Re-dosing of prostaglandin-E₁ versus prostaglandin-E₁ plus phentolamine in male erectile dysfunction: a dynamic color power Doppler study

Abstract

During penile pharmacotesting, anxiety may overcome complete smooth muscle relaxation and lead to false positive diagnosis of organic male erectile dysfunction (ED). We tested the efficacy and safety of re-dosing of PGE₁ alone versus combination of PGE₁ and the α_1,2-blocker phentolamine (PHE) to improve an incomplete pharmaco-induced erection during color-power-Doppler (CPD) sonography. 116 consecutive impotent patients were submitted to CPD and injected with 10 μg PGE₁ plus audiovisual sexual stimulation. Clinical evaluation of rigidity and CPD parameters were normal in 26 patients while in the remaining they were upgraded in 15% and 35% after re-dosing of 10 μg PGE₁ alone and 10 μg PGE₁ plus 1 mg PHE, respectively (P<0.05); furthermore, in these latter patients CPD studies showed increased visualisation of distal ramifications of helicine arterioles. The final diagnosis was changed in those patients who responded to re-dosing with no differences in the occurrence of prolonged erections between the two treatments. We conclude that re-dosing of PGE₁/PHE mixture is a safe and effective procedure to maximize erectile response during dynamic CPD sonography and has a better diagnostic sensitivity than re-dosing of PGE₁ alone.