showed by CDDU studies. These results are in accordance with findings of other authors (Pescatori et al ., 1994; McMahon, 1995; Cormio et al ., 1996; Pagani et al ., 1997; Mills & Sethia, 1999). Interestingly, in our pts flowmetric studies showed that a semi‐rigid erection (type‐2 response), which is a functional erection, was associated with arterial (20%), VO (37%) or mixed (MX) (6%) ED; also, full tumescence without sustained rigidity was almost always (99%) an index of the presence of venous leakage.…”

Age-matched cavernous peak systolic velocity: a highly sensitive parameter in the diagnosis of arteriogenic erectile dysfunction

“…A new dose of alprostadil 10 mg was injected in combination with 1 mg of phentolamine if the erection obtained by patients was not comparable to the one present during sexual activity at home. 9 All ultrasound examinations were performed in a blinded fashion by the same doctor, expert in vascular diagnostics.…”