Intracavernous Injection of Prostagland in E1 in combination With Papaverine: Enhanced Effectiveness in Comparison With Papaverine Plus Phentolamine and Prostaglandin E1 Alone

Abstract

We compared the erectile response to intracavernous injection of a combination of papaverine and prostaglandin E1 with that of a combination of papaverine and phentolamine (49 patients), and prostaglandin E1 alone (38). The degree of erection achieved was significantly better with papaverine plus prostaglandin E1 than with papaverine plus phentolamine and the duration of erection was less, although the incidence of prolonged erections (greater than 5 hours) was similar with both combinations. Papaverine with prostaglandin E1 likewise resulted in a significantly better degree of erection than prostaglandin E1 alone (prolonged erections occurred only after the drug combination). All erections subsided spontaneously and none required medical intervention throughout the study. Pain was noted only after injection of prostaglandin E1. The incidence was clearly lower (7 of 38 versus 13 of 38) after the injection of only 5 micrograms. prostaglandin E1 in combination with papaverine (although the difference is not statistically significant). Subjectively, the side effects caused by the drug combination were described as much less dramatic by the patients than after prostaglandin E1 alone. The combination of papaverine and prostaglandin E1 shows a clearly synergistic effect and might suitably replace papaverine plus phentolamine or prostaglandin E1 alone in patients who do not respond well or suffer side effects after high single doses.

Intracavernous Alprostadil

“…Therefore a better response may be achieved with a combination of intracavernous alprostadil and other intracavernous agents than with intracavernous alprostadil alone because of additive or synergistic effects. [69] One study with 20 patients with ED has compared the efficacy of the combination of papaverine 9mg and phentolamine 0.5mg with that of the combination of alprostadil 51lg, papaverine 4.5mg and phentolamine 0.25mg after intracavernous administration. [67,68] Results of a nonblind, randomised, crossover study in 38 patients with ED of mainly vascular Abbreviations and symbols: ED = erectile dysfunction; NR = not reported; " indicates no significant difference in efficacy; > indicates significantly greater efficacy (p < 0.01 or p < 0.05); < and> indicate a trend towards lower and greater efficacy, respectively.…”

Intracavernous prostaglandin E1 in erectile dysfunction

“…Based on information from the 16 studies that provide information [9,19,26,27,36,37,41,44,56,58,61,65,[71][72][73]97], the frequency of hematoma/ecchymosis after intracavernosal PGEi is calculated to be 1.5% (Table 5). Based on information from the 16 studies that provide information [9,19,26,27,36,37,41,44,56,58,61,65,[71][72][73]97], the frequency of hematoma/ecchymosis after intracavernosal PGEi is calculated to be 1.5% (Table 5).…”

Comparison of a Mixture of Papaverine, Phentolamine and Prostaglandin E(1), with Other Intracavernous Injections

“…Padma-Nathan [11] did a blind study comparing PGE i + papaverine with phentolamine and PGEi with phentolamine, and concluded that the latter was superior. Floth and Schramek [12] compared the effect of papaverine + phentolamine with papaverine + PGEi; they also com pared PGE[ alone with papaverine + PGE[ and conclud ed that the combination of papaverine and PGEi was superior. In a review of the literature and their own expe rience, Buvat et al [2] list several factors that influence a patient's response to an intracavemous injection.…”