title: Intracavernous injections for erectile dysfunction in patients with cardiovascular diseases and failure or contraindications for sildenafil citrate.
abstract: The aim of this study was to evaluate the effectiveness of a progressive program for the treatment of erectile dysfunction in patients with cardiovascular disease in whom sildenafil citrate (Viagra) was not an option. The study population included 106 patients selected from 267 with cardiovascular disease. The intracavernous injection program consisted of three protocols of increasingly complex combinations of vasoactive drugs, papaverine, phentolamine, prostaglandin E1 and atropine sulfate. Patients who failed the first protocol were switched to the second, and those who failed the second were switched to the third. A positive response was defined as an erection sufficient for vaginal penetration. A positive response was achieved on protocol I in 61 of the 106 patients (57.5%); protocol II in 32 of the remaining 45 patients (71.1%); and protocol III in seven of the remaining 13 patients (53.8%); the total success rate was 94.3%. These 100 patients were included in the 1-year follow-up, and 90 reported successful coitus at the end of that period: 79 patients (87.8%) with intracavernous injection and 11 (12.2%) without injection. The remaining 10 patients (10%) dropped out of the program, seven (7.0%) for health or marital reasons and three (3.0%) because of treatment failure. We conclude that a progressive program of intracavernous injections of vasoactive drugs may be a good alternative for the treatment of erectile dysfunction in patients with cardiovascular disease.
authors.affiliation: Institute of Urology, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49110, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Israilov
authors.forename: E
authors.initials: E
authors.lastname: Niv
authors.forename: P M
authors.initials: PM
authors.lastname: Livne
authors.forename: J
authors.initials: J
authors.lastname: Shmueli
authors.forename: D
authors.initials: D
authors.lastname: Engelstein
authors.forename: E
authors.initials: E
authors.lastname: Segenreich
authors.forename: J
authors.initials: J
authors.lastname: Baniel
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001285:Atropine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications*; D003075:Coitus; D000075202:Contraindications; D004338:Drug Combinations; D007172:Erectile Dysfunction / Q000150:complications* / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010208:Papaverine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010413:Penis; D010646:Phentolamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D011687:Purines; D019233:Retreatment; D000068677:Sildenafil Citrate; D013450:Sulfones; D017211:Treatment Failure; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000317:Adrenergic alpha-Antagonists; D004338:Drug Combinations; D018727:Muscarinic Antagonists; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D001285:Atropine; D000068677:Sildenafil Citrate; D010208:Papaverine; D000527:Alprostadil; D010646:Phentolamine