IMPROVED HEMODYNAMIC-RESPONSE AFTER LONG-TERM INTRACAVERNOUS INJECTION FOR IMPOTENCE

Objective. To investigate the phenomenon of spontaneous erections in p atients on long-term intracavernous injection therapy. Methods. We und ertook an objective assessment of the penile circulation of 35 patient s; 21 used prostaglandin E1 (PGE1) alone and 14 used a combination of papaverine, phentolamine, and PGE1. All underwent duplex ultrasonograp hy before initiation of home self-injection and again after a mean of thirty-one months of treatment (most patients performed injections onc e or twice a week). Results. The diameter of the cavernosal arteries d id not change significantly after treatment. However, the mean peak fl ow velocity increased highly significantly (P < 0.001): 17.9 cm/second in the right cavernous artery and 21.2 cm/second on the left before t reatment; 24 cm/second on the right and 29 cm/second on the left after treatment. More than one third (13 of 35 patients [35%]) achieved fun ctional erection without injection at least some of the time, giving c linical support to the sonographic findings. Conclusions. We suggest t hat the combination of vasodilatory drugs and sexual stimulation may a ct to improve sinusoidal and penile arteriolar smooth muscle function.