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Intracavernous injections for erectile dysfunction in patients with cardiovascular diseases and failure or contraindications for sildenafil citrate

Abstract

The aim of this study was to evaluate the effectiveness of a progressive program for the treatment of erectile dysfunction in patients with cardiovascular disease in whom sildenafil citrate (Viagra) was not an option. The study population included 106 patients selected from 267 with cardiovascular disease. The intracavernous injection program consisted of three protocols of increasingly complex combinations of vasoactive drugs, papaverine, phentolamine, prostaglandin E1 and atropine sulfate. Patients who failed the first protocol were switched to the second, and those who failed the second were switched to the third. A positive response was defined as an erection sufficient for vaginal penetration. A positive response was achieved on protocol I in 61 of the 106 patients (57.5%); protocol II in 32 of the remaining 45 patients (71.1%); and protocol III in seven of the remaining 13 patients (53.8%); the total success rate was 94.3%. These 100 patients were included in the 1-year follow-up, and 90 reported successful coitus at the end of that period: 79 patients (87.8%) with intracavernous injection and 11 (12.2%) without injection. The remaining 10 patients (10%) dropped out of the program, seven (7.0%) for health or marital reasons and three (3.0%) because of treatment failure. We conclude that a progressive program of intracavernous injections of vasoactive drugs may be a good alternative for the treatment of erectile dysfunction in patients with cardiovascular disease.

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References

  1. Conti CR, Pepine CJ, Sweeney M. . Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease. Am J Cardiol 1999 83: 29C–34C.

    Article  CAS  Google Scholar 

  2. Goldstein I et al . Oral sildenafil in the treatment of erectile dysfunction. New Engl J Med 1998 338: 1397–1403.

    Article  CAS  Google Scholar 

  3. McMahon CG, Samali R, Johnson H. . Efficacy, safety and patient acceptance of sildenafil citrate as treatment for erectile dysfunction. J Urol 2000 164: 1192–1196.

    Article  CAS  Google Scholar 

  4. Meuleman B et al . A dose-escalation study to assess the efficacy and safety of sildenafil citrate in men with erectile dysfunction. Br J Urology 2001 87: 75–81.

    Article  CAS  Google Scholar 

  5. Kloner RA, Jarow JP. . Erectile dysfunction and sildenafil citrate and cardiologists. Am J Cardiol 1999 83: 576–580.

    Article  CAS  Google Scholar 

  6. Zusman RM, Morales A, Glasser DB, Osterloh IH. . Overall cardiovascular profile of sildenafil citrate. Am J Cardiol 1999 83: 35–43c.

    Article  Google Scholar 

  7. Herrmann HC, Change G, Klugherz BD, Mahoney PD. . Hemodynamic effects of sildenafil in men with severe coronary artery disease. New Engl J Med 2000 342: 1622–1626.

    Article  CAS  Google Scholar 

  8. Mydlo JH, Volpe MA, Macchia RJ. . Initial results utilizing combination therapy for patients with a suboptimal response to either alprostadil or sildenafil monotherapy. Eur Urol 2000 38: 30–34.

    Article  CAS  Google Scholar 

  9. Moreira SG et al . Side-effect profile of sildenafil citrate (Viagra) in clinical practice. Urology 2000 56: 474–476.

    Article  Google Scholar 

  10. Cheitlin MD et al . Use of sildenafil (Viagra) in patients with cardiovascular disease. Circ J Am Health Assoc 1999 99: 166–177.

    Google Scholar 

  11. Tzivoni D, Klein J, Hisdai D, Roth A. . The Israel Heart Society Expert Consensus document: The cardiac patient and sexual activity in the era of sildenafil (Viagra). Isr Med Assoc J (IMAJ) 2000 2: 63–65.

    CAS  Google Scholar 

  12. Rosen RC et al . The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology 1997 49: 822–830.

    Article  CAS  Google Scholar 

  13. Cappelleri JC et al . Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology 1999 54: 346–351.

    Article  CAS  Google Scholar 

  14. Bland M. . Introduction to Medical Statistics Oxford University Press: Oxford 1989 20–104.

    Google Scholar 

  15. McMahon CG, Samali R, Johnson H. . Treatment of intracorporeal injection nonresponders with sildenafil alone or in combination with triple agent intracorporeal injection therapy. J Urol 1999 162: 1992–1997.

    Article  CAS  Google Scholar 

  16. Shabsigh R et al . Intracavernous alprostadil alfadex (Edem/Viridal) is effective and safe in patients with erectile dysfunction after failing sildenafil (Viagra). Urology 2000 55: 477–480.

    Article  CAS  Google Scholar 

  17. Hatzichristou DG et al . Sildenafil versus intracavernous injection therapy: efficacy and preference in patients on intracavernous injection for more than 1 y. J Urol 2000 164: 1197–1200.

    Article  CAS  Google Scholar 

  18. Gasser TC et al . Intracavernous self-injection with phentolamine and papaverine for the treatment of impotence. J Urol 1987 137: 678–680.

    Article  CAS  Google Scholar 

  19. Bechara A et al . Comparative study of papaverine plus phentolamine versus prostaglandin E1 in erectile dysfunction. J Urol 1997 157: 2132–2134.

    Article  CAS  Google Scholar 

  20. Levine SB et al . Side effects of self-administration of intracavernous papaverine and phentolamine for the treatment of impotence. J Urol 1989 141: 54–58.

    Article  CAS  Google Scholar 

  21. Floth A, Schremer P. . Intracavernous injections of prostaglandin E1 in combination with papaverine-enhanced effectiveness in comparison with papaverine plus phentolamine and prostaglandin E. J Urol 1991 145: 56–59.

    Article  CAS  Google Scholar 

  22. Purvis K, Edgetveit I, Christiansen E. . Intracavernosal therapy for erectile failure—impact of treatment and reasons for drop-out and dissatisfaction. Int J Impot Res 1999 11: 287–299.

    Article  CAS  Google Scholar 

  23. Godschalk M, Cheorghiu D, Katz PG, Mulligan T. . Alkalization does not alleviate penile pain induced intracavernous injection of prostaglandin E1 J Urol 1996 156: 999–1000.

    Article  CAS  Google Scholar 

  24. Montorsi F et al . Four-drug intracavernous therapy for impotence due to corporeal veno-occlusive dysfunction. J Urol 1993 149: 1291–1295.

    Article  CAS  Google Scholar 

  25. Sogari PR, Teloken C, Souto CAV. . Atropine role in the pharmacological erection test: study of 228 patients. J Urol 1997 158: 1760–1763.

    Article  CAS  Google Scholar 

  26. Brock G, Lei Mai Tu, Linet O. . Return of spontaneous erection during long-term cavernosal alprostadil (Caverject) treatment. Urology 2001 57: 536–541.

    Article  CAS  Google Scholar 

  27. Mantam P et al . Nocturnal penile tumescence activity unchanged after long-term intracavernous injection therapy. J Urol 2001 165: 830–833.

    Article  Google Scholar 

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Israilov, S., Niv, E., Livne, P. et al. Intracavernous injections for erectile dysfunction in patients with cardiovascular diseases and failure or contraindications for sildenafil citrate. Int J Impot Res 14, 38–43 (2002). https://doi.org/10.1038/sj.ijir.3900812

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