Prolonged erections following intracorporeal injection of medications to overcome impotence

Conservative and medical treatments of non-sickle cell disease-related ischemic priapism: a systematic review by the EAU Sexual and Reproductive Health Panel

Conservative and medical treatments are considered the first step in ischemic priapism (IP) management, although there is no clear evidence regarding their efficacy. We conducted a systematic review on behalf of the EAU Guidelines panel on Sexual and Reproductive health to analyse the available evidence on the efficacy and safety of conservative and medical treatment for non-sickle cell disease-related IP. Databases searched for relevant literature investigating efficacy and safety of conservative measures and medical treatment for IP included Medline, EMBASE, Cochrane Libraries and clinicaltrial.gov published up to September 2021. Overall, 41 retrospective, 3 prospective single-arm studies and 3 randomized controlled trials met the inclusion criteria. Intracavernous injection with sympathomimetic (ICIs) agents were the most frequently utilized treatment with efficacy ranging from 0 to 100% of cases. The combination of ICIs with corporeal aspiration with or without irrigation with saline was successful in 70 to 100% of cases. Oral treatment with β2 receptor agonist (e.g., terbutaline) showed mild to moderate efficacy. Conservative methods including ice pack, exercise, cold enema and ejaculation depicted lower effectiveness in resolving priapism (1-55%). Longer time interval from the onset to the resolution of IP was associated with higher rate of erectile dysfunction at follow-up (30-70%), especially after 24 h.

[Intracavernosal methoxamine self-injection for the treatment of low-flow recurrent priapism]

We report the case of a young man with a recurrent idiopathic priapism, successfully treated with methoxamine intracarvenosal self-injections. The patient was instructed in intracorporeal self-injection of this pure alpha-1 adrenergic agonist, which provided complete detumescence. The patient became asymptomatic after one month of domiciliary treatment. We conclude that intracavernosal self-administered methoxamine can be a useful treatment of recurrent idiopathic priapism.

Intracavernosal papaverine and phentolamine for the medical management of erectile dysfunction in a genitourinary clinic

A total of 160 men with erectile failure received treatment with 13,030 intracavernosal papaverine and phentolamine injections as outpatients. One-hundred-and-fifteen (72%) achieved an erection sufficient for sexual intercourse and after a mean follow-up period of 14.1 months, 55 (48%) are still attending and successfully using intracavernous therapy. Sixteen patients had a total of 22 episodes of priapism and one patient developed corporeal fibrosis. We conclude that intracavernous papaverine and phentolamine is an effective therapy for erectile failure in a genitourinary clinic.

Prostaglandin E1 and the nitric oxide donor linsidomine for erectile failure: a diagnostic comparative study of 40 patients

A total of 40 patients (average age 55.9 years, range 23 to 78 years) with erectile failure was enrolled in a study to compare 1 mg. of the nitric oxide donor linsidomine to 20 micrograms prostaglandin E1 administered for diagnostic purposes. Prostaglandin E1 was considered comparable to linsidomine by 10% of the patients, slightly superior by 15%, moderately superior by 20% and much superior by 55%. No patient rated linsidomine superior to prostaglandin E1. Objective evaluation of erectile response to linsidomine versus prostaglandin E1 by the investigator revealed no response in 7.5% versus 0% of the cases, tumescence in 57.5% versus 17.5%, semirigid erection in 22.5% versus 17.5% and full erection in 12.5% versus 65%, respectively. Duplex sonography after linsidomine and prostaglandin E1 with evaluation of peak flow velocities (centimeters per second) showed that the increase in peak flow velocity after linsidomine was at least a third less than the increase after prostaglandin E1. The appearance after linsidomine often resembled arterial insufficiency, whereas after prostaglandin E1 there was no evidence of arterial insufficiency. The erectile and hemodynamic response to the nitric oxide donor linsidomine was modest compared to that of prostaglandin E1. Therefore, linsidomine is not a genuine alternative to prostaglandin E1 for the diagnosis and treatment of male impotence.

Effects of adenosine on canine penile erection

We investigated the hemodynamic effects of intracavernous injection of adenosine on canine penile erection. In all ten dogs studied, adenosine induced a dose-dependent increase of intracavernous pressure (ICP). Adenosine (0.67 to 15 micrograms/kg., B.W.) increased arterial blood flow by 83 to 325 percent above baseline levels and also increased venous resistance, which resulted in a full erection (ICP = 80 to 140 cm. H2O) for one to 7 minutes. The repeatability of the adenosine effect was confirmed in eight dogs. We found that adenosine, by virtue of its smooth muscle relaxation properties, can induce a dose-dependent increase of ICP and cause a full erection in dogs.

The usefulness of ethylephrine (Efortil-R) in the treatment of priapism and intraoperative penile erections

We present our experience in the treatment of 8 patients with priapism after intravenous injection of vasoactive drugs, and of 15 patients with persistent erections in the course of transurethral cystoscopy surgery. All of them were treated with intracavernous injection of 10 mg ethylephrine (1 ml Efortil-R). The results were satisfactory in all cases. In one patient we had to draw 75 ml blood and give another 10 mg dose of ethylephrine. We have not observed secondary effects of drug administration except two local haematomas with spontaneous resolution. We consider that this treatment is very useful in the management of patients with persistent erections or priapism because of the excellent results obtained without adverse effects.

Risk factors for papaverine-induced priapism

Intracorporeal administration of papaverine hydrochloride is frequently used in the diagnosis and treatment of impotence. Priapism is the most serious potential complication of its use. The historical characteristics of 400 consecutive men receiving a standardized dose of papaverine were reviewed in an effort to determine the risk factors for prolonged erections. Younger men (p less than 0.0001) with better baseline erectile function (p less than 0.023) were more likely to have priapism. Despite use of a significantly lower dose, patients with overt neurological disease also had an increased rate of priapism. Patients with a history of coronary artery disease had a significantly lower risk of priapism (p less than 0.05). Patients with a final diagnosis of either psychogenic or neurogenic impotence had a much greater risk of priapism than those with vasculogenic impotence (p less than 0.001). The initial dosage in pharmacological erection therapy may be adjusted according to these risk factors. However, not all patients with psychogenic or neurogenic impotence had priapism and some patients with vascular disease did have priapism. Therefore, all impotent patients are potentially at risk for pharmacologically induced priapism.

Comparison of effects following the intracorporeal injection of papaverine and prostaglandin E1

A study group of 240 impotent men receiving intracorporeal injections were divided into 2 groups: the first group received papaverine (60 mg) and the second prostaglandin E1 (PGE1 20 micrograms). The effect of the drugs was evaluated according to the onset of erection, rigidity and the duration of erection; 136 patients were treated with papaverine and 104 with PGE1. The onset of action in these groups was 6.42 +/- 5.39 vs 10.14 +/- 5.41 min; the rigidity score was 3.37 +/- 0.89 vs 3.60 +/- 1.10 and the duration of erection was 49.56 +/- 62.56 vs 63.60 +/- 44.57 min respectively. There was a significant difference in the onset of action (PGE1 was slower than papaverine) and maintenance of erection (longer with PGE1 than with papaverine). Another group of 17 patients received both papaverine and PGE1. The effects of papaverine were better in 4 cases, worse in 5 and equal to PGE1 in 8. This study indicates that compared with papaverine, treatment with PGE1 produces a slower onset of action, a longer duration of erection and fewer side effects.

Therapeutic progress--Review XXXVI. Are we making progress in the drug treatment of disorders of the bladder, prostate, and penis?

This paper discusses the novel application of drugs, many of which were first developed for, or have an established role in other indications, in the treatment of disorders of the bladder, prostate and penis. These novel applications have often followed on from an increase in the understanding of the pathophysiological processes involved in the urological condition. Urology also lends itself to novel routes of administration, such as intravesical and intracorporeal routes as well as the more conventional oral, parenteral, and intra-nasal routes.

Experience in the management of erectile dysfunction using the intracavernosal self-injection of vasoactive drugs

We report the results of a survey of 75 patients with erectile dysfunction, all of whom were treated by self-injection of the corpora cavernosa with vasoactive agents. At the time of the survey each patient had been self-injecting at home for at least 3 months. Of the patients 62 were followed for 3 to 21 months. Patients used this form of treatment with minimal assistance from our clinic staff. It was acceptable to them with few complications except for prolonged erections in 11 per cent of the men. Fifteen patients (24 per cent) with psychogenic impotence reported spontaneous improvement in erections during treatment and 4 discontinued treatment for this reason. Another 26 patients (42 per cent) continue to use self-injection as the definitive mode of treatment for erectile dysfunction.