Progressive treatment of erectile dysfunction with intracorporeal injections of different combinations of vasoactive agents

To account for severity of disease in patients with erectile dysfunction, w e introduced a progressive treatment technique using four protocols of drug injections. The study group consisted of 452 men aged 26-85 y with erectile dysfunction . Protocol I. All patients began with a combination of papaverine and Regit ine in doses adjusted to the estimated severity of dysfunction and to age, up to a maximum dose of 25 mg papaverine and 1.5 mg of Regitine, Protocol I I. Patients who could not achieve sufficient rigidity on protocol I were sw itched to prostin VR, to a maximum of 25 meg. Protocol III. Patients who fa iled protocol II received papaverine, Regitine and prostin VR. Protocol IV. Patients who failed protocol III received atropine sulfate (0.02-0.06 mg) in addition to papaverine, Regitine and prostin. Sufficient rigidity was achieved as follows: Protocol I=305 (67.4%) of the original cohort; Protocol II = 61 of the 147 failures with Protocol I (41.5 %); Protocol III = 55 of the 86 failures with Protocol II (63.9%); Protocol IV = 20 of the remaining 31 patients (64.5%). Overall, sustained rigidity was achieved in 441 of the 452 patients (97.5%). Eleven patients (2.5%) fai led all four protocols and were offered a penile prosthesis. Therefore, using our progressive method, by starting with the most availabl e and inexpensive drugs, patients with erectile dysfunction can be given op timal treatment according to the severity of their disease. The success rat e is high while costs are kept to a minimum.