Penile Abscess Caused by Intracavernous Injection of Sildenafil Citrate Oral Pill / 대한남성과학회지

We report the successful treatment by percutaneous aspiration and antibiotics of a penile abscess in an elderly man attributed to misapplication of sildenafil citrate. The etiology, diagnosis, and management of penile abscess are discussed.

The Effects of Sildenafil Citrate as an Intracavernosal Agent / 대한남성과학회지

PURPOSE: Treatment of impotence has advanced considerably by an orally active, effective and well-tolerated drug, sildenafil citrate. However, Sildenafil citrate is not so effective for the treatment of severe organic impotence patients. Intracavernosal injection of vasoactive substance is still the most effective therapy for those patients but side effects, e.g. pain, priapism, require a more comfortable therapy. We performed this study to assess the feasibility of sildenafil citrate as a new intracavernosal agent. MATERIALS AND METHODS: In New Zealand white male rabbits (n=11), relaxations of precontracted cavernosal smooth muscle strips were studied after administration of sildenafil citrate, acetylcholine and sodium nitroprusside (SNP), respectively. In separate in vivo experiment, changes of intracavernosal pressure (ICP), duration of increased ICP and changes of systemic arterial blood pressure after retrograde selective internal pudendal arterial administration of four separate doses (0.1 mg, n=5; 0.3 mg, n=6; 0.5 mg, n=7; 1.0 mg, n=7) of sildenafil citrate were monitored in adult male cats (n=25). RESULTS: Acetylcholine, SNP and sildenafil citrate effectively relaxed the precontracted strips in a dose-dependent manner (3x10 8-3x10 3 M), respectively. Maximal relaxation of strips to acetylcholine, SNP and sildenafil citrate were 50.11%, 98.65%, and 68.32%, respectively. The order of potency was acetylcholine

Priapism Lasting for Over 24 hours Induced by Intracavernous Vasoactive Agents / 대한남성과학회지

PURPOSE: Retrospective study was done to evaluate the causes of priapism lasting for over 24 hours induced by intracavernous vasoactive agents. MATERIALS AND METHODS: Thirteen patients of priapism lasting for 24-60 hours, induced by intracavernous vasoactive drugs, were retrospectively evaluated using medical records or by telephone interviews. Injected vasoactive drugs, providers of the drugs, purpose of the injection, reasons leaving the priapism untreated so long, treatment modalities of the priapism, and change of potency after the treatment were evaluated. RESULTS: Only 2 patients (15.4%) were self-injected to treat erectile dysfunction by doctor's prescription. The others, who received the drugs without doctor's prescription, had injections to enhance their potency (46.1%, n=6) or to treat premature ejaculation (15.4%, n=2). The drugs injected were papaverine (23.1%, n=3), papaverine and phentolamine (23.1%, n=3) or prostaglandin E1(7.7%, n=1), but unknown in 6 (46.1%). The reasons of leaving the priapism untreated were mostly due to lack of no knowledge about the priapism (53.8%, n=7). Aspiration and irrigation with alpha-agonist of corpus cavernosum were applied to all patients. Four patients who did not respond to the treatment underwent shunt operations. All the patients complained of weakened potency after the priapism. CONCLUSIONS: Priapism lasting for over 24 hours induced by intracavernous vasoactive drugs were mostly due to abuse or misuse of the drugs and resulted in weakened potency. To avoid this disaster, the drugs should be given to patients by doctor's prescription with full explanation about the side effects of the drug.

The Erectile Response to Intracavernosal Injection of Prostaglandin E1 in Spinal Cord Injured Men

OBJECTIVE: To study the erectile response to intracavernosal injection of prostaglandin E1 in 33 spinal cord injured men with neurogenic erectile dysfunction. METHOD: The erectile response was assessed by the penile palpation. Thirty three subjects (mean age, 35.5 years) were studied. They received a testing dosage starting from 2.5 microgram with increasing dosage (maximum 40 microgram) to achieve an erection. The positive response accounts for the sufficient erection lasting for more than 30 minutes. RESULTS: After the injection, 30 subjects (90.9%) achieved the positive response and the mean duration of erection was 59.2 minutes. Of the 30 positive responders, the mean dosage needed to induce positive response was 5.8 microgram in the patients with cervical cord injury (12 subjects), 13.1 microgram in the patients with thoracic cord injury (12 subjects), and 33.3 microgram in the patients with lumbar cord injury (6 subjects). The mean dosage required for the positive response was different according to the pre-injection erectile function of the subjects. For the positive response, it required 7.7 microgram in a full erection with short duration group (14 subjects), 9.4 microgram in a partial erection group (8 subjects), and 30.6 microgram in no erection group (8 subjects). No systemic side effect or complication was noted except for the prolonged erection in 1 subject. CONCLUSION: The intracavernosal injection of prostaglandin E1 appears to be a safe and effective treatment for the treatment of erectile dysfunction in spinal cord injured men. The dosage depends on the level of spinal cord injury and pre-injection erectile function.

Efficacy, Satisfaction, and Drop-out Rate of Alprostadil (Prostagladin E1) Intracavernosal Injection According to Etiologic Cause of Erectile dysfunction / 대한남성과학회지

PURPOSE: Intracavernosal self-injection therapy is now being used widely to treat erectile dysfunction. Although several intracavernosal therapies are available, their efficacy and safety have not been studied systematically. We investigates the efficacy and safety of intracavernosal injection of alprostadil (PGE1 ) in patients with erectile dysfunction. MATERIALS AND METHODS: From June 1996 to March 1998, 181 patients with erectile dysfunction were included in this study. Each patient was treated initially with 10micro gram of PGE1 . If the result of the injection was unsatisfactory, 20 micro gram of PGE1 was administered. The erection was evaluated clinically by manual palpation and estimated on a 5-point scale as no response, some enlargement, full enlargement, erection sufficient for intercourse, and full rigidity. In addition, each patient assessed his satisfaction with the treatment using a 3-point scale as poor, fair or good. The erectile dysfunction was classified as psychogenic, vascular, diabetic, neurogenic, or undetermined. To determine possible side effects, penile pain, hematoma, prolonged erection, priapism, and so forth were recorded by a questionnaire. RESULTS: Of the 181 men in this study, 60 (33.2%), 45 (24.9%), 42 (23.2%), 14 (7.7%), and 20 (11.0%) were judged to have psychogenic, vascular, diabetic, neurogenic, and undetermined causes of erectile dysfunction, respectively. A good erectile response to PGE1 was seen in 59 (98.4%), 38 (84.4%), 37 (88.1%), 13 (92.9%), and 16 (80%), respectively, of the patients in these groups. Satisfaction with the treatment was reported by 59 (98.3%), 39 (86.6%), 38 (90.5%), 13 (90%) patients. Only three drug-related side effects were observed: penile pain in 54 patients (33.5%), hematoma in 5 (2.8%), and prolonged erection in 4 (2.4%). Nevertheless, the dropout rate was 46% (83/181). The causes of discontinuation within 3 months were absence of sexual partner (8.8%), recovery of erectile function (9.5%), difficulty of manipulation (19.3%), needle phobia (22.7%), pain (21.5%), and economic status (18.2%). CONCLUSIONS: PGE1 was highly effective at producing an erection satisfactory for vaginal intercourse. The response rate was higher in psychogenic and neurogenic impotence than in vascular and diabetic impotence. Given the freedom from adverse effects such as fibrotic plaques, priapism, and liver dysfunction, PGE1 seems to be a preferable alternative to other drugs for intracavernosal injection therapy and is currently the only FDA-approved drug for this purpose. However, the dropout rate was high. Dilated attention to the procedure and careful follow-up are crucial to achieve maximal success and decrease the dropout rate.

Recurrent Priapism: 3 Cases Report / 대한비뇨기과학회지

Recurrent episodes of venoocclusive priapism have been described previously in patients who have had repeated exposure to a recognized stimulus such as intracavernosal injections of vasoactive agents, or pathologic conditions such as spinal stenosis or hematological disorders. Three patients were referred for evaluation of an unusual sequoia of an initial episode of idiopathic venoocclusive priapism, occurred with a frequency ranging from several times per month to once per year and were symptomatically disabling. We reviewed the characteristics and the possible pathophysiology of this syndrome and some therapeutic options in the management of these patients.