Erectile response profiles of MEN using PDE5 inhibitors combined with intracavernosal injections as part of a penile regabilitation program after radical prostatectomy
Abstract
BACKGROUND: PDE5 inhibitor (PDE5i) labeling states that these agents should not be used in conjunction with other erectogenic medications for fear of priapism occurring. AIM: We explored the risk of priapism and prolonged erections in men in our post-radical prostatectomy (RP) penile injection program who were using regular PDE5i and intracavernosal injections (ICI) as part of their rehabilitation program. METHODS: Study cohort included men on penile injection therapy who (i) were taking tadalafil 5mg daily or taking sildenafil 25mg on non-injection days (ii) had a RP (iii) were using their respective PDE5i regularly at the time of penile injection training and (iv) complied with the program instructions regarding penile injection use. Demographics, comorbidity details, PDE5i dose and utilization as well as injection dose and utilization data were collected. All patients underwent in-office injection training and used trimix (papaverine/phentolamine/PGE1) as the intracavernosal medication. OUTCOMES: Priapism was defined as a patient self-reported penetration hardness erection ≥4 hours in duration, while prolonged erection was defined as a penetration hardness erection lasting ≥2 hours. RESULTS: 112 tadalafil (T) users and 364 sildenafil (S) users were compared. Mean age and duration post-RP were 62±14 years and 5.2±12 months respectively, no difference between T and S groups. Mean trimix dose was: T 24±24 units; S 31±37 units, p<0.05. Priapism occurred in: T 2/112 (1.7%); S…
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