Vascular interventions for impotence: Lessons learned
Ralph G. DePalmaMichael OldingGeorge W. YuFrederick J. SchwabEdward M. DruyHarry C. MillerElizabeth Massarin
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Aortoiliac occlusive disease
Prostaglandin E1
The evaluation of arterial blood supply and venous drainage of the penis is essential in assessing the impotent male. The vaso-active drugs prostaglandin E1 and papaverine, as intracavernous injections, cause penile erections in humans by influencing the arterial blood supply and venous drainage. These drugs were used in the normal baboon and in vascular compromised baboons using a 99mTc-penogram to quantify the vascular status of the penis. Ligation of the A. Iliaca Interna was performed to change the penile blood supply, thus compromising the vascular supply. It was observed that pre- and post-operatively, the increase in the penile bloodpool was more dramatic although not significantly so (P less than 0.05), but more variable after papaverine than with prostaglandin E1. The effect was even more enhanced (P less than 0.05) in the vascular compromised baboons so that the occurrence of priapism after papaverine can speculatively not be excluded. Also the more consistent vasoactive response after prostaglandin E1 seems to establish it as the superior intracavernous injectable agent.
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No AccessJournal of Urology1 Jan 1991Intracavernous Injection of Prostagland in E1 in combination With Papaverine: Enhanced Effectiveness in Comparison With Papaverine Plus Phentolamine and Prostaglandin E1 Alone Andreas Floth, and Paul Schramek Andreas FlothAndreas Floth , and Paul SchramekPaul Schramek View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)38246-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail We compared the erectile response to intracavernous injection of a combination of papaverine and prostaglandin E1 with that of a combination of papaverine and phentolamine (49 patients), and prostaglandin E1 alone (38). The degree of erection achieved was significantly better with papaverine plus prostaglandin E1 than with papaverine plus phentolamine and the duration of erection was less, although the incidence of prolonged erections (greater than 5 hours) was similar with both combinations. Papaverine with prostaglandin E1 likewise resulted in a significantly better degree of erection than prostaglandin E1 alone (prolonged erections occurred only after the drug combination). All erections subsided spontaneously and none required medical intervention throughout the study. Pain was noted only after injection of prostaglandin E1. The incidence was clearly lower (7 of 38 versus 13 of 38) after the injection of only 5µg. prostaglandin E1 in combination with papaverine (although the difference is not statistically significant). Subjectively, the side effects caused by the drug combination were described as much less dramatic by the patients than after prostaglandin E1 alone. The combination of papaverine and prostaglandin E1 shows a clearly synergistic effect and might suitably replace papaverine plus phentolamine or prostaglandin E1 alone in patients who do not respond well or suffer side effects after high single doses. © 1991 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySogari P, Teloken C and Vargas Souto C (2018) ATROPINE ROLE IN THE PHARMACOLOGICAL ERECTION TEST: STUDY OF 228 PATIENTSJournal of Urology, VOL. 158, NO. 5, (1760-1763), Online publication date: 1-Nov-1997.Gupta R, Kirschen J, Barrow R and Eid J (2018) Predictors of Success and Risk Factors for Attrition in the Use of Intracavernous InjectionJournal of Urology, VOL. 157, NO. 5, (1681-1686), Online publication date: 1-May-1997.Shenfeld O, Hanani J, Shalhav A, Vardi Y and Goldwasser B (2018) Papaverine-Phentolamine and Prostaglandin E1 Versus Papaverine-Phentolamine Alone For Intracorporeal Injection Therapy: A Clinical Double-Blind StudyJournal of Urology, VOL. 154, NO. 3, (1017-1019), Online publication date: 1-Sep-1995.Costa P, Sarrazin B, Bressolle F, Colson M, Bondil P and Saudubray F (2018) Efficiency and Side Effects of Intracavernous Injections of Moxisylyte in Impotent Patients: A Dose-Finding Study Versus PlaceboJournal of Urology, VOL. 149, NO. 2, (301-305), Online publication date: 1-Feb-1993.von Heyden B, Donatucci C, Kaula N and Lue T (2018) Intracavernous Pharmacotherapy for Impotence: Selection of Appropriate Agent and DoseJournal of Urology, VOL. 149, NO. 5 Part 2, (1288-1290), Online publication date: 1-May-1993.Montorsi F, Guazzoni G, Bergamaschi F, Ferini-Strambi L, Barbieri L and Rigatti P (2018) Four-Drug Intracavernous Therapy for Impotence Due to Corporeal Veno-Occlusive DysfunctionJournal of Urology, VOL. 149, NO. 5 Part 2, (1291-1295), Online publication date: 1-May-1993.Allen R, Engel R, Smolev J and Brendler C (2018) Objective Double-Blind Evaluation of Erectile Function with Intracorporeal Papaverine in Combination with Phentolamine and/or Prostaglandin E1Journal of Urology, VOL. 148, NO. 4, (1181-1183), Online publication date: 1-Oct-1992. Volume 145Issue 1January 1991Page: 56-59 Advertisement Copyright & Permissions© 1991 by The American Urological Association Education and Research, Inc.Keywordspapaverinepenisprostaglandins EimpotenceMetricsAuthor Information Andreas Floth More articles by this author Paul Schramek More articles by this author Expand All Advertisement Loading ...
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In erectile dysfunction formerly, for both diagnostic and therapeutic purposes, intracavernous injections of papaverine and the combination papaverine/phentolamine were employed. In recent years, promising results have been reported with prostaglandin E1. In a multicenter study, 10 to 20 micrograms prostaglandin E1 were administered for testing corpus cavernosum function. One hundred and fifteen out of 187 patients self-injected themselves with prostaglandin E1 at an average dose of about 13 micrograms. While priapism occurred in 5 to 10% of the patients injecting papaverine or papaverine/phentolamine, and fibrosis and tunica induration in 10 to 57% patients on long-term treatment, the risk of priapism was low in prostaglandin E1. Subsequently, induration and penile deviation were reported in 2 patients each. In this multicenter study, a subjective efficacy of more than 90% was observed, thus confirming similar results with prostaglandin E1 found in other studies. The present results show that prostaglandin E1 can be considered the drug of first choice for intracavernous injection treatment of erectile dysfunction.
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The intracavernous injection of vasoactive drugs is a valuable diagnostic aid and an important tool for the treatment of erectile failure. A comparative study with intracavernous injection of prostaglandin E1 (PGE1) and papaverine was performed in 60 patients with impotence. We evaluated the efficiency and side effects of both agents. The overall positive response rate was 85.0% in the PGE1 group and 65.0% in the papaverine group which suggests PGE1 has a stronger vascular effect. The mean onset of maximal erection was after 9.6 minutes in the PGE1 group and after 6.5 minutes in the papaverine group. The mean maintenance of erection was for 53.2 minutes in the PGE1 group and for 38.6 minutes in the papaverine group. There were no systemic side effects of either agent. Three instances of injection pain and 2 of burning sensation in the penis were noted in the PGE1 group, while in the papaverine group, there were 21 reports of injection pain, 4 of prolonged erection and 2 of burning sensation in the penis. These results suggest that PGE1 is a more desirable vasoactive alternative for the diagnosis of impotence.
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No AccessJournal of Urology1 Sep 1988Efficiency and Side Effects of Prostaglandin El in the Treatment of Erectile Dysfunction Maria Waldhauser and Paul Schramek Maria WaldhauserMaria Waldhauser More articles by this author and Paul SchramekPaul Schramek More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)41709-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail The efficiency and side effects of a single dose of intracorporeally applied prostaglandin El (20mcg.) in inducing penile erection were examined. In addition, the effect of this dose of prostaglandin El was compared to the effect of 7.5mg. papaverine plus 0.25mg. phentolamine in a double-blind, crossover designed study. We tested twice 12 men 52.9 ± 7.6 years old (mean ± standard deviation) with erectile dysfunction. On 1 occasion the subjects received 20mcg. prostaglandin El and on the other they received 7.5mg. papaverine and 0.25mg. phentolamine. At this dosage prostaglandin El was most effective in inducing artificial penile erection (11 of 12 patients). However, 75 per cent of the subjects reported burning sensations during the entire period of erection and in 1 prostaglandin El treatment resulted in a sustained erection. At the doses used, prostaglandin El was more effective in inducing penile erection than papaverine plus phentolamine (11 versus 6 patients). Intracavernous injection of prostaglandin El is a potent tool for artificial penile erection and warrants precise examination for its potential clinical use. © 1988 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPETERSON C, BENNETT A, HELLSTROM W, KAISER F, MORLEY J, NEMO K, PADMA-NATHAN H, PLACE V, PRENDERGAST J, TAM P, TANAGHO E, TODD L, VARADY J and GESUNDHEIT N (2018) ERECTILE RESPONSE TO TRANSURETHRAL ALPROSTADIL, PRAZOSIN AND ALPROSTADIL-PRAZOSIN COMBINATIONSJournal of Urology, VOL. 159, NO. 5, (1523-1528), Online publication date: 1-May-1998.Bechara A, Casabe A, Cheliz G, Romano S, Rey H and Fredotovich N (2018) Comparative Study of Papaverine Plus Phentolamine Versus Prostaglandin E1 in Erectile DysfunctionJournal of Urology, VOL. 157, NO. 6, (2132-2134), Online publication date: 1-Jun-1997.Godschalk M, Gheorghiu D, Katz G and Mulligan T (2018) Alkalization Does Not Alleviate Penile Pain Induced By Intracavernous Injection of Prostaglandin E1Journal of Urology, VOL. 156, NO. 3, (999-1000), Online publication date: 1-Sep-1996.Chen J, Godschalk M, Katz P and Mulligan T (2018) Incidence of Penile Pain After Injection of a New Formulation of Prostaglandin E1Journal of Urology, VOL. 154, NO. 1, (77-79), Online publication date: 1-Jul-1995.Vanderschueren D, Heyrman R, Keogh E, Casey R, Weiske W, Ogrinc F and de Koning Gans H (2018) A Study in Patients with Erectile Dysfunction Comparing Different Formulations of Prostaglandin E1Journal of Urology, VOL. 154, NO. 5, (1744-1747), Online publication date: 1-Nov-1995.Chen J, Godschalk M, Katz P and Mulligan T (2018) The Lowest Effective Dose of Prostaglandin E1 as Treatment for Erectile DysfunctionJournal of Urology, VOL. 153, NO. 1, (80-81), Online publication date: 1-Jan-1995.Schramek P, Plas E, Hübner W and Pflüger H (2018) Intracavernous Injection of Prostaglandin E1 Plus Procaine in the Treatment of Erectile DysfunctionJournal of Urology, VOL. 152, NO. 4, (1108-1110), Online publication date: 1-Oct-1994.Godschalk M, Chen J, Katz P and Mulligan T (2018) Treatment of Erectile Failure with Prostaglandin E1: A Double-Blind, Placebo-Controlled, Dose-Response StudyJournal of Urology, VOL. 151, NO. 6, (1530-1532), Online publication date: 1-Jun-1994.Nunez B and Anderson D (2018) Nitroglycerin Ointment in the Treatment of ImpotenceJournal of Urology, VOL. 150, NO. 4, (1241-1243), Online publication date: 1-Oct-1993.von Heyden B, Donatucci C, Marshall G, Brock G and Lue T (2018) A Prostaglandin E1 Dose-Response Study in ManJournal of Urology, VOL. 150, NO. 6, (1825-1828), Online publication date: 1-Dec-1993.Costa P, Sarrazin B, Bressolle F, Colson M, Bondil P and Saudubray F (2018) Efficiency and Side Effects of Intracavernous Injections of Moxisylyte in Impotent Patients: A Dose-Finding Study Versus PlaceboJournal of Urology, VOL. 149, NO. 2, (301-305), Online publication date: 1-Feb-1993.von Heyden B, Donatucci C, Kaula N and Lue T (2018) Intracavernous Pharmacotherapy for Impotence: Selection of Appropriate Agent and DoseJournal of Urology, VOL. 149, NO. 5 Part 2, (1288-1290), Online publication date: 1-May-1993.Djamilian M, Stief C, Kuczyk M and Jonas U (2018) Followup Results of a Combination of Calcitonin Gene-Related Peptide and Prostaglandin E1 in the Treatment of Erectile DysfunctionJournal of Urology, VOL. 149, NO. 5 Part 2, (1296-1298), Online publication date: 1-May-1993.Allen R, Engel R, Smolev J and Brendler C (2018) Objective Double-Blind Evaluation of Erectile Function with Intracorporeal Papaverine in Combination with Phentolamine and/or Prostaglandin E1Journal of Urology, VOL. 148, NO. 4, (1181-1183), Online publication date: 1-Oct-1992.Takahashi Y, Ishii N, Lue T and Tanagho E (2018) Effects of Adenosine on Canine Penile ErectionJournal of Urology, VOL. 148, NO. 4, (1323-1325), Online publication date: 1-Oct-1992.Mahmoud K, El Dakhli M, Fahmi I and Abdel-Aziz A (2018) Comparative Value of Prostaglandin E1 and Papaverine in Treatment of Erectile Failure: Double-Blind Crossover Study among Egyptian PatientsJournal of Urology, VOL. 147, NO. 3 Part 1, (623-626), Online publication date: 1-Mar-1992.Gerber G and Levine L (2018) Pharmacological Erection Program Using Prostaglandin E1Journal of Urology, VOL. 146, NO. 3, (786-789), Online publication date: 1-Sep-1991.Stief C, Wetterauer U, Schaebsdau F and Jonas U (2018) Calcitonin-Gene-Related Peptide: A Possible Role in Human Penile Erection and its Therapeutic Application in Impotent PatientsJournal of Urology, VOL. 146, NO. 4, (1010-1014), Online publication date: 1-Oct-1991.Floth A and Schramek P (2018) Intracavernous Injection of Prostagland in E1 in combination With Papaverine: Enhanced Effectiveness in Comparison With Papaverine Plus Phentolamine and Prostaglandin E1 AloneJournal of Urology, VOL. 145, NO. 1, (56-59), Online publication date: 1-Jan-1991.Fiorelli R, Manfrey S, Belkoff L and Finkelstein L (2018) Priapism Associated with Intranasal Cocaine AbuseJournal of Urology, VOL. 143, NO. 3, (584-585), Online publication date: 1-Mar-1990. Volume 140Issue 3September 1988Page: 525-527 Advertisement Copyright & Permissions© 1988 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Waldhauser More articles by this author Paul Schramek More articles by this author Expand All Advertisement PDF downloadLoading ...
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Alternations of penile blood flow are believed to be the most frequent organic cause of erectile dysfunction. Penile duplex ultrasonography following intracavernous injection of a vasoactive agent is an accepted method for diagnosis of penile vascular dysfunction. To determine the diagnostic efficacy of commonly used vasoactive drugs we studied the hemodynamic effects of different dosages of papaverine, the combination of papaverine and phentolamine, and prostaglandin E1 in men with erectile dysfunction and men with normal erectile potency using color duplex ultrasonography. We concluded that 12.5 mg. papaverine and 10 micrograms. prostaglandin E1 are the drugs of choice to be used in conjunction with penile duplex ultrasonography because of optimal effects on cavernous arterial dilatation and low risk of prolonged erection. However, low dose papaverine or prostaglandin E1 has a limited value in evaluating veno-occlusive function.
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Background : Sexual dysfunction in males is characterized by the inability to achieve or maintain an erection sufficient for a satisfactory sexual activity. Erectile dysfunction is a common disorder in males and intracavernosal injection of papaverine followed by color Doppler ultrasonography of the penis is used to diagnose and treat vascular impotence. In this study, we examined the relationship between changes in peak systolic velocity (PSV) and erectile dysfunction with vascular cause after a cavernosal injection of papaverin. Methods : We performed this self-controlled clinical trial in Shahid Hasheminejad Hospital in Tehran, Iran during 2010 and 2011. The study population consisted of 90 patients with erectile dysfunction. The peak systolic velocity (PSV) of cavernosal arteries was evaluated before and after injection of 40-80 mg papaverine and it was compared in the patients with and without response to injection. Results : The mean age of participants was 47.7 13.7 years. Response to papaverine injection was positive in 41(45.5%) patients. The mean PSV values were 14.68+5.65 and 53.74+18.8 cm/s before and after the injection, respectively (P Conclusion : A PSV cut-off point of 10 cm/s in flaccid status before papaverine injection has a low sensitivity but high specificity for the diagnosis of arterial erectile dysfunction. Future studies with sufficient cases of arterial erectile dysfunction are necessary for final judgments and suggestion a new cut off point.
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