What is the role of intracavernosal injections in the treatment of erectile dysfunction (ED)?

Updated: Aug 08, 2018
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

The modern age of pharmacotherapy for ED began in 1993, when papaverine, an alpha-receptor blocker that produces vasodilatation, was shown to produce erections when injected directly into the corpora cavernosa. Soon afterward, other vasodilators, such as alprostadil (ie, synthetic PGE1) and phentolamine, [42] were demonstrated to be effective either as single agents or in combination. [97, 98]

Alprostadil is the single agent most commonly used for intracavernosal injections. In a study of 683 men, 94% reported having erections suitable for penetration after alprostadil injections. [99] Self-injection of this and similar agents has been of enormous benefit because they represent an effective way to achieve adequately rigid erections for a wide variety of men who otherwise would be unable to do so.

If the vasculature within the corpora cavernosa is healthy, intracavernosal injection therapy is almost always effective. However, careful instruction in how to perform the injections is essential. The dosage is adjusted so as to achieve an erection with adequate rigidity for no more than 90 minutes. Alprostadil doses as high as 40 µg can be used. An abnormal finding after biothesiometry testing has been suggested as an indicator of possible heightened sensitivity to intracavernosal injections, but this suggestion remains unproven.

The main adverse effects of intracavernosal injection are as follows [99, 100, 101] :

  • Painful erection
  • Priapism
  • Development of scarring at the injection site

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