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

Abstract

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.

Pathophysiology and treatment of diabetic erectile dysfunction

“…It is noted that both side-effects occur with a higher incidence in the papaverine and papaverine/phentolamine groups versus the PGE1 and papaverine/phentolamine/ PGE1 groups. Further, the incidence of priapism is greater in the test dose versus that in the home dose, which is typical of the increased incidence of priapism occurring during the titration phase as reported in other studies [68,69]. Additionally, it has been shown that diabetics have an increased incidence of penile fibrosis, possibly owing to their microangiopathic disease and increased propensity for fibrosis [69].…”

Erectile dysfunction and coronary slow flow: distinct presentations of endothelial disease

“…25,26 Instead, we preferred the IIEF score that is a practical method in diagnosis due to its noninvasiveness and reproducibility. 13,14 In conclusion, ED has an increased prevalence in male patients with SCF compared to the control group.…”

“…All participants completed the IIEF questionnaire. According to questions 1-5 and 15 (six questions that form the so-called 'erectile function domain' 14 ) of the questionnaire, ED severity was classified into five categories as severe (1-10), moderate (11)(12)(13)(14)(15)(16), mild to moderate (17-21), mild (22)(23)(24)(25) and no ED (26)(27)(28)(29)(30) …”

Imaging of penile traumas—therapeutic implications

“…The most common cause of cavernosal fibrosis is repeated intracavernosal injection of papaverine and, less frequently, of prostaglandin E1 [12,[32][33][34] (Fig. 8).…”

“…At US segmental intracavernosal fibrosis is characterized by echogenic foci within the corpus cavernosum that show reduced expansion during erection [3,4,34]. The lesions are usually visible when the penis is flaccid, but they are more prominent with erection when the surrounding sinusoids are distended with blood.…”