Utilisation des injections intracaverneuses dans les dysfonctionnements érectiles du blessé médullaire : à propos d’une expérience sur 36 patients

Abstract

Objectives: To confirm the efficiency of intracavernous injections in the treatment of erectile dysfunction in spinal cord injured (SCI) patients and to determine the mean necessary dose to obtain functional erection. Materials: This prospective study concerns 36 spinal cord injured men. None of them had erectile dysfunction before the neurologic impairement. Sixty four intracavernous injections were performed. Method: The first injection was done with the usually recommanded starting dose. The injections were then repeated with increasing dosage to archieve a rigid erection. The erection was evaluated with Schramek grading. A grade 4 or 5 erection was considered as functionnal. Results: Nine tetraplegics and 27 paraplegics were included. Twenty two were grade A in ASIA classification. The mean age was 31 years. Twenty for patients had a level above T10, 11 between T11 and L2, one below L2. Twenty seven patients obtained an erection of grade 4 or 5. Alprostadil was used 51 times, moxisylite nine times and papaverine four times. The average dose necessary to obtain a grade 4 or 5 functionnal erection adequate for coitus was 12.3 ± 4.8 μg with alprostadil and 14 ± 5.4 mg with moxisylite. No side effects were noted. The nine left patients did not archieve satisfying erection during this study. No clinical differences were noted in this population, compared with the 27 other patients. Conclusion: The findings confirm the efficiency of intracavernous injections in the management of erectile dysfunction in SCI. The average doses required to obtain a functional erection was 12.3 (± 4.8) μg with alprostadil and 14 (± 5.4) mg with moxisylyte.