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Long-Term Injection Therapy Outcomes: Treatment
Efficacy and Patient Satisfaction

Kevin Asher, MD, Daniel Martinez, MD, Ricardo Munarriz, MD.
Boston University, Boston, MA, USA.

BACKGROUND:
Intracavernosal therapy was the first minimally invasive pharmacologic treatment in the management of ED. The introduction of PDE5 inhibitors, penile pain, corporal fibrosis, and lack of efficacy have resulted in high discontinuation rates. We prescribe a customized, tailored regimen of intracavernosal preparations and employ a specially trained sexual medicine nurse for patient teaching. The aim of this study is to report our long-term experience using validated and non-validated instruments.
METHODS:
This is an IRB approved, retrospective single institution study of 999 patients who have been prescribed injection therapy in our center in the last 10 years. We used a questionnaire to assess general demographic questions, patient reported penile rigidity, the IIEF (International Index of Erectile Function) and the EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) validated tools. Questionnaires were mailed or collected in our office.
RESULTS:
Of the 879 patients who were identified, 262 questionnaires (mean age 55.1 +/- 13.9 years) were available. Mean duration of IC therapy was 8.1 +/- 5.54 yrs. Pre and post treatment penile rigidity was 37 +/- 33.1% and 73.3 +/- 18.6%. Pre and post total IIEF was 31.8+/- 13.2 and 51.8 +/- 12.1. Further data is displayed in table. Treatment satisfaction by patient report and EDITS were 86.7 %, and 84.6 +/- 21.3, respectively. In addition, 86.7% would recommend this treatment to other patients. 7.1% had one episode of priapism that required intracavernosal injection of alpha agonist. 13.3% developed penile curvature and 6.7% had 1-3 episodes of penile bruising. Penile pain was reported as mild with a mean of 2.4 +/- 1.07 on a subjective pain scale, measured from 1-10.


Pre-treatment (mean)
Post-treatment (mean) pvalue

Total IIEF score

31.8

51.8
<0.01
IIEF EF Domain14.525.6<0.01
IIEF Q #32.1
4.6
<0.01

IIEF Q #4

1.8

4.5
<0.01

CONCLUSIONS:
Intracavernosal therapy at our center is highly effective and associated with high satisfaction rates and minimal side effects. A future prospective trial is ongoing to address discontinuation rates.
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