The Effect of Intraurethral instillation of PGE1 Solution in the Patients with Erectile Dysfunction / 대한비뇨기과학회지

Intracavernosal self injection therapy is now being widely used to treat patients with erectile dysfunction. However, there is a large number of patients who gives up the self injection program due to the fear of needle or injection. Therefore, the less invasive route of drug administration is highly recommended. We investigated the efficacy of intraurethral instillation of PGE1 solution in comparison with the trimix intracavernosal injection. A total of 24 patients have been observed with either injection of trimix (11 patients), or intraurethral instillation of PGE1 (13 patients). All patients were evaluated with the penile doppler ultrasonography before 5,15,30 and 45 minutes after the drug administration. Penile length and circumference were measured before and after intraurethral administration of PGE1. Ten out of 11 patients (91%) showed positive response in trimix group and nine of 13 patients (69.2%) in PGE1 group. Mean length and circumference of penile shaft before and after the pharmacologic erection test showed significant difference in PGE1 group. The mean peak systolic velocity at 30 minutes was 28.5% 10.53 cm/sec in Trimix group and 28.2 t8.47 cm/sec in PGE, group (p=0.4773). The mean end diastolic velocity at 30 minutes was 8.4 5.23 cm/sec in Trimix group and 8.2=4.21 cm/sec in PGE1 group (p=0.4689). With the intraurethral administration of PGE1, urethral pain and irritation were the noticeable complications but systemic side effect was not noticed In conclusion, PGE1 intraurethral instillation can be satisfactorily used for the patients with erectile dysfunction of psychogenic, less prominent organic and neurogenic origin, although the effect of intraurethral instillation of PGE1 is obviously less than that of Trimix intracavernosal injection.

Trimix Intracavernosal Injection Therapy in the Patients with Erectile Dysfunction / 대한비뇨기과학회지

Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. But the individual vasoactive agent has limitations in its clinical success and potential for side effects. So, the synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy of erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. A total of 223 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). Major underlying diseases were DM(115patients, 51.6%), hypertension(11 patients, 4.9%), spinal injury(three patients, 1.3%) and prior pelvic surgery(three patients, 1.3%). The volume of drug used ranged between 0.04 and 0.6ml(average:0.19ml). After a mean followup of 7.6 months(3-15 months), 141 patients(63.2%) left in the home injection program and among them, 125 patients(88.6%) had very high satisfaction. The drop-out rate was 36.8%(82 of 223) with most of the cases during early home phase. The causes of drop-out were the fear of needle or injection, inadequate response to injection, loss of interest and complications. Priapism(six patients, 3.8%), pain(six patients, 3.8%) and granuloma on injection site(one patient, 0.6%) were noticeable complications, but coporal fibrosis and systemic side effect were not noticed. In conclusion, Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and, most of all, very effective method for the treatment of the patients with erectile dysfunctions.