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Intracavernous, Transurethral, and Topical Therapies for Erectile Dysfunction in the Era of Oral Pharmacotherapy

Salvaging First-Line Therapy Failures With Combination Therapies
  • Hans-Martin A. Fritsche
  • Mustafa F. Usta
  • Wayne J. G. Hellstrom
Part of the Current Clinical Urology book series (CCU)

Abstract

It is estimated that 20 to 30 million American men suffer from some degree of erectile dysfunction (ED) (1). As the male population ages and awareness of the problem increases, this number is expected to at least double by 2025 (2).

Keywords

Erectile Dysfunction Vasoactive Intestinal Polypeptide Penile Erection Erectile Response Intracavernous Injection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Benet AE, Melman A. (1995) The epidemiology of erectile dysfunction. Urol Clin North Am 22:699–709.PubMedGoogle Scholar
  2. 2.
    Aytac IA, McKinlay JB, Krane RJ. (1999) The likely worldwide increase in erectile dysfunction between 1995 an 2025 and some possible policy consequences. BJU Int 84:50–56.CrossRefGoogle Scholar
  3. 3.
    Rosen R, Goldstein I, Heiman J, et al. (1999) The process of care model for evaluation and treatment of erectile dysfunction. Int J Impot Res 11:59–74.CrossRefGoogle Scholar
  4. 4.
    Montorsi F, Guazzoni G, Rigatti P, Pozza G. (1995) Pharmacological management of erectile dysfunction. Drugs 50:465–479.PubMedGoogle Scholar
  5. 5.
    Virag R. (1982) Intracavernous injection of papaverine for erectile failure. Lancet 2:938.PubMedCrossRefGoogle Scholar
  6. 6.
    Brindley GS. (1983) Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence. Br J Psychiatry 143:332.PubMedCrossRefGoogle Scholar
  7. 7.
    Zorgniotti AW, Lefleur RS. (1985) Auto-injection of the corpus cavernosum with a vasoactive drug combination for vasculogenic impotence. J Urol 133:39–41.PubMedGoogle Scholar
  8. 8.
    Ishii N, Watanabe H, Irisawa C, et al. (1986) Studies on male sexual impotence. Report 18. Therapeutic trial with prostaglandin E1 for organic impotence. Jpn J Urol 77:954–962.Google Scholar
  9. 9.
    Kapoor VK, Chahal AS, Jyoti SP, et al. (1995) Intracavernous papaverine for impotence in spinal cord injured patients. Paraplegia 31:675–680.Google Scholar
  10. 10.
    Porst H. (1996) The rationale for PGE1 in erectile failure: a survey of world-wide experience. J Urol 155:802–815.PubMedCrossRefGoogle Scholar
  11. 11.
    Lomas T, Jarow J. (1992) Risk factors for papaverine-induced priapism. J Urol 147:1280.PubMedGoogle Scholar
  12. 12.
    Leungwattanakij L, Flynn V, Hellstrom WJG. (2001) Intracavernosal injection and transurethral therapy for erectile dysfunction. Urol Clin North Am 28:343–354.PubMedCrossRefGoogle Scholar
  13. 13.
    Domer F, Wessler G, Brown R, et al. (1978) Involvement of the sympathetic nervous system in the urinary bladder internal sphincter and in penile erection in the anaesthetized cat. Investig Urol 15:404–407.Google Scholar
  14. 14.
    Padma-Nathan H, Goldstein I, Payton T, et al. (1987) Intracavernosal pharmacotherapy: the pharmacologic erection program. World J Urol 5:160.CrossRefGoogle Scholar
  15. 15.
    Robinette M, Moffat MJ. (1986) Intracorporeal injection of papaverine and phentolamine in the management of impotence. Br J Urol 58:692–695.PubMedCrossRefGoogle Scholar
  16. 16.
    Sidi A, Chen K. (1987) Clinical experience with vasoactive intracavernous pharmacotherapy for treatment of impotence. World J Urol 5:156.CrossRefGoogle Scholar
  17. 17.
    Nellans RE, Ellis LR, Kramer-Levien D. (1987) Pharmacological erection: diagnosis and treatment applications in 69 patients. J Urol 138:52–54.PubMedGoogle Scholar
  18. 18.
    Gasser TC, Roach RM, Larsen EH, et al. (1987) Intracavernous self-injection with phentolamine and papaverine for the treatment of impotence. J Urol 137:678–680.PubMedGoogle Scholar
  19. 19.
    Keogh EJ, Watters GR, Earle CM, et al. (1989) Treatment of impotence by intracavernosal injections. A comparison of papaverine and papaverine and phentolamine: a double-blind crossover trial. J Urol 142:726–728.PubMedGoogle Scholar
  20. 20.
    Bechara A, Casabe A, Cheliz G, et al. (1997) Comparative study of papaverine plus phentolamine versus prostaglandin E1 in erectile dysfunction. J Urol 157(6):2132–2134.PubMedCrossRefGoogle Scholar
  21. 21.
    Adaikan P, Karim S, Kottegoda S, et al. (1983) Cholinoreceptors in the corpus cavernosum of the human penis. J Auton Pharmacol 3:107–111.PubMedGoogle Scholar
  22. 22.
    Porst H. (1989) Prostaglandin E1 bei erektiler Dysfunktion. Urologe A 28:94.PubMedGoogle Scholar
  23. 23.
    Porst H, Buvat J, Meulemann E, et al. (1996) Final results of a prospective multicenter study with self-injection therapy with PGE1 after 4 years of follow-up. Int J Impot Res 8:D118.Google Scholar
  24. 24.
    Linet OI, Ogrinc FG, Alprostadil Study Group. (1996) Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. N Engl J Med 334:873–877.PubMedCrossRefGoogle Scholar
  25. 25.
    Lea AP, Bryson HM, Balfour JA. (1996) Intracavernous alprostadil. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential in erectile dysfunction. Drugs Aging 8(1):56–74.PubMedGoogle Scholar
  26. 26.
    Sato Y, Suzuki N, Adachi H, et al. (1996) Effect of neurotropin for penile pain induced by intracavernous injection of prostaglandin E1. Int J Impot Res 8:139.Google Scholar
  27. 27.
    Earle CM, Chew KK, Stuckey BGA, Keogh EJ. (1996) Pain with intracavernosal therapy. Int J Impot Res 8:114.Google Scholar
  28. 28.
    Marshall GA, Breza J, Lue TF. (1994) Improved hemodynamic response after longterm intracavernous injection for impotence. Urology 43:844–847.PubMedCrossRefGoogle Scholar
  29. 29.
    Brock G, Mai Tu L, Linet O. (2001) Return of spontaneous erection during longterm intracavernosal alprostadil (Caverject) treatment. Int J Impot Res 57:536–541.Google Scholar
  30. 30.
    Maniam P, Seftel A, Corty E. (2001) Nocturnal penile tumescence activity unchanged after long-term intracavernous injection therapy. J Urol 165:830–833.PubMedCrossRefGoogle Scholar
  31. 31.
    Bennet AH, Carpenter AJ, Baranda JH. (1991) An improved vasoactive drug combination for a pharmacological erection program. J Urol 146:1564–1565.Google Scholar
  32. 32.
    McMahon CG. (1991) A comparison of the intracavernosal injection of a combination of papaverine and phentolamine, prostaglandin E1, and a combination of all three agents in the management of impotence. Int J Impot Res 3:113.Google Scholar
  33. 33.
    Bechara A, Casabe A, Cheliz G, et al. (1996) Prostaglandin E1 versus mixture of prostaglandin E1, papaverine and phentolamine in nonresponders to high papaverine plus phentolamine doses. J Urol 155:913–914.PubMedCrossRefGoogle Scholar
  34. 34.
    Roy JB, Petrone RL, Dais SI. (1990) A clinical trial of intracavernous vasoactive intestinal polypeptide to induce penile erection. J Urol 143:302.PubMedGoogle Scholar
  35. 35.
    Gerstenberg TC, Metz P, Otteson B. (1992) Intracavernous self-injection with vasoactive intestinal polypeptide and phentolamine in the management of erectile dysfunction. J Urol 147:1277–1279.PubMedGoogle Scholar
  36. 36.
    Sandhu D, Curless E, Dean J, et al. (1999) A double blind, placebo controlled study of intracavernosal vasoactive polypeptide and phentolamine mesylate in a novel auto-injector for the treatment of non-psychogenic erectile dysfunction. Int J Impot Res 11:91.PubMedCrossRefGoogle Scholar
  37. 37.
    Steif CG, Homlquist F, Djamilian M, et al. (1992) Preliminary results with the nitric oxide donor linsidomine chlorhydrate in the treatment of human erectile dysfunction. J Urol 148:1437.Google Scholar
  38. 38.
    Wegner HE, Knispel HH, Klan R, et al. (1994) Prostaglandin E1 versus linsidomine chlorhydrate in erectile dysfunction. Urol Int 53:214.PubMedCrossRefGoogle Scholar
  39. 39.
    Martinez-Pineiro L, Lopez-Tello J, Dorrego J. (1995) Preliminary results of a comparative study with intracavernous sodium nitroprusside and prostaglandin E1 in patients with erectile dysfunction. J Urol 153:1487–1490.PubMedCrossRefGoogle Scholar
  40. 40.
    Mulhall JP, Daller M, Traish A, et al. (1997) Intracavernosal forskolin: role in management of vasculogenic impotence resistant to standard 3-agent pharmacotherapy. J Urol 158:1752.PubMedCrossRefGoogle Scholar
  41. 41.
    Truss MC, Becker AJ, Thon WF, et al. (1994) Intracavernous calcitonin generelated peptide plus prostaglandin E1: possible alternative to penile implants in selected patients. Eur Urol 26:40–45.PubMedGoogle Scholar
  42. 42.
    Montorsi F, Salonia A, Zanoni M, et al. (2002) Current status of local penile therapy. Int J Impot Res 14(Suppl 1):70–81.CrossRefGoogle Scholar
  43. 43.
    Imagawa A, Kimura K, Kawanishi Y. (1989) Effect of moxisylyte hydrochloride on isolated human penile corpus cavernosum tissue. Life Sci 44:619–623.PubMedCrossRefGoogle Scholar
  44. 44.
    Costa P, Sarrazin B, Bressolle F, et al. (1993) Efficiency and side effects of intracavernous injections of moxisylyte in impotent patients: a dose-finding study versus placebo. J Urol 149:301–305.PubMedGoogle Scholar
  45. 45.
    Buvat J, Costa P, Morlier D, et al. (1998) Double-blind multicenter study comparing alprostadil alpha-cyclodextrin with moxisylyte chlorohydrate in chronic organic erectile dysfunction. J Urol 159:116–119.PubMedCrossRefGoogle Scholar
  46. 46.
    Virag R, Shoukry K, Floresco J, et al. (1991) Intracavernous self-injection of vasoactive drugs in the treatment of impotence: 8-year experience with 615 cases. J Urol 145:287–292.PubMedGoogle Scholar
  47. 47.
    Sogari PR, Teloken C, Vargas Souto CA. (1997) Atropine role in the pharmacological erection test: study of 228 patients. J Urol 158:1760–1763.PubMedCrossRefGoogle Scholar
  48. 48.
    Hatzichristou D, Apostolidis A, Tzortzis V, et al. (2000) Sildenafil versus intracavernous injection therapy: efficacy and preference in patients on intracavernous injection for more than 1 y. J Urol 164:1197–1200.PubMedCrossRefGoogle Scholar
  49. 49.
    Shabsigh R, Padma-Nathan H, Gittleman M, et al. (2000) Intracavernous alprostadil alfadex (EDEX/VIRIDAL) is effective and safe in patients with erectile dysfunction after failing sildenafil (Viagra). Urology 55:477–480.PubMedCrossRefGoogle Scholar
  50. 50.
    Padma-Nathan H, Shabsigh R, Weiss RE, et al. (2000) Efficacy and safety of alprostadil in sildenafil failures. J Urol 166:201–202A.Google Scholar
  51. 51.
    McMahon CG, Samali R, Johnson H. (1999) Treatment of intracorporeal nonresponse with sildenafil alone or in combination with triple agent intracorporeal injection therapy. J Urol 162:1992–1998.PubMedCrossRefGoogle Scholar
  52. 52.
    Irwin MB, Kata EJ. (1994) High attrition rate with intracavernous injection of prostaglandin E1 for impotence. Urology 48:84.CrossRefGoogle Scholar
  53. 53.
    Valdevenito R, Melman A. (1994) Intracavernous self-injection pharmacotherapy program: analysis of results and complications. Int J Impot Res 6:81.PubMedGoogle Scholar
  54. 54.
    Kawanishi Y, Kimura K, Iriguchi H, et al. (1992) Double-blind trial of oral PGE1 on impotence. Nippon Hinyokika Gakki Zasshi 83:1655.Google Scholar
  55. 55.
    Gramkow J, Lendorf A, Zhu J, et al. (1999) Transcutaneous nitroglycerine in the treatment of erectile dysfunction: a placebo controlled clinical trial. Int J Impot Res 11:35.PubMedCrossRefGoogle Scholar
  56. 56.
    Cavallini G. (1994) Minoxidil versus nitroglycerine: a prospective double-blind, controlled trial in transcutaneous erectile therapy for organic impotence. Int J Impot Res 6:205.PubMedGoogle Scholar
  57. 57.
    Kim ED, McVary KT. (1995) Topical PGE1 for the treatment of erectile dysfunction. J Urol 153:1828.PubMedCrossRefGoogle Scholar
  58. 58.
    Kim ED, el-Rashidy R, McVary KT. (1995) Papaverine topical gel for treatment of erectile dysfunction. J Urol 153:361.PubMedCrossRefGoogle Scholar
  59. 59.
    Vardi Y, Sàenz de Tejada I. (1997) Functional and radiologic evidence of vascular communications between the spongiosal and cavernosal compartments of the penis. Urology 49:749–752.PubMedCrossRefGoogle Scholar
  60. 60.
    Hellstrom WJ, Bennett AH, Gesunheit N, et al. (1996) A double-blind placebo controlled evaluation of the erectile response to transurethral alprostadil. Urology 48:851.PubMedCrossRefGoogle Scholar
  61. 61.
    Padhma-Nathan H, Hellstrom WJG, Kaiser FE, et al. (1997) Medicated Urethral System for Erection (MUSE) Study Group: treatment of men with erectile dysfunction with transurethral alprostadil. N Engl J Med 336:1.CrossRefGoogle Scholar
  62. 62.
    Peterson CA, Bennet AH, Hellstrom WJG, et al. (1998) Erectile response to transurethral alprostadil, prazosin and alprostadil-prazosin combinations. J Urol 159:1523.PubMedCrossRefGoogle Scholar
  63. 63.
    Ekman P, Sjogren L, Englund G, Persson BE. (2000) Optimizing the therapeutic approach of transurethral alprostadil. BJU Int 86:68–74.PubMedCrossRefGoogle Scholar
  64. 64.
    Bodner D, Haas CA, Krueger B, Seftel AD. (1999) Transurethral alprostadil for treatment of erectile dysfunction in patients with spinal cord injury. Urology 53:199–202.PubMedCrossRefGoogle Scholar
  65. 65.
    Costabile RA, Spevak M, Fishman IJ, et al. (1998) Efficacy and safety of transurethral alprostadil in patients with erectile dysfunction following radical prostatectomy. J Urol 160:1325–1328.PubMedCrossRefGoogle Scholar
  66. 66.
    Fulgham PF, Cochran JS, Denman JL, et al. (1998) Disappointing initial results with the transurethral alprostadil for erectile dysfunction in a urology practice setting. J Urol 160:2041.PubMedCrossRefGoogle Scholar
  67. 67.
    Labasky RC, Spivack AP. (1998) Transurethral alprostadil for the treatment of erectile dysfunction: two-year safety update. J Urol 159(Suppl 5):907A.Google Scholar
  68. 68.
    Kattan S. (1995) Double-blind randomized crossover study comparing intracorporeal prostaglandin E1 with a combination of prostaglandin E1 and lidocaine in the treatment of organic impotence. Urology 45:1032.PubMedCrossRefGoogle Scholar
  69. 69.
    Moriel EZ, Raijfer J. (1993) Sodium bicarbonate alleviates penile pain induced by intracavernous injections for erectile dysfunction. J Urol 149:1299.PubMedGoogle Scholar
  70. 70.
    Schramek P, Pals EG, Hubner WA, et al. (1994) Intracavernous injection of PGE1 plus procaine in the treatment of erectile dysfunction. J Urol 152:1108.PubMedGoogle Scholar
  71. 71.
    Mydlo JH, Volpe MA, Machia RJ. (2000) Initial results utilizing combination therapy for patients with a suboptimal response to either alprostadil or sildenafil monotherapy. Eur Urol 38:30–34.PubMedCrossRefGoogle Scholar
  72. 72.
    Shabsigh R, Padma-Nathan H, Gittleman M, et al. (2000) Intracavernous alprostadil alfadex is more efficacious, better tolerated, and preferred over transurethral alprostadil plus optional ACTIS: a comparative, randomised, crossover, multicenter study. Urology 55:109–113.PubMedCrossRefGoogle Scholar
  73. 73.
    Porst H. (1997) Transurethral alprostadil with MUSE vs intracavernous alprostadil, a comparative study in 103 patients with erectile dysfunction. Int J Impot Res 9:187–192.PubMedCrossRefGoogle Scholar
  74. 74.
    Shokeir AA, Alserafi MA, Mutabagani H. (1999) Intracavernosal versus transurethral alprostadil: a prospective randomised study. Br J Urol 83:812–815.Google Scholar
  75. 75.
    Werthman P, Raijfer J. (1997) MUSE therapy: preliminary clinical observations. Urology 50:809–811.PubMedCrossRefGoogle Scholar
  76. 76.
    Engel JD, McVary KT. (1998) Transurethral alprostadil as therapy for patients who withdrew from or failed prior intracavernous injection therapy. Urology 51:687–692.PubMedCrossRefGoogle Scholar
  77. 77.
    Borges FD. (1994) A new approach to the pharmacologic treatment of impotence. Int J Impot Res 6:137.PubMedGoogle Scholar
  78. 78.
    Samour CM, Donaruma LG, Daskalakis S, et al. (1989) A new class of percutaneous absorption enhancers. Proc Intern Symp Control Rel Bioact Mater 16:183.Google Scholar
  79. 79.
    McVary KT, Polepalle S, Riggi S, Pelham RW. (1999) Topical PGE1/SEPA gel for the treatment of erectile dysfunction. J Urol 162:726.PubMedCrossRefGoogle Scholar
  80. 80.
    Goldstein I, Payton TR, Scheichter PJ. (2001) A double-blind, placebo-controlled, efficacy and safety study of topical gel formulation of 1% alprostadil (Topiglan) for the in-office treatment of erectile dysfunction. Urology 57:301–305.PubMedCrossRefGoogle Scholar
  81. 81.
    Padma-Nathan H, Steidle C, Salem S, et al. (2003) The efficacy and safety of a topical alprostadil cream, Alprox-TD, for the treatment of erectile dysfunction: two phase 2 studies in mild-to-moderate and severe ED. Int J Impot Res 15:10–17.PubMedCrossRefGoogle Scholar
  82. 82.
    Schanz S, Hauswirth U, Ulmer A, Fierlbeck G. (2002) Prostaglandin E1 ethyl ester, a new agent for topical penile therapy. Int J Impot Res 14:317–318.PubMedCrossRefGoogle Scholar
  83. 83.
    Cavallini G. (1991) Minoxidil versus nitroglycerin: a prospective double-blind controlled trial in transcutaneous erection facilitation for organic impotence. J Urol 146:50–53.PubMedGoogle Scholar
  84. 84.
    Radomski SB, Herscorn S, Rangaswamy S. (1994) Topical minoxidil in the treatment of male erectile dysfunction. J Urol 151:1225–1226.PubMedGoogle Scholar
  85. 85.
    Chancellor MB, Rivas DA, Panzer DE, et al. (1994) Prospective comparison of topical minoxidil to vacuum constriction device and intracorporeal papaverine injection in treatment of erectile dysfunction due to spinal cord injury. Urology 43:365–369.PubMedCrossRefGoogle Scholar
  86. 86.
    Anderson DC, Seifert CF. (1993) Topical nitrate treatment of impotence. Ann Pharmacother 27:1203–1205.PubMedGoogle Scholar
  87. 87.
    Owen JA, Saunders F, Harris C, et al. (1989) Topical nitroglycerine: a potential treatment for impotence. J Urol 141:546–548.PubMedGoogle Scholar
  88. 88.
    Steers WD. (2003) Viability and safety of combination drug therapies for erectile dysfunction. J Urol 170:20–23.CrossRefGoogle Scholar
  89. 89.
    Kaplan SA, Reis RB, Kohn IJ, et al. (1998) Combination therapy using oral alpha-blockers and intracavernosal injection in men with erectile dysfunction. Urology 52:739.PubMedCrossRefGoogle Scholar
  90. 90.
    Nehra A, Blute ML, Barrett DM, Moreland RB. (2002) Rationale for the combination therapy of transurethral prostaglandin E1 and sildenafil in the salvage of erectile dysfunction patients desiring noninvasive therapy. Int J Impot Res 14(Suppl 1):S38.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Hans-Martin A. Fritsche
    • 1
  • Mustafa F. Usta
    • 1
  • Wayne J. G. Hellstrom
    • 1
  1. 1.Department of UrologyTulane University School of MedicineNew Orleans

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