COMBINATION THERAPY USING ORAL ALPHA-BLOCKERS AND INTRACAVERNOSAL INJECTION IN MEN WITH ERECTILE DYSFUNCTION

Objectives. Intracavernosal injection with a combination of agents (ie , phentolamine plus papaverine or alprostadil) has been used in an eff ort to increase efficacy and reduce side effects compared with single agents. The purpose of this pilot study was to determine the potential role of oral alpha-blockers in combination with intracavernosal thera py in mere with erectile dysfunction, for whom intracavernosal therapy alone failed. Methods. Thirty-eight consecutive men with moderate to severe erectile dysfunction on the basis of history and examination an d with minimal or no therapeutic response to intracavernosal alprostad il injection therapy were evaluated. All patients received daily doxaz osin titrated to 4 mg over 3 weeks in combination with intracavernosal therapy as needed for 12 weeks. Efficacy was assessed at 4, 8, and 12 weeks after doxazosin titration using the 15-item, self-administered International Index of Erectile Function (IIEF) and a global efficacy question (GEQ: Did treatment improve your erections?). Results. For th e group, the mean baseline IIEF score before therapy was 29.7 +/- 9.8. After intracavernosal therapy (mean dose 34.7 +/- 7.3 mu g), IIEF imp roved to 36.1 +/- 11.4 (17.7%). After addition of doxazosin, IIEF impr oved to 48.6 +/- 13.4, 46.4 +/- 10.9, and 51.5 +/-. 14.3 at 4, 8, and 12 weeks, respectively (P < 0.01). The GEO response improved from 25.7 % at baseline to 81.4% at 12 weeks. Overall 22 (57.9%) of 38 patients with the combined regimen had a significant (more than 60% improvement in IIEF) therapeutic response. Conclusions. The addition of an oral a lpha-blocker may have a beneficial effect in patients with erectile dy sfunction for whom intracavernosal therapy alone fails. The synergisti c effects of vascular dilation and blockade of sympathetic inhibition may explain this response. The potential role of alpha-blockade in syn ergy with other agents designed to treat erectile dysfunction remains to be determined. (C) 1998, Elsevier Science Inc. All rights reserved.