Advertisement

Acta Diabetologica

, Volume 31, Issue 1, pp 1–5 | Cite as

Clinical reliability of multi-drug intracavernous vasoactive pharmacotherapy for diabetic impotence

  • F. Montorsi
  • G. Guazzoni
  • F. Bergamaschi
  • M. Zucconi
  • P. Rigatti
  • G. Pizzini
  • A. Miani
  • G. Pozza
Originals

Abstract

The aim of this study was to assess the effectiveness and safety of intracavernous injections of a fourdrug vasoactive mixture in diabetic patients with organic impotence. A group of 60 diabetic patients with either pure neurogenic, pure vasculogenic or mixed neurovasculogenic impotence were treated with intracavernous injections of a combination of 12.1 mg/ml papaverine hydrochloride, 1.01 mg/ml phentolamine mesylate, 10.1 μg/ml prostaglandin E1 and 0.15 mg/ml atropine sulphate (‘full-dose’ mixture). A mixture of the same drugs but at one-third concentrations (‘reduced-dose” mixture) was also used. The mean (±SEM) volumes of the full-dose and reduced-dose mixtures used were 0.21±0.03 ml and 0.31±0.02 ml, respectively. All the patients were able to sustain a rigid erection at the end of the titration phase of the study. At a mean follow-up of 18 months, 48 patients (80%) were successfully using the mixture, 6 patients (10%) were using the mixture at a dose lower than the initial dose and 6 patients (10%) had dropped out from the injection therapy. No major complications were seen. The association of multiple vasoactive drugs which use different mechanisms of action, thus exerting a pharmacological synergism, is an effective and safe procedure in intracavernous pharmacotherapy for diabetic patients with organic impotence.

Key words

Diabetic impotence Papaverine Phentolamine Alprostadil Atropine 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Zemel P, Sexual dysfunction in the diabetic patient with hypertension. Am J Cardiol 61: 27H-33H, 1988Google Scholar
  2. 2.
    McCulloch DK, Campbell IW, Wu FC, Prescott RJ, Clarke BF, The prevalence of diabetic impotence. Diabetologia 18: 279–283, 1980Google Scholar
  3. 3.
    Saenz de Tejada I, Goldstein I, Diabetic penile neuropathy. Urol Clin North Am 15: 17–22, 1988Google Scholar
  4. 4.
    Staubesand J, Wetterauer U, Kulvelis F, Ultrastructural findings in patients with erectile dysfunction. In: Jonas U, Thon WF, Stief CG (eds) Erectile dysfunction. Springer, Berlin, Heidelberg, New York, pp 34–43, 1991Google Scholar
  5. 5.
    Mersdorf A, Goldsmith PC, Diederichs W, Padula CA, Lue TF, Fishman IJ, Tanagho EA, Ultrastructural changes in impotent penile tissue: a comparison of 65 patients. J Urol 145: 749–758, 1991Google Scholar
  6. 6.
    McCulloch DK, Young RJ, Prescott RJ, Campbell IW, Clarke BF, The natural history of impotence in diabetic men. Diabetologia 26: 437–440, 1984Google Scholar
  7. 7.
    Kabalin JN, Kessler R, Penile prostheses surgery: review of ten-year experience and examination of reoperations. Urology 33: 17–19, 1989Google Scholar
  8. 8.
    Price DE, Cooksey G, Jehu D, Bentley S, Herrnshaw JR, Osborn DE, The management of impotence in diabetic men by vacuum tumescence therapy. Diabetic Med 8: 964–967, 1991Google Scholar
  9. 9.
    Lue TF, Tanagho EA, Physiology of erection and pharmacological management of impotence. J Urol 137: 829–834, 1987Google Scholar
  10. 10.
    Gasser TC, Roach RM, Larsen EH, Madsen PO, Bruskewitz RC, Intracavernous self-injection with phentolamine and papaverine for the treatment of impotence. J Urol 137: 678–681, 1987Google Scholar
  11. 11.
    Bell DSH, Cutter GR, Hayne VB, Lloyd LK, Factors prediting efficacy of phentolamine-papaverine intracorporeal injection for treatment of erectile dysfunction in diabetic male. Urology 40:36–40, 1992Google Scholar
  12. 12.
    Meuleman EJH, Bemelmans BLH, Van Asten WNJC, Doesburg WH, Skotnicki SH, Debruyne FMJ, Assessment of penile blood flow by duplex ultrasonography in 44 men with normal erectile potency in different phases of erection. J Urol 147: 51–56, 1992Google Scholar
  13. 13.
    Goldstein I, Krane RJ, Diagnosis and therapy of erectile dysfunction. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED (eds) Campbell's urology. WB Saunders, Philadelphia, pp 3033–3072, 1992Google Scholar
  14. 14.
    Goldstein I, Evaluation of penile nerves. In: Contemporary management of impotence and infertility. Tanagho EA, Lue TF, McClure RD (eds) Contemporary management of impotence and infertility. Williams and Wilkins, Baltimore, pp 70–83, 1988Google Scholar
  15. 15.
    Stief CG, Single potential analysis of cavernous electrical activity (SPACE): a possible diagnosis of autonomic cavernous dysfunction and cavernous smooth muscle degeneration. In: Jonas U, Thon WF, Stief CG (eds) Erectile dysfunction. Springer, Berlin, Heidelberg, New York, pp 194–206, 1991Google Scholar
  16. 16.
    Karacan I, Moore CA, Sahmay S, Measurement of pressure necessary for vaginal penetration. Sleep Res 14: 269–272, 1985Google Scholar
  17. 17.
    Gerber GS, Levine LA, Pharmacological erection program using prostaglandin E1. J Urol 146: 786–789, 1991Google Scholar
  18. 18.
    Kolodny RC, Kahan CB, Goldstein HH, Barnett DM, Sexual dysfunction in diabetic men. Diabetes 23: 306–309, 1974Google Scholar
  19. 19.
    Krane RJ, Goldstein I, Saenz de Tejada I, Impotence. N Engl J Med 321: 1648–1659, 1989Google Scholar
  20. 20.
    Persson C, Diederichs W, Lue TF Yen TSB, Fishman IJ, McLin PH, Tanagho EA, Correlation of altered penile ultrastructure with clinical arterial evaluation. J Urol 142: 1462–1468, 1989Google Scholar
  21. 21.
    Fani K, Lundin AP, Beyer MM, Jimenez FA, Friedman EA, Pathology of the penis in long-term diabetic rats. Diabetologia 25: 424–428, 1983Google Scholar
  22. 22.
    Azadzoi KM, Saenz de Tejada I, Diabetes mellitus impairs neurogenic and endothelium-dependent relaxation of rabbit corpus cavernosum smooth muscle. J Urol 148: 1587–1591, 1992Google Scholar
  23. 23.
    Lincoln J, Crowe R, Blacklay PF, Pryor JP, Lumley JSP, Burnstock G, Changes in the vipergic, cholinergic and adrenergic innervation of human penile tissue in diabetic and non-diabetic impotent males. J Urol 137: 1053–1059, 1987Google Scholar
  24. 24.
    Virag R, Shoukry K, Floresco J, Nollet F, Greco E, Intracavernous self-injection of vasoactive drugs in the treatment of impotence: 8-year experience with 615 cases. J Urol 145: 287–293, 1991Google Scholar
  25. 25.
    McMahon CG, A comparison of the response to 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 Impotence Res 3: 113–121, 1991Google Scholar
  26. 26.
    Floth A, Schramek P, Intracavernous injection of prostaglandin E1 in combination with papaverine: enhanced effectiveness in comparison with papaverine plus phentolamine and prostaglandin E1 alone. J Urol 145: 56–59, 1991Google Scholar
  27. 27.
    Keogh EJ, Watters GR, Earle CM, Carati CJ, Wisniewsky ZS, tulloch AGS, Lord DJ, Treatment of impotence by intrapenile injections. A comparison of papaverine versus papaverine and phentolamine: a double blind, crossover trial. J Urol 142: 726–730, 1990Google Scholar
  28. 28.
    Langer SZ, Presynaptic regulation of the release of catecholamines. Pharmacol Rev 32: 337–340, 1981Google Scholar
  29. 29.
    Juenemann KP, Luo JA, Lue TF, Tanagho EA, Further evidence of venous outflow restriction during erection. Br J Urol 58: 320–323, 1986Google Scholar
  30. 30.
    Hall S, Honig SC, Payton TR, Krane RJ, Goldstein I, Use of atropine sulfate in pharmacologic erections: initial experience with one year followup in the United States (abstract). J Urol 147: 265A, 1992Google Scholar
  31. 31.
    Saenz de Tejada I, Goldstein I, Azadzoi K, Krane RJ, Cohen RA, Impaired neurogenic and endothelium-mediated relaxation of penile smoothmuscle from diabetic men with impotence. N Engl J Med 320: 1025–1030, 1989Google Scholar
  32. 32.
    Montorsi F, Guazzoni G, Bergamaschi F, Orlandini A, Da Pozzo L, Barbieri L, Rigatti P, Intracavernous vasoactive pharmacotherapy: the impact of a new self-injection device. J Urol 150: 1829–1832, 1993Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • F. Montorsi
    • 1
    • 5
  • G. Guazzoni
    • 2
  • F. Bergamaschi
    • 2
  • M. Zucconi
    • 3
    • 5
  • P. Rigatti
    • 2
  • G. Pizzini
    • 1
    • 5
  • A. Miani
    • 1
    • 5
  • G. Pozza
    • 4
    • 5
  1. 1.Institute of Human AnatomyMilanItaly
  2. 2.Department of UrologyScientific Institute H. San RaffaeleMilanItaly
  3. 3.Department of NeurologyScientific Institute H. San RaffaeleMilanItaly
  4. 4.Department of Internal MedicineScientific Institute H. San RaffaeleMilanItaly
  5. 5.University of Milan School of MedicineMilanItaly

Personalised recommendations