Intracorporal Prostaglandin E1

1. Indications
   1. Psychogenic Impotence
   2. Neurogenic Impotence
   3. Vasculogenic Impotence
2. Contraindications
   1. Penile deformity (e.g Peyronie's Disease)
   2. Priapism risk
      1. Sickle Cell Disease or Sickle Cell Trait
      2. Leukemia
      3. Multiple Myeloma
      4. Polycythemia Vera
      5. Thrombocythemia
3. Mechanism: Corporal smooth muscle relaxation
   1. Increases arterial inflow
   2. Decreases venous outflow
4. Intracorporal Injection Preparations
   1. PGE1 or Alprostadil (Caverject)
      1. See also Intraurethral Alprostadil (MUSE)
   2. Papaverine
   3. Phentolamine
   4. Combinations: Alprostadil + papaverine + phentolamine
      1. May be more effective with less pain
5. Dosage Alprostadil (titrate in physicians office)
   1. Dose
      1. Start: 2.5 ug (1.25 ug in neurogenic Impotence)
      2. Next: 5 ug
      3. Increase: 5 ug increments
   2. Endpoint
      1. Erection adequate for intercourse (duration <1 hour)
      2. Maximum reached (see below)
   3. Maximum dosing
      1. Maximum dose: 60 ug
      2. Do not exceed more than 3 times per week
      3. Do not exceed more than once in 24 hours
6. Technique:
   1. Inject at dorso-lateral aspect in penis proximal third
   2. Alternate sides and sites for each injection
7. Adverse Effects of Intracorporal Injection (41%)
   1. Hematoma
   2. Prolonged Erection exceeding 4 hours (4%)
   3. Priapism with Erection exceeding 6 hours (1%)
      1. See Priapism Reversal Protocol
   4. Penile Plaques (10%)
8. Efficacy (Caverject)
   1. Success Rates: 67 to 85%
   2. Compliance
      1. Discontinued therapy after 1 year: 56%
      2. Discontinued therapy after 2 years: 68%
9. References
   1. Viera (1999) Am Fam Physician 60:1159-72
   2. Sundaram (1997) Urology 49:932-5