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Nonsurgical Treatment of Erectile Dysfunction (cont.)

Penile Injection Therapy

Although many substances are touted as male sexual boosters, the modern age of such drug therapies began in 1993.

At that time, papaverine, a drug that produces vasodilatation (widening of the blood vessels), was shown to produce erections when injected directly into the penis. Soon afterward, other vasodilators were demonstrated to be effective as a treatment of erectile dysfunction.

  • Alprostadil is currently the most commonly used drug for injections into the penis. Alprostadil works well in most men who try it.
  • TriMix (a combination of alprostadil, phentolamine, and papaverine) has roughly twice the effectiveness of alprostadil alone. However, it is relatively expensive and usually not covered by insurance, whereas alprostadil is often covered by most insurance plans.

Self-injection of these drugs has been very beneficial. Penile injection therapy represents the most effective way to achieve erections in a wide variety of men who would otherwise be unable to obtain adequate rigid erections. In fact, if the vascular structure of the penis is healthy, the use of injectable drugs is almost always effective. Men on anticoagulant medications (blood thinners) cannot use this therapy.

Your doctor will determine an appropriate dose. The dose is adjusted to achieve an erection with adequate rigidity for no more than 90 minutes. The injection cannot be done more than 3 times per week.

Side effects include:

  • Pain from the medication (not from the injection)
  • Priapism
    • Priapism is a persistent or abnormally prolonged erection that lasts 4 hours or more.
    • Priapism is a urologic emergency. If an erection lasts for 4 hours or more, you must either contact your urologist or go to an emergency department for immediate treatment.
  • Scarring or bleeding at the site of the injection

If you choose this therapy, your doctor will teach you how to perform the injections. Even though the injection itself is painless, many men are still uncomfortable with penile injection therapy.

Intraurethral Pellet Therapy

Intraurethral pellet therapy, also called the medicated urethral system for erections (MUSE), is a useful alternative for men who do not want to use self-injections or for men in whom oral medications have failed.

  • Intraurethral pellet therapy is effective in a majority of men.
  • Intraurethral pellet therapy may be effective in men with vascular disease or with diabetes and in those who have undergone prostate surgery.
  • Intraurethral pellet therapy has been successful when used together with Viagra; however, this type of combination treatment should only be done under the supervision of a urologist who is experienced in treating erectile dysfunction.

Alprostadil, a drug also discussed in Penile Injection Therapy, has been formulated into a small suppository. This suppository is inserted into the urethra (the canal through which urine and semen are excreted). Because of this, urinating immediately before use is important in order to moisten the passage.

A temporary tourniquet is often helpful in allowing the medication to stay in the erectile tissue a little longer and seems to give a somewhat better response.

Few side effects occur with intraurethral pellet therapy. The most common side effect is pain at the site where the pellet is deposited. A small amount of bleeding may also occur.

Medically Reviewed by a Doctor on 8/27/2014
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