The Results of Intracavernous Papaverine Injection: Experience with 92 Patients

Jung, Gyung Woo; Jeong, Moon Kee; Cha, Young Il; Yoon, Jong Byung

Abstract

A total of 92 men with impotence underwent a trial of intracavernous injection of papaverine 30mg. Underlying causes of impotence were psychogenic (26 Pts.), posterior urethral injury (28 Pts.), spinal cord injury (15 Pts.), pelvic surgery (14 Pts.) and eldly (9 Pts.). The results were as follows 1. The underlying causes of impotence in papaverine responders were psychogenic 23 (88.5%), posterior urethral injury 19 (67.9%), spinal cord injury 13(86.7%), Pelvic surgery 5 (35.7%) and eldly 3 (33.3%). 2. Fourteen patients of the moderate papaverine responders underwent intracavernous injection of papaverine 30mg with phentolamine 1mg and 8 of them attained full erection. 3. After injection, the erection started in an average of 2.6 minutes, rigidity of penis attained in an average of 7.3 minutes, and erection status sustained for an average of 42.6 minutes in 60 patients. 4. Normal nocturnal penile tumescence monitoring (NPTM) or stamp test was found in 19 of 40 patient and 18 of them (94.7%) were papaverine responders, while 21 had an abnormal NPTM or stamp test and 11 of them were papaverine non-respoders. 5. A penile brachial index (PBI) of 0.6 or more was found in 62 of 73 patients and 53 of them(85.5 %) were papaverine responders, while 11 had an index of less then 0.6 and all of them were papaverine non-responders. 6. Thitry patients had sexual intercourse. Twenty-seven of them had a satisfactory result and 23 of them had ejaculation. 7. Papaverine induced prolonged erection occurred as major complicatiun in 4 patients after trial injection. Erection was subsided after intracavernous phenylepinephrine injection. There were minor complications such as ecchymosis at the injected site on the prepuce but subsided spontaneously in a few days. We conclude that intracavernous papaverine injectiun currently is a good screening technique for the differential diagnosis of severe vasculosenic impotence and is a useful chemical prosthesis of non-vasculogenic impotence.