Efficacy and Preference of Sildenafil in Patients on Trimix Intracavernous Injection

Jeon, Hyeouk Joon; Kim, Sae Chul

Abstract

PURPOSE: We investigated the efficacy and safety of oral sildenafil, and the selection rate of sildenafil, for the continuous treatment of erectile dysfunction (ED) in patients who received intracavernous injection (ICI) therapy.
MATERIALS AND METHODS
A total of 69 ED patients (55.1+/-12.3 years) who received ICI therapy, with trimix (papaverine 18.75mg+phentolamine 0.625mg+PGE1 6.25microgram/ ml) for more than 6 months, were recruited for this study. All patients received a starting dose of 50mg sildenafil. The dose was adjusted to 100mg or 25mg based on its efficacy and tolerability. The erection quality, side effects, and selection rates of sildenafil for the continuous treatment, with reasons for its selection, were compared with those of ICI.
RESULTS
Good erectile responses, to both trimix and sildenafil, were noted in 52 (75.4%) patients. There were no differences in the age, frequency of associated diseases, dose of trimix, duration of the injection therapy, and IIEF Q3 or Q4 on the ICI between sildenafil-responders and -nonresponders. The dose of sildenafil in the responders was 100mg, 50mg and 25mg in 37, 14 and 1, respectively. Of the 52 sildenafil-responders, the erectile quality with ICI was better than with the sildenafil in 46 (88.5%), whereas only 2 showed a better quality, and 4 showed similar responses. Among the 52 responders, 18 (34.6%) preferred to continue the oral drug, 18 (34.6%) used both treatment alternatively, and 16 (30.8%) returned to the ICI. The main reason for selecting sildenafil was its easier administration (88.9%), whereas that for the ICI was its better erection quality (74.3%). The most common adverse reactions to the sildenafil included, hot flushes (17.4%) and headaches (13%).
CONCLUSIONS
Patients with ED on the ICI therapy are likely to have similar erectile responses and adverse reactions to those on sildenafil from their comparison with other clinical trials on sildenafil. However, the selection rate of ICI for the continuous treatment in sildenafil-responders was high due to its better erection quality.