Is Intracavernosal Injection Therapy a Dinosaur? Long-Term Efficacy and Safety
Kevin Asher, MD, Daniel Martinez, MD, Terry Payton, RN, Ricardo Munarriz, MD.
Boston University, Boston, MA, USA.
Intracavernosal injection therapy (ICI) was the first pharmacologic therapy in the management of erectile dysfunction (ED) with over 90% effectiveness rates. However, due to many factors, discontinuation rates are high. At the Center for Sexual Medicine at Boston University, patients have been using ICI since the mid 1980s. We believe that the success of our injection program is due to: i) dedicated staff to train and educate patients, ii) patient -specific bi and tri-mixtures, iii) routine follow-up care to identify and handle treatment related problems, iv) long-term personal relationship with a compound pharmacy that provides high quality, reliable, convenient, reasonably-priced intracavernosal preparations. The aim of the study was to evaluate the efficacy and safety of ICI in patients using this treatment modality for more than 10 years and to characterize their experience.
This is a single institution, retrospective, IRB-approved study of 38 patients who have been using ICI for over 10 years. All patients completed validated (International Index of Erectile Function and the Erectile Dysfunction Inventory of Treatment Satisfaction) and non-validated questionnaires.
The mean follow up was 15 years and 7/38 patients had used ICI for more than 20 years. Mean patient age was 61. Average duration of erection was 68.1 minutes (7.5-180) and 76% of patients reported penile rigidity greater than 90% with ICI. The mean number of intracavernosal injections per month was 4 and the vast majority (87%) report performing the injection alone, not in presence of partner. Interestingly, 60% of patients are responsive to PDE-5 inhibitors, however they continue to use ICI due to better penile rigidity and fewer side effects. Mean pre and post treatment IIEF score was 36.6 and 64.7. Mean IIEF Question III and IV scores pre and post treatment were 2.6 and 4.8, and 1.8 and 4.8 respectively. Mean EDITS score was 27.2 for the cohort. All differences were statistically significant.
No major complications were reported. However, 23% of patients reported a loss of penile length, 16% development of some degree of penile curvature, and 7% reported penile pain with injections.
Intracavernosal injection therapy is an effective, reliable and safe treatment of erectile dysfunction for 10 years or more. High adherence rates require a dedicated staff and readily available, patient-specific pharmacologic preparations.