Diabetic impotence treated by intracavernosal injections: high treatment compliance and increasing dosage of vaso-active drugs.
OBJECTIVE
To compare patient compliance with treatment and the dosages of vaso-active drugs used, for the management of impotence in diabetic and non-diabetic patients.


METHODS
Eighteen diabetic and a control group of 22 non-diabetic men were followed up regularly for 7 years after they had begun self-injections for severe erectile dysfunction. Rigiscan was used for the objective determination of the initial dosage and then doses were regulated in order to introduce an erection suitable for penetration and maintenance of erection for 30 min.


RESULTS
Sixteen of 18 diabetic men are still using self-injections successfully after 7 years while of the 22 non-diabetic men, only 7 still continue injections. Compliance of diabetic men with treatment is significantly higher compared to the control group (p = 0.001). Doses of prostaglandin E(1) (PGE(1)) or mixtures of PGE(1) and papaverine (PAP) had to be increased over time. Although self-injections were a safe kind of treatment and no major complications were observed in both groups, a decrease in the frequency of injections was observed, particularly in the diabetic group, but this was not statistically significant (p = 0.15).


CONCLUSIONS
Diabetic patients with severe erectile dysfunction have much higher compliance with self-injections than the non-diabetic patients. They respond initially to reasonable doses of PGE(1) but over time need increasing doses of PGE(1) or mixtures of PGE(1) and PAP. Frequent follow-up visits and the adjustment of dosage to continue the success of therapy may prevent patient dissatisfaction and drop-out from treatment. Patients treated with self-injections decrease the frequency of injections over time. They are satisfied with less frequent but successful intercourse and have a low risk of side-effects.
Perimenis
P
P
Department of Urology, University Hospital, Patras, Greece. perimenis@internet.gr
Gyftopoulos
K
K
Athanasopoulos
A
A
Barbalias
G
G
D000527:Alprostadil / Q000008:administration & dosage / Q000627:therapeutic use*; D048909:Diabetes Complications; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D010208:Papaverine / Q000008:administration & dosage / Q000627:therapeutic use*; D010349:Patient Compliance; D010410:Penile Erection / Q000187:drug effects; D012646:Self Administration; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D004338:Drug Combinations; D014665:Vasodilator Agents; D010208:Papaverine; D000527:Alprostadil