Efficiency of intracavernosal alprostadil and oral clomiphene citrate combination treatment in penile vasculogenic erectile dysfunction patients accompanied by late‐onset hypogonadism

Abstract

Erectile dysfunction (ED) refers to difficulty in starting and maintaining an adequate erection for satisfactory sexual performance and the stability of this condition (Burnett et al., 2018). The estimated prevalence of ED in men > 40 years of age is almost 50% (Bella, Lee, Carrier, Benard, & Brock, 2015). Different therapeutic agents have been developed for ED treatment, and their effect mechanism depends on the understanding of erection physiology. In ED treatment-resistant patients, lifestyle changes as a first-line treatment option and phosphodiesterase type 5 inhibitors (PDE5 inhibitors) as a second-line treatment option are used. PDE-5 inhibitors are noninvasive, generally well tolerated and efficient in most males. Intracavernosal injections (ICUs), such as alprostadil and papaverine, can be used in 25%-50% of patients who are irresponsive to the treatment and who contraindicate PDE5 inhibitors (Bella et al., 2015; Hatzimouratidis et al., 2019).

Assessing the use habits and efficacy of intracavernosal alprostadil: is it tolerable and sustainable?

“…20 In different studies, it was also found that clomiphene combined with PDE-5 inhibitors improved the treatment response. 21,22 In this study, in accordance with the literature, intracavernosal alprostadil treatment resulted in significant improvement in all IIEF-15 scores and degree of erection.…”

Evaluation of the efficacy and patient satisfaction of the intracavernosal alprostadil in the treatment of erectile dysfunction following robot-assisted radical prostatectomy

“…One study reported an incidence of pain in the injection site or during erection of 11%, hematoma or ecchymosis at 1.5%, priapism (defined as a painful erection exceeding 4 h in duration) at 1.5%, and penile plaque at 2% (21). Another study reported penile pain and priapism at a rate of 6.4% (22). Bearelly et al reported that plaque or scar formation was 10%, pain 2%, ecchymosis <1%, irritability <1%, headache <1% and tissue damage <1% (17).…”