Erectile dysfunction: a global review of intracavernosal injectables

Abstract

Purpose

Data assessing the effectiveness of intracavernosal injections (ICIs) for the treatment of erectile dysfunction (ED) are limited. This study evaluates intracavernosal injectable therapies for ED and reviews available guidelines that inform clinical practice.

Methods

A systematic search using electronic databases (Medline, Pubmed) was performed for studies investigating injectable management strategies for ED published after 1990. Primary outcome measures were to comparatively evaluate clinical efficacy, continuation rates and adverse event profiles of each injectable agent as monotherapy or in combination. The secondary outcome measurement was to discuss available guidelines that inform clinical practice for injectable agents.

Results

ICIs demonstrate clinical efficacy in 54–100% of patients, early discontinuation rates of ≤ 38% and adverse events in ≤ 26%. Discontinuation rates are typically greatest within 3–6 months of commencement. Anxiety related to the initial injection occurs in approximately 65% and anxiety levels can remain high for 4 months. Approval of intracavernosal injection agents is mainly limited to alprostadil with the recent addition of aviptadil/phentolamine combination therapy in a select few geographical regions. Although combination therapies are attractive alternative options, their formulations are variable and should be standardised before widespread acceptance is achieved.

Conclusions

ICIs are associated with good clinical efficacy rates, high discontinuation rates and a moderate side-effect profile. They represent an important tool in the urological armamentarium for treating ED in patients that cannot tolerate or are refractory to oral therapies.

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Abbreviations

AUA:

American Urology Association

BSSM:

British Society of Sexual Medicine

cAMP:

Cyclic adenosine monophosphate

cGMP:

Cyclic guanosine monophosphate

EAU:

European Association of Urology

ED:

Erectile dysfunction

FDA:

Food and Drug Authority, USA

ICI:

Intracavernosal injection

JSSM:

Japanese Society of Sexual Medicine

KSSM:

Korean Society of Sexual Medicine

PDE5:

Phosphodiesterase type 5

PGE1:

Prostaglandin 1

TGA:

Therapeutic Goods Administration, Australia

VIP:

Vasoactive intestinal polypeptide

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Funding

No funding was provided for this review.

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Authors

Contributions

CD: Project development, data collection, data analysis, manuscript writing & revision. JGO: Project development, data collection, data analysis. JT: data analysis, manuscript writing & revision. NFD: manuscript writing and editing. DMB: Project development, manuscript editing. NL: Project development, data collection, manuscript editing

Corresponding author

Correspondence to Nathan Lawrentschuk.

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None of the authors have conflicts of interest to disclose.

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Ethics approval for this project was not required as no human or animal participants were involved in this review.

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Duncan, C., Omran, G.J., Teh, J. et al. Erectile dysfunction: a global review of intracavernosal injectables. World J Urol 37, 1007–1014 (2019). https://doi.org/10.1007/s00345-019-02727-5

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Keywords

  • Erectile dysfunction (ED)
  • Intracavernosal injections
  • Treatment of erectile dysfunction
  • Treatment of ED