Andrology Unit, Institute of Urology, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Correspondence to: Dr J Shmueli, Institute of Urology, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49 100, Israel

To account for severity of disease in patients with erectile dysfunction, we introduced a progressive treatment technique using four protocols of drug injections.

The study group consisted of 452 men aged 26-85 y with erectile dysfunction. Protocol I. All patients began with a combination of papaverine and Regitine in doses adjusted to the estimated severity of dysfunction and to age, up to a maximum dose of 25 mg papaverine and 1.5 mg of Regitine. Protocol II. Patients who could not achieve sufficient rigidity on protocol I were switched to prostin VR, to a maximum of 25 mcg. Protocol III. Patients who failed protocol II received papaverine, Regitine and prostin VR. Protocol IV. Patients who failed protocol III received atropine sulfate (0.02-0.06 mg) in addition to papaverine, Regitine and prostin.

Sufficient rigidity was achieved as follows: Protocol I=305 (67.4%) of the original cohort; Protocol II=61 of the 147 failures with Protocol I (41.5%); Protocol III=55 of the 86 failures with Protocol II (63.9%); Protocol IV=20 of the remaining 31 patients (64.5%). Overall, sustained rigidity was achieved in 441 of the 452 patients (97.5%). Eleven patients (2.5%) failed all four protocols and were offered a penile prosthesis.

Therefore, using our progressive method, by starting with the most available and inexpensive drugs, patients with erectile dysfunction can be given optimal treatment according to the severity of their disease. The success rate is high while costs are kept to a minimum.

erectile dysfunction; progressive intracorporeal injection; papaverine; Regitine; prostin VR; atropine sulfate