Document Detail


Treatment of intracorporeal injection nonresponse with sildenafil alone or in combination with triple agent intracorporeal injection therapy.
MedLine Citation:
PMID:  10569554     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We assess the efficacy of sildenafil as salvage therapy for intracorporeal injection therapy nonresponse. MATERIALS AND METHODS: The study group comprised 93 patients with a mean age of 53.6 years (range 24 to 77) with chronic erectile dysfunction. In all cases a home trial of intracavernosal injection of high dose alprostadil and triple agent intracavernosal injection therapy had failed. Patients were treated with sildenafil citrate alone or in combination with intracavernosal injection therapy. RESULTS: The etiology of erectile dysfunction was arteriogenic in 29 cases, cavernosal venous leakage in 36, mixed vasculogenic in 24, psychogenic in 3 and post-priapism intracavernous fibrosis in 1. Of the 32 sildenafil responders (34% of the study group) 30 required 100 and 2 required 50 mg. The 29 sildenafil intracavernosal injection (combined therapy) responders (31% of the study group) required 100 mg. sildenafil. There were 32 nonresponders (34% of the study group). Mean International Index of Erectile Function questions 3 and 4 scores were 1.7 and 1.5 at baseline, 2.3 and 1.9 with intracavernosal injection, 4.6 and 42.2 with sildenafil, and 4.1 and 4.10 with combined therapy, respectively. Of the 93 patients 29 (31%) treated with intracavernosal injection reported adverse effects, including penile pain in 27, dizziness in 5 and headache in 2. Of the patients treated with sildenafil 34 (37%) reported side effects, including headache in 30, facial flushing in 25, dyspepsia in 12, nasal congestion in 9, dizziness in 5 and visual disturbances in 1. Of the 41 patients given combined therapy 20 (49%) reported adverse effects, including penile pain in 15, headache in 15, facial flushing in 12, dyspepsia in 7, nasal congestion in 3, dizziness in 12 and syncope in 1. CONCLUSIONS: Sildenafil alone or sildenafil plus intracavernosal injection is effective salvage therapy for intracavernosal injection nonresponse. Sildenafil in combination with intracavernosal injection is associated with a 33% incidence of adverse effects, including a 20% incidence of dizziness.
Authors:
C G McMahon; R Samali; H Johnson
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of urology     Volume:  162     ISSN:  0022-5347     ISO Abbreviation:  J. Urol.     Publication Date:  1999 Dec 
Date Detail:
Created Date:  2000-01-06     Completed Date:  2000-01-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1992-7; discussion 1997-8     Citation Subset:  AIM; IM    
Affiliation:
Australian Centre for Sexual Health, Sydney.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Alprostadil / administration & dosage,  adverse effects
Drug Therapy, Combination
Erectile Dysfunction / drug therapy*
Humans
Injections
Middle Aged
Papaverine / administration & dosage,  adverse effects
Phentolamine / administration & dosage,  adverse effects
Phosphodiesterase Inhibitors / administration & dosage*,  adverse effects
Piperazines / administration & dosage*,  adverse effects
Prospective Studies
Purines
Questionnaires
Sulfones
Vasodilator Agents / administration & dosage,  adverse effects
Chemical
Reg. No./Substance:
0/Phosphodiesterase Inhibitors; 0/Piperazines; 0/Purines; 0/Sulfones; 0/Vasodilator Agents; 139755-83-2/sildenafil; 50-60-2/Phentolamine; 58-74-2/Papaverine; 745-65-3/Alprostadil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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