Intracavernosol Injection Algorithm

Jeffrey A. Albaugh, MS, APRN, CUCNS

Disclosures

Urol Nurs. 2006;26(6):449-453. 

In This Article

Patient Education

Each patient I see in the clinic who has not previously performed intracavernosal injections is given comprehensive instruction and follow-up. The initial instruction session includes several important steps for education. If the patient is using Edex or Caverject Impulse, he watches the video instruction provided by the appropriate manufacturer. All patients are given both verbal and written instructions on how to prepare and self-inject the medication, side effects, and what to do if problems occur (including priapism, Peyronie's disease, and pain). The client's partner may need to be the one injecting the medication if the client is unable. Manufacturer's written instructions are given to patients who use Edex or Caverject, while the written instructions I developed were created for use with generic prostaglandin or multi-agent compounded medication. Additional written instructions may be available through some of the compounding pharmacies such as the directions supplied by University Compounding Pharmacy (https:// www.ucprx.com/ed_dysfunction.htm). I also developed a supplemental one-page patient education handout for each of the injectable agents to provide a quick, simple reference for patients (see Table 2 ).

After the patient receives written and verbal instructions, a demonstration of the technique for preparing and injecting the medication is done utilizing a prosthetic model of the penis. The final step of teaching is for the patient to return demonstrate appropriate technique for preparing and injecting the actual intracavernosal injection. Any questions are answered and the patient is evaluated for the strength of the erection and adverse side effects (especially pain). The patient is taught to rotate injection sites with each injection and how often he can safely use the injections (Edex and Caverject prescribing guidelines recommend no more than 3 times a week and once in 24 hours to prevent corporal scarring).

The patient is given contact information for the advanced practice nurse and told to report back on how the injection therapy went at home with the determined next doses of injections. Contact information is also obtained from the patient for followup purposes and it is essential to communicate with patients after they have initiated treatment at home. Often patients may have questions or concerns about the injections or dose titration and they always appreciate the followup communication to ensure they are progressing with the treatment appropriately. Some clinicians may prefer to do further titrating of medications in the clinic and additional instruction may be needed for patients when they switch to different agents.

The patient is instructed to come to the clinic (if during normal clinic hours) or go to the emergency room if he develops priapism lasting greater than 2 to 3 hours. Some clinics may prescribe Brethine® (terbutaline) 5 mg tablets (one to two tablets) for priapism to try and resolve the problem and possibly avoid the trip to the emergency room. The patient takes the terbutaline tablets and waits approximately 45 minutes to see if the erection begins to resolve and becomes easily bendable. If this oral medication does not work, the patient must go to the emergency room for treatment (typically an injection of phenylephrine 0.1 mg/ml).

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