Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Research
  • Published:

Combining programmed intracavernous PGE1 injections and sildenafil on demand to salvage sildenafil nonresponders


In a prospective, placebo-controlled, one group crossover design study, we tested whether adding programmed intracavernous PGE1 injections (IC-PGE1) can improve the effectiveness of sildenafil in erectile dysfunction (ED) patients unresponsive to monotherapy with this drug. In all, 40 ED patients who had experienced unsatisfactory erections with both the 50 and 100 mg sildenafil doses were treated with four bi-weekly 20 μg IC-PGE1 injections given in the clinic and provided with either placebo or 50 mg sildenafil capsules for the next 4 weeks. Thereafter, they were crossed over to the other oral treatment for an additional 4-week period. The IIEF-Erectile Function domain score (IIEF-EFS), the main outcome measure, was found considerably higher (P<0.001) with the combined IC-PGE1–50 mg sildenafil treatment than with IC-PGE1–placebo or sildenafil alone (50 or 100 mg) in a subset of 26 subjects (65%). They thus shifted from the ‘severe’ or ‘moderate’ to the ‘mild’ grading of ED classification.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others


  1. Fazio L, Brock G . Erectile dysfunction: management update. Canadian Med Assoc J 2004; 170: 1429–1437.

    Article  Google Scholar 

  2. Porst H . Current perspectives on intracavernosal pharmacotherapy for erectile dysfunction. Int J Impot Res 2000; 12(Suppl 4): S91–S100.

    Article  Google Scholar 

  3. Porst H et al. Intracavernous alprostadil Alfadex—an effective and well tolerated treatment for erectile dysfunction. Results of a long-term European study. Int J Impot Res 1998; 10: 225–231.

    Article  CAS  Google Scholar 

  4. Virag R et al. Intracavernous self-injection of vasoactive drugs in the treatment of impotence: 8-year experience with 615 cases. J Urol 1991; 145: 287–293.

    Article  CAS  Google Scholar 

  5. Sundaram CP et al. Long-term follow-up of patients receiving injection therapy for erectile dysfunction. Urology 1997; 49: 932–935.

    Article  CAS  Google Scholar 

  6. Casabé A et al. Drop-out reasons and complications in self-injection therapy with a triple vasoactive drug mixture in sexual erectile dysfunction. Int J Impot Res 1998; 10: 5–9.

    Article  Google Scholar 

  7. Rowland DL, Boedhoe HSM, Dohle G, Slob AK . Intracavernosal self-injection therapy in men with erectile dysfunction: satisfaction and attrition in 110 patients. Int J Impot Res 1999; 11: 145–151.

    Article  CAS  Google Scholar 

  8. Purvis K, Egdetveit 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 

  9. Mulhall JP et al. The causes of patient dropout from penile self-injection therapy for impotence. J Urol 1999; 162: 1291–1294.

    Article  CAS  Google Scholar 

  10. Mydlo JH, Volpe MA, Macchia RJ . Results from different patient populations using combined therapy with alprostadil and sildenafil: predictors of satisfaction. Br J Urol Int 2000; 86: 469–473.

    Article  CAS  Google Scholar 

  11. Nehra A, Blute ML, Barrett DM, Moreland RB . Rationale for combination therapy of intraurethral prostaglandin E1 and sildenafil in the salvage of erectile dysfunction patients desiring noninvasive therapy. Int J Impot Res 2002; 14(Suppl 1): S38–S42.

    Article  Google Scholar 

  12. McMahon CG, Samali R, Johnson H . Treatment of intracorporal injection non-response with sildenafil alone or in combination with triple agent intracorporeal injection therapy. J Urol 1999; 162: 1992–1997.

    Article  CAS  Google Scholar 

  13. Escrig A, Marin R, Mas M . Repeated PGE1 treatment enhances nitric oxide and erection responses to nerve stimulation in the rat penis by upregulating constitutive NOS isoforms. J Urol 1999; 162: 2205–2210.

    Article  CAS  Google Scholar 

  14. 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 

  15. Steers WD . Viability and safety of combination drug therapies for erectile dysfunction. J Urol 2003; 170: S20–S23.

    Article  Google Scholar 

  16. McMahon CG . Priapism associated with concurrent use of phosphodiesterase inhibitor drugs and intracavernous injection therapy. Int J Impot Res 2003; 15: 383–384.

    Article  CAS  Google Scholar 

  17. Montorsi F et al. Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J Urol 1997; 158: 1408–1410.

    Article  CAS  Google Scholar 

  18. 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 

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

    Article  CAS  Google Scholar 

  20. Buvat J, Lemaire A, Ratajcyk J . Acceptance, efficacy and preference of sildenafil in patients on long-term auto-intracavernosal therapy: a study with follow-up at one year. Int J Impot Res 2002; 14: 483–486.

    Article  CAS  Google Scholar 

Download references


This work was supported by a Medical Grant from Pfizer SA, Madrid, Spain and Grant PM 99/0144 from the Spanish Ministry of Science and Technology.

Author information

Authors and Affiliations


Corresponding author

Correspondence to M Mas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gutierrez, P., Hernandez, P. & Mas, M. Combining programmed intracavernous PGE1 injections and sildenafil on demand to salvage sildenafil nonresponders. Int J Impot Res 17, 354–358 (2005).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


This article is cited by


Quick links