Three-year outcome of a progressive treatment program for erectile dysfunction with intracavernous injections of vasoactive drugs

Objectives. To perform a comparative evaluation and follow-up of patients w ith erectile dysfunction (ED) who were treated with intracavernous injectio n of vasoactive drugs, starting with simple drugs and advancing to complex combinations. Methods. The study included 625 patients, 26 to 85 years old, with ED. Four intracavernous injection protocols were used: protocol 1, papaverine plus phentolamine; protocol 2, prostaglandin E-1; protocol 3, papaverine, phento lamine, and prostaglandin E-1; and protocol 4, atropine sulfate, papaverine , phentolamine, and prostaglandin E-1. A positive response was defined as a n erection sufficient for penetration. Patients for whom the basic protocol failed were successively switched to the more advanced protocols until a p ositive response was achieved. Results. A positive response was achieved by 415 (66.4%) of the 625 patient s given protocol 1; 75 (36%) of the remaining 210 patients given protocol 2 ; 98 (72.6%) of the 135 patients given protocol 3; and 22 (59.5%) of 57 pat ients given protocol 4. All four protocols failed in only 15 patients (2.4% ). At the 3-year follow-up visit (n = 610), 349 had achieved coitus, 65 (10 .6%) without an injection and 202 (33.1%) with an injection. Eighty-two pat ients sometimes performed coitus without an injection. Sixty-three patients (10.3%) abandoned the program because of marital or health problems; 198 a sked to be switched to Viagra during the follow-up period, and 120 returned to the program. Conclusions. Overall, our progressive treatment yielded a high positive res ponse rate (97.6%), with 57.2% achieving successful coitus on follow-up. Th e main advantage of the program is that it spares patients who are responsi ve earlier from using more complex, painful, and costly drugs. UROLOGY 56: 647-652, 2000. (C) 2000, Elsevier Science Inc.