Clinical and Sonographic Assessment of the Side Effects of Intracavernosal Injection of Vasoactive Substances

Abstract

The aim of this work was to evaluate the side-effects of intracavemous vasoactive agents on clinical and Sonographic basis. Two groups were included, Group I included 305 patients, 40 to 60 years old, complaining of ED who were trained for self-injection therapy with one of three protocols: protocol A papaverine , protocol B PGE1 and protocol C trimix(papaverine, phentolamine, and PGE 1). They were then followed­ up clinically, sonographically and by laboratory investigations for 6 months to evaluate the occwTence of side-effects of ICI. Group II included 21 patients presentin g to our department for the first time with one ofthe complications oflCJ received elsewhere. They were evaluated and managed accordingl y. One hundred and sixty-eight patients of group I completed the study. Patients on protocol A had the hi ghest incidence of complications concerning priapism, subcutaneous hematoma and penile fibrosis. Postinjection penile pain was observed more with PGEI and trimix than papaverine. No systemic side-effects were reported. Duplex ultraso und proved beneficial in clarifying fibrosis which was clinically undetectable. Ten patients of group II complained of priapism. Four of whom received the injection during dynamic duplex study, another four received it in private clinics of specialized doctors, while the last two received it at a phannacy. Seven patients( of group II) complained of penile fibrosis, three of cavernositis and one of intracavernous needle breakage. While Side-effects of ICI are more common with papaverine, PGEl has the highest incidence of postinjection penile pain.. Duplex ultrasound showed considerable value in detection ofpenile fibrosis. Performing intracavernous injection a nd trainin g patients to self-inject themselves should be supervised by an andrologist. Regular follow-up of patients on intracavernous self-injection therapy clinically and sonographically is mandatory. There is a great need for safer intracavemosal vasoactive agents with less invasive delivery systems.