4-DRUG INTRACAVERNOUS THERAPY FOR IMPOTENCE DUE TO CORPOREAL VENOOCCLUSIVE DYSFUNCTION

Although veno-occlusive dysfunction is a frequent cause of impotence, a definitive therapeutic strategy has not yet been clearly defined. A total of 56 patients with corporeal veno-occlusive dysfunction diagnos ed by dynamic infusion cavernosometry-cavernosography (flow to maintai n erection greater than 10 ml. per minute and rate of corporeal pressu re decrease after interruption of intracavernous infusion greater than 50 mm. Hg for 30 seconds) not considered suitable candidates for surg ery underwent self-injection therapy. A vasoactive mixture composed of 12.1 mg./ml. papaverine hydrochloride, 10.1 mugm./ml. prostaglandin E 1, 1.01 mg./ml. phentolamine mesylate and 0.15 mg./ml. atropine sulfat e was used. After dose titration of the drug mixture 54 patients (95%) were able to obtain sustained rigid erections that guaranteed satisfa ctory sexual activity. Mean (plus or minus standard error of mean) vol ume of injected mixture was 0.42 +/- 0.09 ml. (range 0.25 to 0.90 ml.) . Four patients (7%) reported transient hypotension that did not recur after the application of a penile rubber band before injection. At a mean followup of 16 months 6 patients (11%) discontinued use of inject ions, 37 (69%) were satisfied and using the mixture, and 11 (20%) main tained rigid erections using a lower than initial dose. No major compl ications were encountered. The association of drugs with different mec hanisms of action caused a synergism that potentiated the therapeutic activity and reduced side effects by decreasing the total drug dose.