title: Intracavernous Injections in Spinal Cord Injured Men With Erectile Dysfunction, a Systematic Review and Meta-Analysis.
abstract: Despite improvements in the care of patients after spinal cord injury (SCI), permanent impairment of locomotion, sensation, and autonomic function remains a major hurdle. After the acute stage of injury, recovering sexual function is a high priority.
  
  
  
  To review the efficacy of intracavernous injections (ICIs) in men with SCI and to identify prognostic factors affecting the efficacy of ICIs in this population.
  
  
  
  Systematic review of the literature was conducted using the PubMed-Medline, Embase, EBSCO, Web of Science, and Cochrane Library databases. The literature search was restricted to articles published in English, French, and Spanish up to November 2014 using the key words alprostadil, papaverine, moxisylite, alpha-blocking agent, phentolamine, intracavernous injection, spinal cord injuries, paraplegia, quadriplegia, and erectile dysfunction. Studies involving patients with SCI and erectile dysfunction treated with ICIs of alprostadil, papaverine, and α-blocking agents, including retrospective and prospective cohorts, population studies, and randomized controlled trials, were included.
  
  
  
  Overall response rate to ICI for erectile dysfunction in patients with SCI.
  
  
  
  Of 283 studies identified, 23 involved 713 patients with SCI. ICIs resulted in successful erections in 88% of patients (n = 713, 95% CI = 83%-92%). Erections were obtained in 93% of patients (n = 101, 95% CI = 83%-99%) with the combination of papaverine and phentolamine, in 91% (n = 274, 95% CI = 78%-97%) with papaverine alone, and in 80% (n = 119, 95% CI = 64%-90%) with alprostadil. Type of injected drug, doses, level of injury (complete or incomplete), extent of injury, age, time since injury, and persistence or transience of erections were evaluated, but statistical analysis could not identify specific factors predictive of a response to ICI.
  
  
  
  ICIs are an effective treatment of erectile dysfunction in men with SCI. No predictive factor for efficacy could be identified. Studies comparing the response to ICI in upper vs lower motor neuron lesions could improve our understanding of ICI failure.
authors.affiliation: PRM Department, University Hospital of Rennes, Rennes, France. Electronic address: lucie.chochina@chu-rennes.fr.
authors.forename: Lucie
authors.initials: L
authors.lastname: Chochina
authors.affiliation: Pharmacology Department, University Hospital of Rennes, Rennes, France.
authors.forename: Florian
authors.initials: F
authors.lastname: Naudet
authors.affiliation: PRM Department, University Hospital of Rennes, Rennes, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Chéhensse
authors.affiliation: Urology Department, University Hospital of Rennes, Rennes, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Manunta
authors.affiliation: PRM Department, University Hospital of Rennes, Rennes, France.
authors.forename: Mireille
authors.initials: M
authors.lastname: Damphousse
authors.affiliation: PRM Department, University Hospital of Rennes, Rennes, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bonan
authors.affiliation: R. Poincaré Hospital AP-HP, Garches, Inserm U1179, Versailles-Saint Quentin en Yvelines University, Montigny-le-Bretonneux, France.
authors.forename: François
authors.initials: F
authors.lastname: Giuliano
mesh_terms: D000527:Alprostadil / Q000008:administration & dosage / Q000627:therapeutic use; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D013948:Moxisylyte / Q000008:administration & dosage / Q000627:therapeutic use; D010208:Papaverine / Q000008:administration & dosage / Q000627:therapeutic use; D010410:Penile Erection; D011446:Prospective Studies; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000503:physiopathology*; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D010208:Papaverine; D000527:Alprostadil; D013948:Moxisylyte
keywords: Alprostadil; Erectile Dysfunction; Papaverine; Paraplegia; Quadriplegia