Intracavernous injection of papaverine (ICIP)

Summary

A total of 310 intracavernous injections of papaverine (ICIP) were performed in 100 impotent patients. The results were compared to those of multidisciplinary etiologic investigations, including nocturnal penile tumescence monitoring, the artificial erection test and arteriography. The response to ICIP was fairly reproducible. It differed slightly according to the position of the patient (supine or upright). We observed prolonged erections in 14% and priapism in 4% of the patients that resulted in 2 definitive iatrogenic impotences. The response to 80 mg ICIP was positive (fully rigid erection) in 17% of the organic patients, most of whom were neurogenic and endocrine patients. It was negative (no response or soft erection) in most cases with severe venous incompetence or severe arterial occlusion, but also in 44% of the patients without important vascular abnormality, and 33% of the well-documented psychogenic cases. Apart from self-injections, 27% of the patients (mainly psychogenic cases) were improved by repeating the injections. We observed a high rate of complications among 6 patients who performed self-ICIP, including 2 cases of fibrosis of the cavernous bodies. In conclusion, ICIP is of real, but limited, value in the assessment of the vascular component in impotence. It can also improve certain patients, but involves a significant risk of priapism. Today, less dangerous drugs must be selected for the therapeutic application of ICI.