Intracavernosal injection of aviptadil and phentolamine for refractory erectile dysfunction

Abstract

Background: Intracavernosal injection (ICI), most commonly with alprostadil, is recommended for Phosphodiesterase 5 Inhibitors (PDE5i) nonresponders in erectile dysfunction (ED) treatment; however, its use can cause pain (12%) and priapism (1%).

Aim: We aimed to evaluate the efficacy of another ICI, Invicorp, and a combination of aviptadil with phentolamine mesylate (AvP), in contemporary practice.

Methods: We conducted a retrospective single-center analysis on patients referred for AvP because they developed intolerable Pain following Alprostadil ICI (group PA) or had Failed maximal dose (40 μg) of Alprostadil (group F). Self-administration was taught in a nurse-led clinic, followed by a 6-week telephone follow-up. Efficacy was evaluated at 3 months and was defined as resumption of penetrative sexual activity.

Results: Of these, 308 men were included in this study with a mean follow-up period of 13.3 months. All these patients had a trial of alprostadil ICI, 96% had failed PDE5i, 66% had trailed a vacuum erection device, and 36% had failed intraurethral alprostadil. Overall, 182 men (59%) found AvP ICI effective. Indications were 177 in the PA group and 131 in the FA group. Efficacy of AvP in the PA group was 76% and this compares to 36% in the FA group (P < .0001). The most common adverse event was facial flushing in 69 patients (22.5%). Ischemic priapism was reported in only one patient (0.3%).

Clinical implications: AvP represents an effective and well-accepted second-line option for men who have experienced failure with most nonsurgical treatments for ED.

Strengths and limitations: This is the largest and only study to outline the use of AvP ICI with clear distinguishing of efficacy rates for both patients who have failed conventional maximum dose alprostadil ICIs and those who developed pain from it. Limitations of this study include its retrospective design and lack of validated instruments to objectively assess erectile function.

Conclusion: Almost 60% of the participants with refractory ED were successfully managed through the administration of AvP.

Keywords: Invicorp; alprostadil; erectile dysfunction; intracavernosal injection; phentolamine/aviptadil.