title: Complications of intracavernous injections and penile prostheses in spinal cord injured men.
abstract: Erectile dysfunction is a common complication in men who have had spinal cord injury (SCI). This retrospective study focuses on the complications encountered at our institution with both penile prostheses and intracavernous injections in men with SCI. Seventy-two men with SCI were treated with intracavernous injections for erectile dysfunction, and 30 penile prostheses were implanted in 19 men with SCI. Twenty-two of the 72 patients in the intracavernous injection program had adverse effects; none were severe. Prolonged erections lasting four to six hours and ecchymosis were the most common complications. No complication required discontinuation of treatment. There were 23 inflatable prostheses and seven semirigid rods. Mechanical failures occurred in 15 instances, infection occurred in nine, and late erosion occurred in three. Although multiple revisions and replacements were necessary, 14 of the 19 patients had satisfactorily functioning implants at their last outpatient visit. Patients were selected carefully for penile implant placement and yet significant complications and expense were incurred to obtain satisfactory results. Although follow-up has been relatively short, the intracavernous injections of vasoactive medications appear to be a more attractive initial means of treating the erectile dysfunction in men with SCI. The complications are relatively minor and the incidence of prolonged erections has decreased with increased experience. Furthermore, the cost of treatment will be considerably less than that with implant surgery, particularly in view of the high drop-out rate. Although improved implants have decreased the occurrences of mechanical failure, it seems likely that infection and extrusion will continue to be significant problems among men with SCI.
authors.affiliation: King's Daughters' Medical Center, Ashland, KY.
authors.forename: C J
authors.initials: CJ
authors.lastname: Dietzen
authors.forename: L K
authors.initials: LK
authors.lastname: Lloyd
mesh_terms: D000328:Adult; D007172:Erectile Dysfunction / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis / Q000009:adverse effects*; D016459:Prosthesis-Related Infections; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000534:rehabilitation*