Intracavernous Pharmacotherapy for Impotence: Selection of Appropriate Agent and Dose

Heyden, Burkhard von; Donatucci, Craig F.; Kaula, Norbert; Lue, Tom F.

doi:10.1016/s0022-5347(17)36370-x

Cited by 46 publications

(16 citation statements)

References 20 publications

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“…To overcome this problem, most clinicians begin interfering with priapism at an earlier timepoint. 7 Color Doppler ultrasound has been described as an accurate measure of differentiating low-flow and high-flow priapism. 8 Secil et al 6 studied eight patients with prolonged erections, and suggested that papaverine-induced priapism may be predicted by color Doppler sonography.…”

Section: Discussionmentioning

confidence: 99%

The value of penile duplex in the prediction of intracavernous drug-induced priapism

et al. 2004

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The aim of this work is to assess the value of penile duplex in the prediction of intracavernous druginduced ischemic priapism. A total of 400 patients with erectile dysfunction were evaluated before and after diagnostic intracavernous injection of a trimix solution (papaverine þ phentolamine þ PGE1) using color Doppler sonography. In all, 29 patients experienced sustained rigid erections for more than an hour. Patients were further divided into two groups. Group A included patients with spontaneous resolution of their rigid erection within 3 h (10/29) and group B included patients with priapism (19/29) that did not resolve within 3 h. In group A, patients had minimal cavernous artery blood flow within the first hour postinjection, that increased with relief of their erection. Group B patients had no blood flow in their cavernous artery an hour after intracavernous injection and for 6 h later. The disappearance of blood flow in the cavernous artery after an hour of sustained rigid erection predicted priapism with 100% specificity and sensitivity. The persistent absence of cavernous artery blood flow for more than an hour, as detected by color Doppler ultrasound, is an objective predictor of priapism. This may guide early intervention to resolve the prolonged erection.

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Section: Discussionmentioning

confidence: 99%

The value of penile duplex in the prediction of intracavernous drug-induced priapism

et al. 2004

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“…between 2.5 mg and 10 mg may produce an optimal response in more than half of men suffering from ED, regardless of etiology. Starting with a 2.5 mg dose may minimize the risk of prolonged erection or priapism in all patients 17 as well as help to determine the lowest optimal dose for individual patients. In this study the mean optimal dose of alprostadil was 11.9 mg, and the mean minimal dose was 9.9 mg.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study of 101 patients with vasculogenic impotence, 17 reported the successful use of an average dose of 5.58 mg of PGE 1 in 70 patients using it for selfinjection home therapy.…”

Section: Introductionmentioning

confidence: 99%

A dose-response study of alprostadil sterile powder (S.Po.) (Caverject®) for the treatment of erectile dysfunction in Korean and Indonesian men

et al. 1997

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This open-label, dose-escalation study investigated the ef®cacy and safety of alprostadil (PGE 1 , prostaglandin E 1 ) Sterile Powder (S.Po.) (Caverject # ) for treatment of erectile dysfunction (ED) in 84 men with ED of various etiologies lasting ! 4 months. Doses started with 2.5 mg, then 5 mg, 10, 15, 20, 30, up to a 40 mg maximum. Eligible patients received single alprostadil injections in the physician's of®ce until an erection occurred. Ten minutes after injection, the patient's erection was clinically evaluated. Optimal response was de®ned as erection suf®cient to permit vaginal penetration and lasting 30±60 min. The patient also reported his own evaluation of response and any side effects. Patients were 24±65 y old (mean: 43.7 y), had ED of psychogenic, vascular, or neurogenic origin lasting 4 months±30 y (mean: 3.75 y). Of 84 patients enrolled, 82 completed the study. In the 82 patients who completed the study 78 (92.9%) achieved an optimal response; 18/78 patients (23.1%) had an optimal response at 2.5 mg, 9/78 (11.5%) at 5 mg, 21/78 (26.9%) at 10 mg, 12/ 78 (15.4%) at 15 mg, and 11/78 (14.1%) at 20 mg. Only 5/78 (6.4%) at 30 mg and 2/78 (2.6%) at 40 mg achieved an optimal response. Mean optimal alprostadil dose was 11.9 mg, and the mean minimal effective dose was 9.9 mg. Mean onset of erection was 11.2 min; mean duration of erection was 50.5 min. Penile pain in ®ve patients (6%) was the only reported side effect.

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“…The dose of vasoactive drugs for intracavernous injection varies according to the etiology and severity of the ED, age of the patient, and size of the penis [1]. Aging is the most common etiology for ED and the dose of intracavernous injection increases linearly with age [6,7]. In our study, the dose was significantly higher in patients over 50 than in those under 50.…”

Section: Discussionmentioning

confidence: 54%

“…Seventy-nine of the impotent patients using intracavernous pharmacotherapy with tri-mix (papaverine 18.75 mg/ml, phentolamine 0.625 mg/ml, PGE 1 6.25 Ìg/ml), who visited our clinic every 3 months for 3-4 years were enrolled in this study. Their age distribution ranged from 33 to 71 (mean 52 B 8.9) years and the duration of ED was from 4 months to 20 years (mean 3.4 B 3.7 years).…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for an Early Increase in Dose of Vasoactive Agents for Intracavernous Pharmacotherapy

Kim¹,

Seo²,

Park³

et al. 2000

Urol Int

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Aims: This study was to identify factors that influence the early increase in the dose of intracavernous vasoactive agents to maintain erection for satisfactory intercourse and to elucidate when the dose increase would begin. Methods: Seventy-nine patients using intracavernous pharmacotherapy with tri-mix (PGE₁, papaverine, and phentolamine) over a 3- to 4-year period were enrolled. At 3-month intervals, patients were questioned about changes in dose to maintain erection for satisfactory intercourse and frequency of injection, and underwent examination of the penis. The patients were divided into 2 groups: group A, dose increase of ≧20% after initiating home therapy, and group B, no change or an increase in dose <20%. Results: A significant increase (p < 0.01) in dose was started 2–3 years after initiating pharmacotherapy. The initial doses of group A at 2–3 and 3–4 years were significantly higher than those of group B (p < 0.01). There were no significant differences in the age of the patients, duration of erectile dysfunction, incidence of accompanying vascular risk factors, frequency of injection, or incidence of fibrous plaques between group A and group B, both at 2–3 and 3–4 years. Conclusion: The initial dose of intracavernous vasoactive agents (tri-mix) may be a unique risk factor for the early increase in dose to maintain erection for satisfactory intercourse.

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Intracavernous Pharmacotherapy for Impotence: Selection of Appropriate Agent and Dose

Cited by 46 publications

References 20 publications

The value of penile duplex in the prediction of intracavernous drug-induced priapism

The value of penile duplex in the prediction of intracavernous drug-induced priapism

A dose-response study of alprostadil sterile powder (S.Po.) (Caverject®) for the treatment of erectile dysfunction in Korean and Indonesian men

Risk Factors for an Early Increase in Dose of Vasoactive Agents for Intracavernous Pharmacotherapy

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