Intracavernosal Injection for Treatment of Erectile Dysfunction using Four-Mix Drugs

Kim, Jin Hong; Min, Jun Ki; Park, Jong Kwan; Kim, Hyung Jin; Park, Young Kyung

Abstract

PURPOSE: We evaluated the erectile response to intracavernosal injection of a combination of papaverine, phentolamine, prostaglandin E1, and verapamil (Four-Mix). A verapamil may attenuate fibrosis in the penile corpus cavernosum during the intracavernosal injection therapy. MATERIALS AND METHOD: We undertook an assessment of the time of rigid erection, rigidity of 26 patients after intracavernosal injection. All patients had only vasculogenic erectile dysfunction. We compared pH of the drugs. All patients were performed alternative injection (initial-Tri-Mix, second-Four-Mix, third-Tri-Mix, fourth-Four-Mix) of 0.3 ml once a week, over 4 weeks. We compared erectile responses to Four-Mix with Tri-Mix using by rigidity, tumescence, and erecting time. The grade of rigidity was determined by palpation and inspection of the penis according to a scale from 1 to 4 (1-parital tumescence, 2-full tumescence, 2.5- between 2 and 3, 3-incomplete rigidity, 3.5- between 3 and 4, 4- full rigidity).
RESULTS
Mean value of rigidity and erecting time to the first intracavernosal injection of Tri-Mix was 3, 107 min, respectively. Mean value of rigidity and erecting time to the second intracavernosal injection of Four-Mix was 3.52, 121 min, respectively. Mean value of rigidity and erecting time to the third intracavernosal injection of Tri-Mix was 3.52, 138 min, respectively. Mean value of rigidity and erecting time to the fourth intracavernosal injection of Four-Mix was 3.77, 113 min, respectively. The rigidity to Four-Mix injected was better than Tri-Mix (P<0.05). The erecting time was longer in Tri-Mix than Four-Mix. There were 7 cases of priapism, 4 of them were occurred using by Tri-Mix and 3 of them were occurred Using by Four-Mix.
CONCLUSION
The degree of erection achieved was better with Four-Mix than with Tri-mix. The erecting time to Four-Mix injected was shorter than Tri-Mix, although the incidence of prolonged erections (greater than 5 hours) was similar with both combinations.