RESUMO
We studied the efficacy of combination therapy in impotent patients with inadequate response to sildenafil and intracorporal injection monotherapy. Patients and Methods: Enrolled in this study were 23 impotent patients 28-55 years old [mean 46.7] with inadequate response to both sildenafil and intracorporal injection monotherapy. All patients underwent detailed history and physical examination, FBS determination, penile duplex doppler ultrasound and pharmaco-cavernosometry. A trial of combination therapy using oral sildenafil [50-100 mg] and intracorporal injection of trimixture [28 mg/ml papaverine, 0.58 mg/ml phentolamine and 10 micro ug alprostadil]. The response was evaluated and side effects recorded. The etiology of erectile dysfunction in the studied group was venogenic in 56.52%, arteriogenic in 21.73% and combined anteriogenic and venogenic in 21.73%. Seven out of these 23 patients [30.43%] responded to combination therapy either by complete erection in 4 patients or by moderate rigidity enough for intromission in 3. Non responders showed a higher FME and EDV than those responding to combined therapy. These differences in FME and EDV were statistically highly significant between both groups. All patients not responding to both oral sildenafil and intracorporal injection monotherapy had vasculogenic etiology for impotence. Combination treatment may potentially salvage one third of cases refractory to single modality treatment