CLINICAL RELIABILITY OF MULTIDRUG INTRACAVERNOUS VASOACTIVE PHARMACOTHERAPY FOR DIABETIC IMPOTENCE

The aim of this study was to assess the effectiveness and safety of in tracavernous injections of a four-drug vasoactive mixture in diabetic patients with organic impotence. A group of 60 diabetic patients with either pure neurogenic, pure vasculogenic or mixed neurovasculogenic i mpotence were treated with intracavernous injections of a combination of 12.1 mg/ml papaverine hydrochloride, 1.01 mg/ml phentolamine mesyla te, 10.1 mu g/ml prostaglandin El and 0.15 mg/ml atropine sulphate ('f ull-dose' mixture). A mixture of the same drugs but at one-third conce ntrations ('reduced-dose' mixture) was also used. The mean (+/- SEM) v olumes of the full-dose and reduced-dose mixtures used were 0.21 +/- 0 .03 ml and 0.31 +/- 0.02 ml, respectively. All the patients were able to sustain a rigid erection at the end of the titration phase of the s tudy. At a mean follow-up of 18 months, 48 patients (80%) were success fully using the mixture, 6 patients (10%) were using the mixture at a dose lower than the initial dose and 6 patients (10%) had dropped out from the injection therapy. No major complications were seen. The asso ciation of multiple vasoactive drugs which use different mechanisms of action, thus exerting a pharmacological synergism, is an effective an d safe procedure in intracavernous pharmacotherapy for diabetic patien ts with organic impotence.