F. Montorsi et al., 4-DRUG INTRACAVERNOUS THERAPY FOR IMPOTENCE DUE TO CORPOREAL VENOOCCLUSIVE DYSFUNCTION, The Journal of urology, 149(5), 1993, pp. 1291-1295
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.