Recent experimental studies showed an important role o f endothelium-derived relaxing factor in penile erection. Therefore, an in vivo study was done to examine the effect o f the nitric oxide d o n o r SIN-I on h u m a n erection. Eight patients with erectile dysfunction received doses o f 0.1 to 1 mg SIN-1 intracavernously. In all patients, SIN-1 induced a dose-dependent erectile response. A l t h o u g h applied in 2 patients with prolonged erections to minimal doses o f a p a p a v e r i n e -p h e n t o l a m i n e combination, the d u r a t i o n of the full erection achieved in response to 1 mg SIN-1 was limited to about 60 min. The erectile response was due to an increase in arterial inflow and to cavernous s m o o t h muscle relaxation. There were no systemic or local side-effects. Our preliminary study suggests SIN-1 to be an attractive alternative for autoinjection therapy in the treatment o f erectile dysfunction. Cavernous s m o o t h muscles play a crucial role in penile erection. Relaxation o f the arterial and sinusoidal cavernous s m o o t h muscles induces an erection by decreasing peripheral arterial resistance, entrapping b l o o d within the sinusoids and restricting cavernous outflow [3, 9]. Like the m e d i a t i o n o f cholinergic neurotransmission o f vascular s m o o t h muscles by endothelium-released E D R F (endothelium-derived relaxing factor [21, cavernous cholinergic neurotransmission was also shown to be endotheliurn-mediated [12]. Recent in vitro studies suggested that nitric oxide (NO), which is believed to account for the biological actions o f E D R F [1, 7], plays a role in the regulation o f the cavernous s m o o t h muscle tone, b o t h in the flaccid [4] and the erect [4, 5, 8] state. Recent in vivo studies in rabbits f u r t h e r m o r e underlined the role of the N O / E These experimental d a t a suggest that it is worth testing N O / E D R F for the treatment of erectile dysfunction: its local spontaneous d e c o m p o s i t i o n should prevent prolonged erections and its receptor-independent action should account for m a x i m a l s m o o t h muscle relaxation.In the present in vivo study we examined the effect of the intracavernous administration of SIN-1 (NO donor) on h u m a n penile erection.
Patients and methods
SIN-1 (linsidomine chlorhydrate, Corvasal Intracoronaire, H6chstFrance) was injected intracavernously in eight patients attending at our impotence clinic. Before entering the study, the patients were approached in a comprehensive work-up slanted to the etiology of their erectile dysfunction. The following tests wre done: Case history, physical examination, sexual case history (by a psychiatrist), blood laboratory tests, pharmaco-Doppler, SPACE evaluation [11] and pharmacotesting [10]. When indicated on the grounds of the case history or the aforementioned examinations [10], pharmaco-angiography or cavernosometry was done. Only one dose a day was injected. To enhance reproducibility, the patients were advised to restrain from psychogenic or reflexogenic...