intracavernosal injections

Last reviewed 01/2018

Intracavernous injection therapy is the most effective form of pharmacotherapy for ED

• does not require an intact nerve supply and can therefore be highly effective after spinal cord injuries and after major pelvic surgery such as after radical prostatectomy
• due to the invasive nature of the procedure long-term compliance is poor

Alprostadil was the first and until recently was the only licensed drug approved for intracavernous ED treatment.

• this treatment is effective in providing adequate erections - up to 80% of patients respond to treatment with intracavernosal alprostadil (1)
• erection occurs typically 5-15 minutes after penile injection and frequently last 30-40 minutes, although the duration can be dose dependent.
• contraindications include
  • history of hypersensitivity to alprostadil
• a risk of priapism
• bleeding disorders

• requires training, reasonable manual dexterity and eyesight. Partner participation in the consultation and training programme can be valuable and improve long-term compliance.
• a common side effect include
  • penile pain on injection (usually mild)
• priapism may occur
• penile fibrosis may occur - reported incidence varies from <1% to >20%. (1)

Papaverine has also been given by intracavernosal injection for impotence and is still used ‘off-license’ in some patients as monotherapy but it has more complications than alprostadil

• a combination prepaeration of papaverine and alprostadil may be useful due to reduce side effects by using a lower dose of each drug

Recently a combination of aviptadil (formerly known as vaso-intestinal polypeptide), and phentolamine (a short-acting alpha-adrenoreceptor antagonist that also has a direct effect on smooth muscle, causing relaxation) was approved and licensed in several European countries for ED.

Reference:

• (1) Hackett G et al. British Society for Sexual Medicine guidelines on the management of erectile dysfunction. J Sex Med. 2008;5(8):1841-65.