Intracavernous Injection Of Vasoactive Drugs Research Articles

Prospective Cross-Sectional Evaluation of Penile Helicine Circulation by Power Doppler During Dynamic Ultrasound in Veno-Occlusive Erectile Dysfunction

ObjectiveTo evaluate the usefulness of Power Doppler to improve the diagnostic work up of veno-occlusive erectile dysfunction patients. Materials and MethodsPatients affected by erectile dysfunction, mean IIEF 5 = 13.5 (12-17) for at least 6 months, were enrolled in a prospective cross-sectional study. All patients underwent Dynamic Power Doppler after intracavernous injection of vasoactive drugs (PGE1 20 mcg and Papaverine 6 mg). Poor responders’ patients subsequently underwent to cavernosometry to get a full assessment of the vascular framework. Results202 patients (mean age 46 years), were included in the study. 96 subjects (47.5%) who did not adequately respond to the intracavernous injection -test, subsequently underwent to cavernosometry. In 42 of 96 patients (43.7%) cavernosometry was positive for veno-occlusive dysfunction. In a total of 160 patients who did not have veno-occlusive dysfunction (54 with negative cavernosometry + 106 intracavernous injection-test responders), the Power Doppler was normal in 126 (78.8%) and pathological in 34 (21.3%) in terms of steric conformation of “low flow” vessels corresponding to the Cavernosal Terminal Unit. The diagnostic sensitivity of Power Doppler towards veno-occlusive dysfunction was found to be 52.4% (Positive Predictive Value: 39.3%), the specificity was 78.8% (Negative Predictive Value: 86.3%) and the total diagnostic accuracy was equal to 73.3%. ConclusionCollected data evidenced that patients who reported altered morphological features of the Cavernosal Terminal Unit had an approximately 4-fold greater risk of having veno-occlusive dysfunction compared to patients who had normal Power Doppler features (OR = 4.076; 95% CI: 1.996-8.327).

Pathophysiology and Grayscale Ultrasonography of Penile Corporal Fibrosis.

Penile corporal fibrosis may occur secondary to explantation of an infected penile prosthesis, severe penile trauma, refractory low-flow priapism, Peyronie's disease, or chronic intra-cavernous injection of vasoactive drugs. Other etiologies of corporal fibrosis, presenting primarily with erectile dysfunction, can develop in chronic smokers, hypertensive patients, alcoholics, diabetics, and after radical prostatectomy. Corporal erectile tissue fibrosis is a significant pathophysiologic component of erectile dysfunction; however, current ultrasound-based penile imaging protocols do not directly assess it. To determine if grayscale ultrasonography (US) is a suitable imaging modality to identify and assess penile corporal erectile tissue fibrosis. A PubMed literature review was performed for studies that detailed ultrasonographic methods and findings of pathologies causing penile corporal fibrosis. Our main outcome measure was the ultrasonographic findings of pathologies causing penile corporal fibrosis. Grayscale US demonstrates the capability to detect and localize the fibrotic changes of the corpora cavernosa. Ultrasonographic findings capture penile corporal tissue heterogeneity including diffuse, circumscribed, or localized patterns. Overall, grayscale US may be a useful and convenient imaging modality to assess penile corporal fibrosis secondary to explantation of an infected penile prosthesis, priapism, penile trauma, chronic intra-cavernous injection of vasoactive drugs, diabetes, Peyronie's disease, and vascular disease. While limited by the skill and knowledge of the US operator, the combined knowledge of pathophysiology and US may help clinicians identify and manage the underlying etiology of penile corporal fibrosis. Kim J, Drury R, Morenas R et al. Pathophysiology and Grayscale Ultrasonography of Penile Corporal Fibrosis. Sex Med Rev 2022;10:99-107.

Erectile dysfunction in men with diabetes (literature review). Part 2

The second part of review article highlights modern views on the diagnosis and treatment of erectile dysfunction (ED) in men with diabetes mellitus (DM). Google Scholar and PubMed databases were used to search for literature sources. The role of comorbid diseases in the development of ED in men with diabetes mellitus has been shown. The generalized data on the main clinical manifestations of erectile dysfunction, methods of its diagnosis and treatment are given. A number of epidemiological studies over the past 20 years have found that erectile dysfunction in men with diabetes may be an early marker of cardiovascular complications. Thus, in the algorithm for the diagnosis of ED in patients with diabetes it is necessary to conduct a thorough examination of the cardiovascular system. The article describes modern therapeutic and surgical methods of ED treatment. Numerous literature sources indicate an important role of the correction of androgen deficiency in men with type 2 diabetes to enhance the effectiveness of phosphodiesterase type 5 (PDE5) inhibitors. The literature review shows the data on the emergence of new PDE5 inhibitors, which have a higher selectivity compared to existing ones that provides a better therapeutic effect and reduces the frequency and severity of side effects. The modern algorithm for the treatment of ED in men involves the sequential stages of using different treatments. The last link of therapy, in case of inefficiency of the previous ones, is penile prosthesis. Implantation of three-piece penile prosthesis is an effective method of ED treatment. The use of this method in patients with severe forms of ED on the background of diabetes, in case of ineffectiveness of PDE5 inhibitors and intracavernous injections of vasoactive drugs, is considered promising.

Removal of retained intracavernous needle tip using intraoperative fluoroscopy

Intracavernous injections of vasoactive drugs, such as alprostadil, are widely used as an effective treatment method for erectile dysfunction. Intracavernous breakage of the needle is a very rare complication of self-injections, with only a few case reports available in the current literature. Treatment methods described vary in the literature, ranging from immediate surgical exploration under ultrasound guidance to non-operative management with delayed needle removal once it is easily palpable. We report a case of an 82-year-old man with a retained intracavernous 1 cm 30 gauge needle tip after injection of alprostadil (Caverject; marketing authorisation number PL 00057/0942) and the innovative use of intraoperative X-ray imaging (fluoroscopy) for removal of this. Level of evidence: level 5 (case report/technique)

Current approaches to the diagnosis of vascular erectile dysfunction.

Vascular erectile dysfunction (ED) is closely related to cardiovascular events, and early diagnosis of vascular ED may be helpful to predict the occurrence of cardiovascular events and improve prognosis. At present, there are many approaches to diagnose ED, but each method has its advantages and limitations. This study retrospectively reviewed all available literature focusing on the diagnosis of vascular ED through a systematic PubMed and EMBASE search. According to the different application scenarios, the main methods for the diagnosis of vascular ED are divided into four categories. Intra-cavernous injection of vasoactive drugs is the earliest method used in the diagnosis of vascular ED and is a basic test. For the diagnosis of arterial ED, color duplex Doppler ultrasound, selective penile angiography, magnetic resonance imaging, and computed tomography are more commonly used. While for the diagnosis of venous ED, shear wave elastography, dynamic infusion cavernosometry and cavernosography are more accurate. Endo-peripheral arterial tonometry (PAT) has also been used to detect vascular endothelial function. Although various existing examinations are widely used for the evaluation of vascular ED, they still have some shortcomings, such as invasiveness, contingency, high false positive (negative) rate. New methods of long-term dynamic detection are needed.

Intravenous dexmedetomidine for treatment of intraoperative penile erection

Intraoperative penile erections following the initiation of either regional or general anaesthesia is rare; however, when it occurs in patients undergoing urologic procedures it may delay, or even cancel the planned surgery. The aetiology is unclear. Various treatments proposed for producing detumescence are not always effective. Use of intracavernous alpha-adrenergic agonists is an efficient and rapid but short-lasting treatment. Furthermore, repeated intracavernous injections of vasoactive drugs may be harmful. Dexmedetomidine is a potent, selective α(2)-adrenoreceptor agonist. In our study, we evaluated the effect of dexmedetomidine on intraoperative penile erection. Penile erection developed during an endoscopic procedure in 12 more than 7,800 patients. Anaesthesia used was general in 3 patients, epidural in 1 patient and spinal in 8 patients. The erection rigidity was evaluated by the operating urologist. Dexmedetomidine was diluted in normal saline to a concentration of 4 μg/ml. In all of the cases, 0.5 μg/kg dexmedetomidine was injected intravenously. The incidence of intraoperative penile erection was 0.34% for general anaesthesia, 0.11% spinal anaesthesia and 1.72% epidural anaesthesia at our institution. Detumescence was achieved in 9 patients during the first 5 min and in one patient at the 9th minute after a single intravenous dexmedetomidine (83%). There was no detumescence in two patients after 15 min (17%). This study demonstrated that 0.5 μg/kg intravenous injection of dexmedetomidine is a simple, effective and safe method for immediate relief of intraoperative penile erection with high success rate.

Le pharmaco-écho-doppler pénien : quel rôle dans la prise en charge d’une dysfonction érectile ?

Erectile dysfunction (ED) is a common multifactorial disease, in most situations arising from an organic or mixed cause. Most cases of ED classified as arterial are linked to endothelial dysfunction in relation to the key factors of cardiovascular risk. ED is an indicator of vascular health in general. It is also a predictor of cardiovascular events, including coronary heart disease. It has also been associated with lower peripheral arterial disease and stroke. At the present time, penile Doppler ultrasound examination is relatively little used in the management of ED, knowledge of the etiologic factors being most often not necessary for therapeutic management, but also because of the absence of standardization. Nonetheless, recent large-scale studies have shown that the vascular nature of ED, based on Doppler parameters recorded after intracavernous injection of vasoactive drugs, was also predictive of cardiovascular events and cardiovascular mortality, warranting greater interest in this test.

Premature Ejaculation

Premature ejaculation (PE) is a frequent male sexual complaint that is mediated mainly by disturbances of serotonergic neurotransmission and certain serotonin (5-HT) receptors and, to a lesser extent, oxytocinergic neurotransmission in the CNS. The current Diagnostic Manual of Mental Disorders (fourth edition, revised text) [DSM-IV-TR] definition of PE has a low positive predictive value and is inadequate for clinical, epidemiological and drug treatment research. Categorisation of PE into four well defined syndromes has recently been proposed for the pending DSM (fifth edition) definition of PE. Over the last decade, an increasing number of studies of drug treatment of PE have been published. A meta-analysis of those studies, conducted in accordance with current standards of evidence-based medicine, demonstrated similar efficacies for daily treatment with the serotonergic antidepressants paroxetine hemihydrate, clomipramine, sertraline and fluoxetine, with paroxetine (hydrochloride) hemihydrate exerting the strongest effect on ejaculation. On the basis of fundamental insights into serotonergic neurotransmission, it has been suggested that on-demand selective serotonin reuptake inhibitor (SSRI) treatment will not lead to similarly impressive delays in ejaculation as has been observed with daily SSRI treatment. Indeed, some on-demand studies with SSRIs and studies with the new SSRI dapoxetine have shown a weak ejaculation-delaying effect after 1-2 hours of drug intake. Apart from daily treatment with SSRIs, PE can be delayed by on-demand use of topical anaesthetics and tramadol. Treatment with phosphodiesterase type 5 inhibitors should not be prescribed to men with PE with normal erectile function, but may be used if PE is accompanied by erectile difficulties. There is no scientific support for treatment of PE with intracavernous injection of vasoactive drugs. Animal studies have shown that strong immediate ejaculation delay may be induced by administration of a combination of an SSRI with a serotonin 5-HT(1A) receptor antagonist. The combination of an SSRI and any other compound that immediately and potently raises serotonin neurotransmission and/or use of oxytocin receptor antagonists may form the basis for the development of new on-demand and/or daily drugs for the treatment of PE.

ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: Peak Systolic Velocities May Be Falsely Low in Young Patients with Erectile Dysfunction

Introduction of duplex ultrasonography with color flow Doppler analysis after intracavernous injection of vasoactive drugs has been reported to be a minimally invasive and accurate method, and considered the gold-standard technique for evaluating penile hemodynamics. However, several studies have demonstrated that in some cases Color Doppler Ultrasound (CDU) testing may result in wrong diagnosis because of anxiety and increased sympathetic stimulation. This study was carried out to evaluate the impact of age on the decision to repeat CDU in patients with initial low peak systolic velocities (PSVs). This is a prospective study involving 71 patients with erectile dysfunction (ED) who presented to the Department of Andrology, Sexology and Sexually Transmitted Diseases at Cairo University between December 2000 and April 2002. An intracavernous pharmacotest and CDU with prostaglandin E1, papaverine, and phentolamine was performed. All patients in the study had poor response to intracavernous pharmacotesting and achieved a low PSV (<30 cm/second) during the initial CDU examination. The CDU was repeated 2 weeks later. The 71 patients were grouped into four according to age: group A (20-29 years old) consisted of 11 patients, group B (30-39 years old) consisted of 19 patients, group C (40-49 years old) consisted of 20 patients, and group D (50-59 years old) consisted of 21 patients. The group A patients experienced a statistically significant increase (P < 0.05) in their PSV measurements, which reached normal values in the second CDU. None of the patients of groups B, C, or D experienced any statistically significant change (P > 0.05) in their PSV measurements in the second CDU, which remained below normal values. Also, there was a statistically significant difference between the PSV measurements of group A and the other three groups. Low PSV measurements in young men (less than 30 years old) with ED should be interpreted with caution. The effect of sympathetic overtone because of the environment in the office and anxiety related to penile injection, together with any underlying psychological disturbance, should be taken into consideration during the evaluation of the results of the CDU. Repetition of the CDU is recommended before considering any additional invasive diagnostic or therapeutic modalities.

Specific aspects of erectile dysfunction in psychiatry

The participation of the psychiatrist in the management of erectile dysfunction (ED) is focused on three types of patients based on the origin of the dysfunction: (1) patients with functional or psychogenic ED, (2) patients with mixed, organic psychogenic ED, and (3) patients with ED and active psychopathology. The second group is influenced by three psychological factors: perpetuating factors, aggravating factors, and accompanying factors. The main psychopathological disorders that interfere directly with the erectile mechanism are depressive disorders (18-35%), anxiety disorders (37%), obsessive-compulsive disorder, psychotic disorders (46-47%), and the antipsychotic medications used to treat these disorders. The diagnostic proposal includes psychological and sexologic evaluation and differential diagnosis. The therapeutic proposal includes the basic principles of sex therapy in the model of behavioral-cognitive therapy (eg, prohibition of intercourse, sensate focus, voluntary loss of erections, no expectations about response), pharmacological therapy (eg, sildenafil, intracavernous injection of vasoactive drugs), and a combination of both therapies.

New achievements and pharmacotherapeutic approaches to impotence in the elderly.

Erectile dysfunction (ED) has a negative impact on the quality of life of elderly men, but impotence is not an absolute concomitant of aging. Aging changes influencing sexual function in men consist of a decreased capacity to reach arousal by imagination or view, fragility of erection, and an increase in the refractory period. These events may be part of the andropause syndrome, which includes a decrease in intellectual activity, fatigue, depression, decreases in body hair, lean body mass and bone mineral density, accompanied by an increase in weight. As a consequence, the overlap of aging processes, concurrent diseases and social situations to which elderly men are subject, results in the great variability reported in epidemiological studies. In the same way, the complex physiology of erection depends on the social, environmental, or physical context in which it occurs. New achievements in research on intracellular mechanisms of erection and on the neuroendocrinology of aging contribute to better understanding the pathophysiology of ED in the elderly. For example, testosterone declines with age with great interindividual variability, since other hormonal changes are also involved. What currently can be easily identified is the alteration of LH-testosterone feedback alterations, although hormone levels fall in the normal range. Nevertheless, the extent to which age-dependent decline in hormones leads to health problems that may affect the quality of life remains to be clarified. Several concepts on aging-related processes have been challenged, and conditions that were once accepted as physiologically age-related are now thought to lead to medical problems, but until now erectile dysfunction remains underreported, underdiagnosed, and undertreated, especially in the elderly. Nowadays, we are witnessing a rapid growth in available pharmacotherapies, from intracavernous injections of vasoactive drugs, to powerful new oral agents, with differing pharmacological dynamic and kinetic properties. New options for treatment are therefore possible, taking into account both the possibility of changing ineffective drugs and augmenting efficacy by means of synergistic associations. This rich generation of progress is certainly contributing to a better medical approach to sexuality in aging people.

Intracavernous injections for erectile dysfunction in patients with cardiovascular diseases and failure or contraindications for sildenafil citrate.

The aim of this study was to evaluate the effectiveness of a progressive program for the treatment of erectile dysfunction in patients with cardiovascular disease in whom sildenafil citrate (Viagra) was not an option. The study population included 106 patients selected from 267 with cardiovascular disease. The intracavernous injection program consisted of three protocols of increasingly complex combinations of vasoactive drugs, papaverine, phentolamine, prostaglandin E1 and atropine sulfate. Patients who failed the first protocol were switched to the second, and those who failed the second were switched to the third. A positive response was defined as an erection sufficient for vaginal penetration. A positive response was achieved on protocol I in 61 of the 106 patients (57.5%); protocol II in 32 of the remaining 45 patients (71.1%); and protocol III in seven of the remaining 13 patients (53.8%); the total success rate was 94.3%. These 100 patients were included in the 1-year follow-up, and 90 reported successful coitus at the end of that period: 79 patients (87.8%) with intracavernous injection and 11 (12.2%) without injection. The remaining 10 patients (10%) dropped out of the program, seven (7.0%) for health or marital reasons and three (3.0%) because of treatment failure. We conclude that a progressive program of intracavernous injections of vasoactive drugs may be a good alternative for the treatment of erectile dysfunction in patients with cardiovascular disease.

Intracavernous injections: still the gold standard for treatment of erectile dysfunction in elderly men

The objective of this work was to determine the effectiveness of intracavernous injections (ICI) of vasoactive drugs in elderly men with erectile dysfunction and to compare the results obtained with the injection of two different drug combinations. It was a case control study. The sample consisted of 300 men, 63-85 y of age (mean 67.1) with erectile dysfunction of organic origin. Among the patients 180 underwent first trial with injection of prostaglandin E1 (PE). Further on these 180 patients and another 120 (in total 300 patients) were treated with a triple combination of papaverine hydrochlorate, phentolamine messylate and prostaglandin E1 (PPR). The number of responders to the injection of either PE alone or the drug combination was recorded. The quality of the erections was evaluated in the outpatient clinic by the medical staff and through patient's report after home trial. The average volume of either PE or PPR necessary to obtain a functional erection was measured. We observed a statistically significant association between the results obtained after the injection of PPR as compared to PE (chi2 with 2 d.f.: 34.666; P= < 0.001). A functional erection was obtained in 224/300 (74.7%) after the injection of PPR as compared to 87/180 men (48.3%) treated with PE. The average volume of PPR necessary to obtain a functional erection was 0.35+/-0.14 ml whereas that of PE was 1.3+/-0.3 ml. intracavernous injection of vasoactive drugs is still one of the most successful therapies for patients suffering from organic impotence. It is less effective in the older age group as compared to younger. However, if this form of therapy is chosen for aged men the triple combination therapy (PPR) yields a higher response rate than that obtained with prostaglandin alone.

Three-year outcome of a progressive treatment program for erectile dysfunction with intracavernous injections of vasoactive drugs

Objectives. To perform a comparative evaluation and follow-up of patients with erectile dysfunction (ED) who were treated with intracavernous injection of vasoactive drugs, starting with simple drugs and advancing to complex combinations. Methods. The study included 625 patients, 26 to 85 years old, with ED. Four intracavernous injection protocols were used: protocol 1, papaverine plus phentolamine; protocol 2, prostaglandin E 1; protocol 3, papaverine, phentolamine, and prostaglandin E 1; and protocol 4, atropine sulfate, papaverine, phentolamine, and prostaglandin E 1. A positive response was defined as an erection sufficient for penetration. Patients for whom the basic protocol failed were successively switched to the more advanced protocols until a positive response was achieved. Results. A positive response was achieved by 415 (66.4%) of the 625 patients given protocol 1; 75 (36%) of the remaining 210 patients given protocol 2; 98 (72.6%) of the 135 patients given protocol 3; and 22 (59.5%) of 37 patients given protocol 4. All four protocols failed in only 15 patients (2.4%). At the 3-year follow-up visit (n = 610), 349 had achieved coitus, 65 (10.6%) without an injection and 202 (33.1%) with an injection. Eighty-two patients sometimes performed coitus without an injection. Sixty-three patients (10.3%) abandoned the program because of marital or health problems; 198 asked to be switched to Viagra during the follow-up period, and 120 returned to the program. Conclusions. Overall, our progressive treatment yielded a high positive response rate (97.6%), with 57.2% achieving successful coitus on follow-up. The main advantage of the program is that it spares patients who are responsive earlier from using more complex, painful, and costly drugs.

Respuesta y valoración por parte del paciente de la farmacoinyección intracavernosa y del vacuum

One of the various therapeutic options currently used in erectile dysfunction (ED), vacuum is a procedure that should not be ruled out as it can benefit certain types of patient. To understand each patient's response and usage readiness, a vacuum test is routinely performed by the andrology service as part of the diagnostic study. The present study conducted on 200 patients with ED of different etiologies, included the vacuum test and the intracavernous injection of vasoactive drugs. The assessment included the response to each methodology; which of the two systems offered better response; and initial usage readiness to each system. Positive response was 93% in the vacuum test, and 40% in the intracavernous injection. Improved erection was reported by 73% with vacuum and only 13% with the intracavernous injection. With regard to usage readiness 60.5% favoured vacuum and only 14.5% the intracavernous injection. It was apparent that vacuum is a highly effective methodology with very high initial usage readiness, although ultimate use may be limited for different reasons.

Erectile Dysfunction: The Rational Utilization of Diagnostic Testing

Current assessment of erectile dysfunction often places excessive reliance on diagnostic testing, particularly on testing involving the intracavernous injection of vasoactive drugs. Such tests, especially cavernosometry and cavernosography, have not been validated by studies in control subjects and are associated with a high incidence of falsely abnormal results. Overreliance on these tests is often associated with taking of an abbreviated sexual history. In addition, nocturnal penile tumescence testing, which has been well validated by studies in control subjects, has been abandoned by many workers. In this era of the patient's goal-directed therapy, diagnostic testing should focus on the sexual and medical histories, physical examination, and blood studies to uncover associated systemic disorders. If nonsurgical treatment is elected, further diagnostic testing is usually not indicated. If surgical treatment is selected, psychogenic erectile dysfunction should be ruled out. The nocturnal penile tumescence test, when interpreted in light of the patient's sexual and medical histories, remains the best single test for differentiating psychogenic from organic erectile dysfunction.

Review Article - Does natural erectile function improve following intracavernous injections of vasoactive drugs?

Improvement in natural erections has been reported in approximately 9% of impotent men using intracavernous injections of vasoactive drugs for erection induction. The mechanisms which may account for this improvement are psychogenic, improved cavernous hemodynamics, prostaglandin-induced angiogenesis, improved cavernous oxygenation, cavernous smooth muscle hypertrophy and/or normal episodic fluctuations in erectile function. A review of the basic science literature on this subject reveals several theoretical explanations for this phenomenon but a review of the clinical literature reveals little convincing evidence that physiologic and/or pharmacologic factors are responsible for improvement in natural erections with intracavernous injection therapy. Furthermore, the prevalence of a placebo effect from impotence therapy exceeds the reported rate of improvement in natural or spontaneous erections. The most plausible explanations for spontaneous improvement in erections during or after intracavernous injection therapy are psychogenic and episodic variations in erectile function, rather than physiologic or pharmacologic factors. However, intracavernous injection therapy started soon after radical prostatectomy may have a protective effect in preserving normal cavernous physiology and erectile function in men being treated for prostate cancer.

Erectile dysfunction: an overview.

Erectile dysfunction is a common (affecting 10-20 million men in the USA) and multifactorial disease due to organic and/or psychological factors that strongly impairs the quality of life in man. During the past decade many advances in the understanding of the pathophysiology of erectile dysfunction have been made and new therapeutic strategies have become available. It has been established that an insufficient production of nitric oxide by penile nerve terminals and/or vascular endothelium may result in an impaired erection or complete impotence. Nowadays, intracavernous injection of vasoactive drugs represents a standardized approach for the diagnosis, and the treatment of choice, for erectile dysfunction, but is not widely accepted by the patients. The possibility of treating erectile dysfunction with intraurethral administration of prostaglandin-E1 has recently become available in the USA, and is a therapy more acceptable to the patients. Other noninvasive medical therapies are undergoing evaluation.

Noninvasive vacuum constriction device in the management of erectile dysfunction.

The effectiveness of a device designed to overcome erectile impotence was assessed in 21 patients: 5 patients with vasculogenic impotence due to venous leakage, 6 with diabetes mellitus with or without atherosclerotic cardiovascular disease, 2 paraplegic patients after spinal cord injury, 3 severely obese patients and 5 patients with psychogenic impotence. They were instructed how to use the device, which uses suction to induce penile engorgement and maintains erection with a constriction band. A total of 17 patients (81%) achieved an erection or an erection-like state that was satisfactory for intercourse. No serious ill effect from the use of the device has been reported. In selected patients the device is an alternative to either surgical placement of penile prosthesis, intracavernous injection of vasoactive drugs or sexual abstinence.

Traitement de l'érection peropératoire par le bloc pénien

Erection during endoscopic or penile surgery is a troublesome event. In this case report, the erection was first treated with intracavernous injection of etilefrine (8 mg) and detumescence was obtained rapidly. However, one hour later, the erection occurred again. Therefore a dorsal penile nerve block was performed by the median route, using 8 mL of 0.25 % bupivacaine injected into the subpublic space. Mechanisms and treatments of intraoperative erections are discussed. Repeated intracavernous injections of vasoactive drugs may be dangerous, whereas a penile nerve block carries a lower risk of cardiovascular complications and provides an improved postoperative analgesia.