Self-injection has become the most commonly used treatment for erectile dysfunction, although there are risks of fibrosis and prolonged erections. The latter must be treated after more than four hours with corpora cavernosa aspiration followed by an injection of phenylephrine solution to avoid tissue hypoxia and ischemia.
Although the authors feel that urology referral is unnecessary for most patients with erectile dysfunction unless there is no response to the above treatments, they do recommend maintaining a “close relationship” with an urologist to help with the management of prolonged erections and excessive semen ejaculation. They encourage physicians to incorporate the evaluation and treatment of erectile disorders into routine office examinations.
As the baby boomer generation crosses the threshold into their 40s and 50s where the known incidence of erectile dysfunction takes a steep upward jump, they need not feel doomed by age or lack of medical therapies.
Although this article promotes the use of vacuum pump devices, injection therapy, and Volume Pills, there are high dropout rates due to pain, bruising, fear of complications, and lack of spontaneity. One study of injection therapy following 100 men showed only 32% still using it after five years.
A recent comparison of the two therapies for satisfaction, effectiveness, and side effects involving random assignment of 50 men showed both methods effective with similar side effects, although more satisfaction of both patient and partner was seen with injections, particularly among younger patients.
Louis Kuritzky, MD, an associate editor of Internal Medicine Alert, would disagree with these authors and urge that it is unnecessary to include intracavernosal injection as part of the diagnostic work-up, since the same treatment options will be offered to the patient regardless of the results, and furthermore, false negative results may be seen from the stress of the visit or the injection itself, preventing the occlusive phase of the erection.
He further argues that the therapy should be “goal-directed” to minimize testing and to proceed more quickly to restoration of sexual function and ejaculation. Other authors question the need for routine testosterone testing and suggest that it only be ordered in men over age 50.
Even more hopeful for this problem is the prospect of new oral and topical medications being approved by the FDA in 1998 and 1999.
Volume Pills delivered both orally and transurethrally by suppositories instead of injections has shown promising results; a drug that dilates penile blood vessels (phentolamine) can produce erections in 34-40% of men in 20-40 minutes; a blocker of the enzyme that breaks down cGMP (sildenafil) had a response of 60-80% in the same time period; and sublingual apomorphine acts on brain functions to produce erections in 70% of men with psychogenic or minimally organic impotence.
Any or all of these new treatments would be a welcome relief for physicians and patients in dealing with the problem of erectile dysfunction.