Pharmacologically induced penile erections in the assessment and treatment of erectile impotence: a preliminary study of 100 patients.

OBJECTIVE: To assess and compare the immediate and subsequent response to pharmacologically induced penile erections, using intracavernosal injections of papaverine. DESIGN: Preliminary, prospective study. SETTING: Male sexual dysfunction clinic at the National Hospital of Sri Lanka. PATIENTS: 100 consecutive patients receiving 20 mg papaverine hydrochloride intracavernosally as the first dose. MAIN OUTCOME MEASURES: Assessment of the quality of the erection following the initial injection and determination of the optimum dose to achieve a normal erection; number who elected self-injection at home. RESULTS: Mean age of the 100 impotent men was 36.6 years and the mean duration of erectile dysfunction 43.9 months. Of men in the third decade 87.5% had a normal erection but only one-third of patients over 50 years showed a normal response. 16 patients had a reasonably well established organic problem. 42% of patients had normal nocturnal or early morning erections. The drop-out rate after the initial injection was 17%, 19% of men had a normal erection with 20 mg papaverine and 67% had a normal response to 20 to 80 mg papaverine. Seven patients continued on the self-injection program. Prolonged erections were experienced by 6% of men (1.9% of injections). CONCLUSIONS: Intracavernosal injection of papaverine hydrochloride is effective in a dose of 20 to 80 mg.

Propanil poisoning.

OBJECTIVE: To document clinical features of propanil poisoning and discuss treatment. DESIGN, SETTING AND PATIENTS: Five patients treated in the University medical unit at the Karapitiya teaching hospital over the past two years. INTERVENTIONS AND MEASUREMENTS: Relevant laboratory investigations were done. The patients were treated on accepted lines. RESULTS: All had methaemoglobinaemia. The first patient died after severe poisoning in spite of intensive treatment. The second had severe poisoning requiring exchange transfusion and treatment with methylene blue. The third, fourth and fifth patients had mild poisoning which responded readily to oral methylene blue. The last patient had taken a combination of propanil and oxydiazone. The first and second patients had features of haemolysis and the second patient had acute hepatitis. CONCLUSIONS: Propanil poisoning is uncommon. Lower levels of methaemoglobin than were previously thought may be associated with a fetal outcome. Methylene blue is used in the treatment as it reduces blood methaemoglobin but in severe poisoning exchange transfusion may be necessary as a life saving measure.