Sildenafil versus intracavernous injection therapy: Efficacy and preference in patients on intracavernous injection for more than 1 year

Purpose: To our knowledge comparative data on the effectiveness of and pati ent preference for intracavernous injection therapy and sildenafil are stil l not available, We evaluated the efficacy of sildenafil as well as patient preference in a group of impotent men on intracavernous injection for more than a year. Materials and Methods: Patients on intracavernous injection therapy for mor e than a year without neurological disease and/or a contraindication to sil denafil treatment were recruited for study. In phase 1 we determined the ef ficacy of 50 and 100 mg. sildenafil citrate at home. In phase 2 responders to sildenafil were asked to use the preferred dose orally for a month and c hoose intracavernous injection or sildenafil. In phase 3 patients were aske d to continue either treatment for 3 more months. Patient preferences were reported at the end of phases 2 and 3. Results: Of the 180 men recruited 155 with a mean age of 56.4 +/- 12.6 year s on intracavernous injection for a mean of 26 +/- 9 months accepted and we re included in our series. Overall 116 men (74.8%) responded to sildenafil during study phase 1. After 1 month of treatment 71 responders (61.2%) pref erred to continue with the oral drug, 31 (26.7%) returned to intracavernous injection and 14 (12.1%) used each drug alternately. Three months later 74 of the 116 responders (63.8%) preferred oral treatment and 38 (32.8%) chos e intracavernous injection, while 4 (3.4%) continued to use each treatment alternately. Conclusions: Sildenafil is highly effective in intracavernous injection res ponders, although a certain group prefer to continue intracavernous injecti on. While sildenafil should be considered first line treatment, men with er ectile dysfunction should be aware of all treatment options available becau se nonresponders to sildenafil may respond to intracavernous injection.