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Intracorporal Prostaglandin E1

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Intracorporal Prostaglandin E1, Intracorporal Alprostadil, Caverject

  • Indications
  1. Psychogenic Impotence
  2. Neurogenic Impotence
  3. Vasculogenic Impotence
  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%