The causes of patient dropout from penile self-injection therapy for impotence

Purpose: Penile self-injection therapy, a second line treatment for erectil e dysfunction, is the most efficacious means of reestablishing functional e rections when first line therapies fail and the patient wants to avoid peni le prosthesis implantation. Despite high efficacy rates, injection therapy has high dropout rates. To our knowledge studies to date analyzing patient attrition have reviewed small numbers of patients followed for only short p eriods. We elucidate the main reasons for patient dropout in a large penile self-injection program with long-term followup. Materials and Methods: A questionnaire was mailed to 1,424 patients who com pleted the office training and home use phases of a penile self-injection p rogram. Results: The overall attrition rate was 31% of the 720 men who completed th e questionnaire, with a mean followup of 38 months. The main reasons for dr opout were cost of therapy, patient and partner problems with the concept o f penile injection, lack of partner availability and spontaneous improvemen t in erections. Lack of efficacy of therapy was the primary reason for only 1 of 7 dropouts. Furthermore, adverse effects of penile injections (priapi sm, penile nodules, pain) appeared to be only minor contributors to dropout . Conclusions: To our knowledge this study is the largest published, single c enter cohort of patients treated with injection and followed for an analysi s of dropout rates. Based on study data a reduction in dropout rates may be achieved by keeping the cost of therapy low, and ensuring patient and part ner education as well as continued support throughout treatment.