Intracavernosal Injection for the Diagnosis, Evaluation, and Treatment of Erectile Dysfunction: A Review

Belew, Daniel; Klaassen, Zachary; Lewis, Ronald W.

doi:10.1002/smrj.35

Cited by 46 publications

(50 citation statements)

References 90 publications

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“…Overall, it is very well tolerated with only a few side effects. 265,271,272 A mild form of local pain has been reported in 11% after self-injection but it decreases over time and can be minimized by coadministration of sodium bicarbonate or procaine. Penile ecchymosis has been reported in 8%, whereas priapism and cavernosal fibrosis are very rare (1%e 2%), when PGE 1 is used as monotherapy.…”

Section: Alprostadil (Pge 1 )mentioning

confidence: 97%

“…The commercial preparation contains papaverine hydrochloride (15 mg/mL) and phentolamine mesylate (0.5 mg/mL) in 2-mL ampoules. 265 The addition of phentolamine decreases arterial resistance and promotes vasodilatation in synergy with papaverine. As monotherapy, phentolamine has limited erectile capacity because it does not provide notable therapeutic success.…”

Section: Alprostadil (Pge 1 )mentioning

confidence: 99%

“…264 They also are in the armamentarium to assess or diagnose an erectile failure, as in investigations of cavernosal relaxation and arterial dilatation with penile Doppler and duplex ultrasound in the evaluation of vascular causes for ED. 265,266 Furthermore, they can be handy in creating an artificial erection when there is a need to facilitate ejaculation for semen collection in a fertility setting. Classically, they also are known to boost confidence in psychogenic ED and any subjective perceptions of small penis anxiety.…”

Section: Ic Injection Therapymentioning

confidence: 99%

“…For the same reason, local nodular changes, penile fibrosis, and any systemic effects also are less common with PGE 1 . 265 IC PGE 1 (2.5e20 mg) provides an optimal erectile response conducive for sexual satisfaction in more than 70% and a significant increase in rigidity scores in 90% of men with ED of psychogenic, organic, or mixed etiology. 265,271,272 Supported by large clinical data in the past three decades, PGE 1 remains a safe and effective vasoactive agent for monotherapy in ED and the commonly used therapeutic dose ranges from 1 to 40 mg, depending on the etiology.…”

Section: Alprostadil (Pge 1 )mentioning

confidence: 99%

“…281 Therefore, papaverine is reserved for the following combinations with other vasoactive drugs, when it can be used in lower concentrations for an advantageous therapeutic synergy of safety and efficacy and as a diagnostic tool. 265,282 Papaverine-Phentolamine Combination (Bi-Mix)…”

Section: Alprostadil (Pge 1 )mentioning

confidence: 99%

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

Hatzimouratidis

Salonia

Adaikan

et al. 2016

The Journal of Sexual Medicine

184

199

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Introduction Treatment of erectile dysfunction is based on pharmacotherapy for most patients. Aim To review the current data on pharmacotherapy for erectile dysfunction based on efficacy, psychosocial outcomes, and safety outcomes. Methods A review of the literature was undertaken by the committee members. All related articles were critically analyzed and discussed. Main Outcome Measures Levels of evidence (LEs) and grades of recommendations (GRs) are provided based on a thorough analysis of the literature and committee consensus. Results Ten recommendations are provided. (i) Phosphodiesterase type 5 (PDE5) inhibitors are effective, safe, and well-tolerated therapies for the treatment of men with erectile dysfunction (LE = 1, GR = A). (ii) There are no significant differences in efficacy, safety, and tolerability among PDE5 inhibitors (LE = 1, GR = A). (iii) PDE5 inhibitors are first-line therapy for most men with erectile dysfunction who do not have a specific contraindication to their use (LE = 3, GR = C). (iv) Intracavernosal injection therapy with alprostadil is an effective and well-tolerated treatment for men with erectile dysfunction (LE = 1, GR = A). (v) Intracavernosal injection therapy with alprostadil should be offered to patients as second-line therapy for erectile dysfunction (LE = 3, GR = C). (vi) Intraurethral and topical alprostadil are effective and well-tolerated treatments for men with erectile dysfunction (LE = 1, GR = A). (vii) Intraurethral and topical alprostadil should be considered second-line therapy for erectile dysfunction if available (LE = 3, GR = C). (viii) Dose titration of PDE5 inhibitors to the maximum tolerated dose is strongly recommended because it increases efficacy and satisfaction from treatment (LE = 2, GR = A). (ix) Treatment selection and follow-up should address the psychosocial profile and the needs and expectations of a patient for his sexual life. Shared decision making with the patient (and his partner) is strongly recommended (LE = 2, GR = A). (x) Counterfeit medicines are potentially dangerous. It is strongly recommended that physicians educate their patients to avoid taking any medication from unauthorized sources (LE = 2, GR = A). The first seven recommendations are the same as those from the Third International Consultation for Sexual Medicine and the last three are new recommendations. Conclusion PDE5 inhibitors remain a first-line treatment option because of their excellent efficacy and safety profile. This class of drugs is continually developed with new molecules and new formulations. Intracavernosal injections continue to be an established treatment modality, and intraurethral and topical alprostadil provide an alternative, less invasive treatment option.

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Section: Alprostadil (Pge 1 )mentioning

confidence: 97%

Section: Alprostadil (Pge 1 )mentioning

confidence: 99%

Section: Ic Injection Therapymentioning

confidence: 99%

Section: Alprostadil (Pge 1 )mentioning

confidence: 99%

Section: Alprostadil (Pge 1 )mentioning

confidence: 99%

See 3 more Smart Citations

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

Hatzimouratidis

Salonia

Adaikan

et al. 2016

The Journal of Sexual Medicine

184

199

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Emerging structural and pathological analyses on the erectile organ, corpus cavernous containing sinusoids

Hashimoto,

Fujimoto,

Kim

et al. 2023

Reprod Medicine & Biology

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BackgroundThe corpus cavernosum (CC) containing sinusoids plays fundamental roles for erection. Analysis of pathological changes in the erectile system is studied by recent experimental systems. Various in vitro models utilizing genital mesenchymal‐derived cells and explant culture systems are summarized.Methods3D reconstruction of section images of murine CC was created. Ectopic chondrogenesis in aged mouse CC was shown by a gene expression study revealing the prominent expression of Sox9. Various experimental strategies utilizing mesenchyme‐derived primary cells and tissue explants are introduced.Main FindingsPossible roles of Sox9 in chondrogenesis and its regulation by several signals are suggested. The unique character of genital mesenchyme is shown by various analyses of external genitalia (ExG) derived cells and explant cultures. Such strategies are also applied to the analysis of erectile contraction/relaxation responses to many signals and aging process.ConclusionErectile dysfunction (ED) is one of the essential topics for the modern aged society. More comprehensive studies are necessary to reveal the nature of the erectile system by combining multiple cell culture strategies.

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Pharmacotherapy for Inducing an Erection

Miranda,

Carneiro

2024

Penile Color Duplex-Doppler Ultrasound in Erectile Dysfunction Diagnosis and Management

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Intracavernosal Injection for the Diagnosis, Evaluation, and Treatment of Erectile Dysfunction: A Review

Cited by 46 publications

References 90 publications

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

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

Emerging structural and pathological analyses on the erectile organ, corpus cavernous containing sinusoids

Pharmacotherapy for Inducing an Erection

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