Improved hemodynamic response after long-term intracavernous injection for impotence.

ABSTRACT

OBJECTIVE: To investigate the phenomenon of spontaneous erections in patients on long-term intracavernous injection therapy. METHODS: We undertook an objective assessment of the penile circulation of 35 patients; 21 used prostaglandin E1 (PGE1) alone and 14 used a combination of papaverine, phentolamine, and PGE1. All underwent duplex ultrasonography before initiation of home self-injection and again after a mean of thirty-one months of treatment (most patients performed injections once or twice a week). RESULTS: The diameter of the cavernosal arteries did not change significantly after treatment. However, the mean peak flow velocity increased highly significantly (P < 0.001) 17.9 cm/second in the right cavernous artery and 21.2 cm/second on the left before treatment; 24 cm/second on the right and 29 cm/second on the left after treatment. More than one third (13 of 35 patients [35%]) achieved functional erection without injection at least some of the time, giving clinical support to the sonographic findings. CONCLUSIONS: We suggest that the combination of vasodilatory drugs and sexual stimulation may act to improve sinusoidal and penile arteriolar smooth muscle function.