• Indications
  1. Psychogenic Impotence
  2. Neurogenic Impotence
  3. Vasculogenic Impotence
  • Contraindications
  1. Penile deformity (e.g Peyronie's Disease)
  2. Priapism risk
    1. Sickle Cell Disease or Sickle Cell Trait
    2. Leukemia
    3. Multiple Myeloma
    4. Polycythemia Vera
    5. Thrombocythemia
    6. Anticoagulant use
  1. Increases arterial inflow
  2. Decreases venous outflow
  • Preparations
  • Intracorporal Injection
  1. PGE1 or Alprostadil (Caverject)
    1. See also Intraurethral Alprostadil (MUSE)
  2. Papaverine
  3. Phentolamine
  4. Combinations: Alprostadil + papaverine + Phentolamine
    1. May be more effective with less pain
  • Dosage Alprostadil (titrate in physicians office)
  1. Dose
    1. Start: 2.5 ug (1.25 ug in neurogenic Impotence)
    2. Next: 5 ug
    3. Increase: 5 ug increments
  2. Endpoint
    1. Erection adequate for intercourse (duration <1 hour)
    2. Maximum reached (see below)
  3. Maximum dosing
    1. Maximum dose: 60 ug
    2. Do not exceed more than 3 times per week
    3. Do not exceed more than once in 24 hours
  • Technique
  1. Inject at dorso-lateral aspect in penis proximal third
  2. Alternate sides and sites for each injection
  • Adverse Effects of Intracorporal Injection (41%)
  1. Hematoma
  2. Prolonged Erection exceeding 4 hours (4%)
    1. Patients should seek emergency attention for Erection lasting more than 4 hours
  3. Priapism with Erection exceeding 6 hours (1%)
    1. See Priapism Reversal Protocol
  4. Penile Plaques (10%)
  5. Penile fibrosis (5%)
  • Efficacy (Caverject)
  1. Injectable alprostadil is more effective than Intraurethral Alprostadil
  2. Success Rates: 67 to 85%
  3. Compliance
    1. Discontinued therapy after 1 year: 56%
    2. Discontinued therapy after 2 years: 68%
  • References
  1. Viera (1999) Am Fam Physician 60:1159-72 [PubMed]
  2. Sundaram (1997) Urology 49:932-5 [PubMed]