Skip to main content

Advertisement

Les injections intracaverneuses de prostaglandine E1: un reel progres dans l’efficacite et la securite des injections intracaverneuses

Prostaglandin E1: a real progress in the efficacy and safety of intracavernosal injections

Article metrics

  • 222 Accesses

  • 4 Citations

Abstract

Intracavernosal injections of vaso-active agents were a major breakthrough in the investigation and treatment of impotence. However the first generation agents (papaverine ± phentolamine, phenoxybenzamine) result in a too high rate of complications (prolonged erection, priapism, corporeal fibrosis,), what requires strict precautions, making their use cumbersome and even stressing. A tremendous development of the pharmacological research arises in order to find agents not resulting in those risks. This article reviews the litterature concerning one of them, Prostaglandin E1 (PGE1), and compares its effects in near 4000 patients to those of papaverine ±phentolamine in over 5000. Experimental data suggests that PGE1 might act in normal erection, and its local tolerance might be better than that of Papaverine, specially as regards the risk of fibrosis. The studies without intraindividual comparison done in men tend to confirm this better tolerance: during the workup period, PGE1 induces prolonged erection in 2.7% of men (requiring treatment in only 0.3%) compared to 9.5% with papaverine and 5.3 % with papaverine + phentolamine (p<0.001); during auto-intracavernosal therapy, the rate of prolonged erections is 0.8% with PGE1 compared to 8.7% with papaverine, and the rate of fibrosis is 0.4% versus 3.5 to 5.4% with papaverine (p<0.001). PGE1 induces slightly more erections compatible with penetration than papaverine ± phentolamine (77% vs 73 %). However it induces pain in 23% of the cases, either at the time of injection, or, more specifically, during erection. This pain is intense in only 3.9% of the cases. General tolerance is excellent. The studies with intra-individual comparison confirm the statistically significant reduction of the risk of prolonged erection requiring treatment (1.7% with PGE1 versus 4.3% with papaverine and 6% with the combination, p<0.05) and the increase in efficacy (75% versus 64% with the combination), though papaverine is superior to PGE1 in a minority of the cases. By reducing the risks, PGE1 allows directly using the effective dosage as regards the diagnostic injections. Its higher effectiveness reduces the false-negative rate in the psychogenic patients, and widens the possibilities of the intracavernosal therapy.

Resume

Les injections intracaverneuses (IIC) de substances vasoactives ont constitué une avancée majeure dans l’exploration et le traitement de l’impuissance. Les substances de première génération (papavérine ± phentolamine et phenoxybenzamine) sont cependant à l’origine d’un taux notable de complications. Cet article fait la revue de la littérature consacrée à une substance de 2ème génération, la prostaglandine E1 (PGE1) et compare ses résultats chez près de 4000 patients à ceux obtenus de la papavérine ± phentolamine chez plus de 5000. Des données expérimentales suggèrent que la PGE1 pourrait jouer un rôle dans l’érection normale et que sa tolérance locale devrait être meilleure que celle de la papavérine. Les études cliniques sans comparaison intra-individuelle tendent à confirmer cette meilleure tolérance: érection prolongée en cours de bilan chez 2,7% des patients (dont seulement 0,3% nécessitent un traitement) contre 9,5% avec la papavérine et 5,3% avec l’association; après un traitement par auto-IIC, fibrose chez 0,4% contre 3,5 à 5,4% après papavérine. La PGE1 induit un peu plus souvent que la papavérine ± phentolamine une érection compatible avec la pénétration (77% vs 73 %). Elle entraine cependant dans 23% des cas une douleur accompagnant l’injection ou, plus spécifiquement l’érection (intense dans seulement 3,9% des cas). Les études avec comparaison intraindividuelle confirment la diminution statistiquement significative du risque d’érection prolongée nécessitant un traitement, et l’efficacité supérieure, bien que la papavérine soit supérieure à la PGE1 dans une minorité des cas. En réduisant les risques, la PGE1 permet d’utiliser d’emblée les doses efficaces pour les injections diagnostiques. Son efficacité supérieure réduit le taux des faux négatifs chez les psychogènes, et repousse les limites des traitements par auto-IIC.

References

  1. 1

    -Aboseif S.R., Juenemann K.P., Luo L.A., Lue T.F., Yen T.S.B., Tanagho E.A. Chronic papaverine treatment: the effect of repeated injections of the simian erectile response and penile tissue. J. Urol., 1987, 138: 1263–1266.

  2. 2

    -Aboseif S.R., Breza J., Bosch J.L.H., Bernard F., Stief C.G., Stackl W., Lue T.F., Tanagho E.A. Local and systemic effects of chronic intracavernous injection, prostaglandin E1 and saline in primates. J. Urol., 1989, 142: 403–408.

  3. 3

    -Adaikan P.G., Kottegoda S.R., Ratnam S.S. A possible role for prostaglandin E1 in human penile erection. Proceedings of the IInd World Meeting on Impotence, Prague, 1986, Abstract 2–6.

  4. 4

    -Adaikan P.G., Lau L.C., Singh G., Susheela K., Vasatha K., Ratnam S.S. Long term intracavernous injection of papaverine and saline are detrimental to the primate cavernosum as compared to PGE1 — Pharmacological and histological evidences. Int. J. Impot. Res., 1990, 2, Suppt 2: 327–328.

  5. 5

    -Azadzoi K.M., Kim N., Goldstein I., Krane R.J., Saenz de Tejada I. The role of the endothelium in the control of corpus cavernosum smooth muscle tone. Int. J. Impot. Res., 1990, 2, suppt 2: 17–18.

  6. 6

    -Bennett A.H., Carpentier A.J.. An improved vasoactive drug combination for a pharmacological erection program (PEP). J. Urol., 1990, 143, Suppt 4, Abstract 514.

  7. 7

    -Berger R.E., Hartsell C. Comparison of patient-administered intracorporal injections of papaverine 30 mg plus 0,5 mg phentolamine versus 16,6 mg of PGE1. Proceedings of the Third Biennal World Meeting on Impotence, Boston, 1988, Abstract 155.

  8. 8

    -Bondil P., Doremieux J., Nguyen Qui J.L. Les injections intracaverneuses de drogues vasoactives. Contribution à l’étude de leur valeur dans l’impuissance érectile. J. Urol., 1987, 93: 361–368.

  9. 9

    -Brindley G.S. Cavernosal alpha-blockage: a new technique for investigating and treating erectile impotence. Brit. J. Psy., 1983, 143: 332–337.

  10. 10

    -Buvat J. Données non publiées.

  11. 11

    -Buvat J., Buvat-Herbaut M., Dehaene J.L., Lemaire A.: Is intracavernous injection of papaverine a reliable screening test for vascular impotence? J. Urol., 1986, 135: 478–479.

  12. 12

    -Buvat J., Buvat-Herbaut M., Lemaire A., Marcolin G. Applications diagnostiques et thérapeutiques des injections intracaverneuses (IC) de drogues vasoactives dans l’impuissance. Plaidoyer pour l’utilisation de drogues facilitatrices. I — Pharmacologie, classification et complications des drogues vaso-actives. J. Urol., 1989, 95: 33–39. II — Applications diagnostiques et thérapeutiques. J. Urol., 1989, 95: 89–96.

  13. 13

    -Buvat J., Buvat-Herbaut M., Lemaire A., Marcolin G. Reduced rate of fibrotic nodules in the cavernous bodies following auto-intracavernous injection of Moxisylyte compared to Papaverine. Int. J. Impot. Res., 1991, 3: 123–128.

  14. 14

    -Buvat J., Lemaire A., Buvat-Herbaut M., Marcolin G. Safety of intracavernous injections using an alpha-blocking agent. J. Urol., 1989, 141: 1364–1367.

  15. 15

    -Buvat J., Lemaire A., Buvat-Herbaut M. Marcolin G., Wagner G., Sister M.P. Traitement de l’impuissance par injection intracaverneuse de Vasoactive-Intestinal-Polypeptide (VIP). Poster au 7è Congrès de la Société d’Andrologie de Langue Française, Bruxelles, 1989.

  16. 16

    -Buvat-Herbaut M., Buvat J., Lemaire A., Marcolin G., Dehaene J.L. Diagnostic value of intracavernous injection of 20μg Prostaglandin E1 in erectile dyfunction. Int. J. Impot. Res., 1990, 2: 218–219.

  17. 17

    -Calvet U., Balza B., Maillet N., Leandri P., Rossignol G., Gautier J.R., Corraze J. PGE1 intracaverneuse lors de la lère consultation. A propos de 414 cas. Andrologie, 1992, 1. Sous presse.

  18. 18

    -Chiang H.S., Wen T.C., Wu C.C., Chiang W.H. Prostaglandin E1 versus papaverine for diagnosis of erectile dysfunction. Int. J. Impot. Res., 1990, 2, Suppt 1: 127–130.

  19. 19

    -Gerstenberg T.C. Experience with Vasoactive-Intestinal-Polypeptide (VIP)/Phentolamine and Peptide Histidine-Methionine-Amine (PHM) in penile erection. Présenté au “Symposium on pharmacological erection”, Herlev Hospital, Copenhagen 15 Février, 1990.

  20. 20

    -Goldstein I., Borges F.D., Fitch H.P., Kaufman J., Damron K., Moreno J., Payton T., Yingst J. Krane R.J. Rescuing the failed papaverine/phentolamine erection: a proposed synergistic action of papaverine, phentolamine and prostaglandin E1. J. Urol., 1990, 143, Suppt 4, Abstract 463.

  21. 21

    -Golub M., Zia P., Matsuko M., Horton R. Metabolism of prostaglandins A1 and E1 in man. J. Clin. Invest., 1975, 56: 1404–1410.

  22. 22

    -Hashmat A.I., Abrahams J., Fani K., Nostrand I. A lethal complication of papaverine-induced priapism. J. Urol., 1991, 143: 146–147.

  23. 23

    -Hedlund H., Andersson K.E. Contraction and relaxation induced by some prostanoids in isolated human penile erectile tissue and cavernous artery. J. Urol., 1985, 134: 1245–1247.

  24. 24

    -Hwang T.I.S., Yang C.R., Wang S.J., Chang C.L., Tzai T.S., Chang C.H., Wu H.C. Impotence evaluated by the use of prostaglandin E1. J. Urol., 1989, 141: 1357–1359.

  25. 25

    -Ishii N., Watanabe H., Irisawa C., Kikuchi Y., Kybota Y., Kawamura S., Susuki K., Chiba R., Tokiwa M., Shirai M. Intracavernous injection of prostaglandin E1 for the treatment of erectile impotence. J. Urol., 1989, 141: 323–325.

  26. 26

    -Jünemann K.P., Alken P. Pharmacotherapy of erectile dysfunction: a review. Int. J. Impot. Res., 1989, 1: 71–93.

  27. 27

    -Lakin M.M., Montague D.K., Vanderbrug Medendorp S., Tesar L., Schover L.R. Intracavernous injection therapy: analysis of results and complications. J. Urol., 1990, 143: 1138–1141.

  28. 28

    -Lee L.H., Stevensen R.W., Szasz G. Prostaglandin E1 versus phentolamine/papaverine for the treatment of erectile impotence: a double-blind comparison. J. Urol., 1989, 141: 549–550.

  29. 29

    -Leriche A. Pharmacologie intracaverneuse. Médecine et Hygiène, 1988, 46: 3408–3417.

  30. 30

    -Levine S.B., Althof S.E., Turner L.A., Risen C.B., Bodner D.R., Kursh E.P., Resmich M.I. Side effects of self-administration of intracavernous papaverine and phentolamine for the treatment of impotence. J. Urol., 1989, 141: 54–77.

  31. 31

    -Li S.M.C., Lin S.N. Treatment of impotence: comparison between the efficacy and safety of intracavernous injection of papaverine plus phentolamine (regitine) and prostaglandin E1. Int. J. Impot. Res., 1990, 2, Supplt 1: 147–157.

  32. 32

    -Lue T.F., Tanagho E.A. Physiology of erection and pharmacological management of impotence. J Urol., 1987, 137: 829–836.

  33. 33

    -Padma-Nathan H. The efficacy and synergy of polypharmacotherapy in primary and salvage therapy of vasculogenic erectile dysfunction. Int. J. Impot. res., 1990, 2, Suppt 2: 257–258.

  34. 34

    -Porst H. Diagnostic use and side effects of vasoactive drugs. A report on over 2100 patients with erectile failure. Int. J. Impot. Res., 1990, 2 Suppt 2: 222–223.

  35. 35

    -Porst H., Van Ahlen H., Brock T., Halbig W., Hautmann R., Lochner-Ernst D., Rudnick J., Stähler G., Weber H.M., Weidner W., Weiske W.H. Intracavernous self-injection therapy with prostaglandin E1. Results of a multicenter study with 189 patients. Int. J. Impot. Res., 1990, 2, Suppt 2: 259–260.

  36. 36

    -Porst H., Weller S., Hermanns M., Vahlensieck W. Acceptance and side effects of vasoactive drugs in erectile dysfunction: results of an inquiry of over 1000 urologists. Proceedings of the Third Biennal World Meeting on Impotence, Boston, International Society for Impotence Research (ISIR), 1988, Abstract 176.

  37. 37

    -Ravnik-Oblack M., Oblack C., Vodusek D.B., Kristil V., Ziherl S. Intracavernous injection of prostaglandin E1 in impotent diabetic men. Int. J. Impot. Res., 1990, 2: 143–150.

  38. 38

    -Roy J.B., Petrone R.L., Said S.I. A clinical trial of intracavernous Vasoactive Intestinal Polypeptide to induce penile erection. J. Urol., 1990, 143: 304–307.

  39. 39

    -Roy A.C., Tan S.M., Kottegoda S.R., Ratnam S.S. Ability of human corpora cavernosa muscle to generate prostaglandins and thromboxanes in vitro. IRCS Med. Sci., 1984, 12: 608–611.

  40. 40

    -Seidmon E.J., Samaha A.M. The pH analysis of papaverine-phentolamine and prostaglandin E1 for pharmacological erection. J. Urol., 1989, 141: 1458–1459.

  41. 41

    -Sethi GK, Scott SM, Takaro T. Effect of intraarterial infusion of PGE1 in patients with severe ischemia of lower extremity. J. Cardiovasc. Surg., 1980, 21: 185–187.

  42. 42

    -Sister M.P. Prostaglandin E1 in erectile dysfunction: 20 months of experience with 483 patients in a self-injection program. Int. J. Impot. Res., 1990, 2, Suppt 2: 287–288.

  43. 43

    -Stackl W., Rudolf H., Clemens H. Apport de la Prostaglandine E1 dans l’exploration de l’impuissance. Andrologie, 1991, 2, Sous presse.

  44. 44

    -Stackl W., Stief C.G., Benard F., Aboseid S.R., Bosch R.J.L.H., Loupal G., Lue T.F., Tanagho E.A. Intracavernous injections of solutions with different osmolarity and pH in the rabbit. Int. J. Impot. Res., 1989, 1: 197–200.

  45. 45

    -Stief C.G., Thon W.F., Wetterauer U., Schaebsdan F., Jonas U. Calcitonin-Gene Related Peptide (CGRP). A possible neurotransmitter for human penile erection and its therapeutical application in impotent patients. Int. J. Impot. Res., 1990, 2, Suppt 2: 22–23.

  46. 46

    -Stief C.G., Holmquist F., Andersson K.E. Résultats préliminaires d’injections intracaverneuses d’un donneur d’oxyde d’azote (NO) la linsidomine, dans le traitement de l’impuissance. Andrologie, 1991, 1. Sous presse.

  47. 47

    -Tamura M., Hashine K., Kimura K., Kawanischi Y., Imagawa A. Comparison of the effect of papaverine hydrochloride and prostaglandin E1 on human corpus cavernosum. Int. J. Impot. Res., 1990, Suppt 1: 141–145.

  48. 48

    -Virag R. Intracavernous injection of papaverine for erectile failure. Lancet. 1982, 1: 938.

  49. 49

    -Wagner G., Gerstenberg T. Intracavernosal injection of Vasoactive-Intestinal-Polypeptide (VIP) does not induce erection in man per se. World J. Urol., 1987, 5: 171–173.

  50. 50

    -Waldhauser M., Schramek P. Dose-dependent effect and side effects of PGE1 in the treatment of erectile dysfunction. Proceedings of the Third Biennal World Meeting on Impotence. Boston, 1988, Abstract 88.

  51. 51

    -Weiske W.H. Prostaglandin E1 (PGE1) in diagnosis and treatment of erectile dysfunction (ED) Int. J. Impot. Res., 1990, 2, Suppt 2: 234–235.

  52. 52

    -Wetterauer U., Kopperman U., Bischoff R., Sommerkamp H. Intraindividual comparison of papaverine-phentolamine combination versus prostaglandin E1 in intracavernous injection therapy for erectile dysfunction. Int. J. Impot. Res., 1990, 2, Suppt 2: 238–239.

  53. 53

    -Wilken S.H., Elger B., Cassidy F., Caspary L., Creutzig A., Frölich J.C. Cardiac and microcirculatory effects of different doses of prostaglandin E1 in man. Eur. J. Clin. Pharmacol., 1987, 33: 133–137.

Download references

Author information

Correspondence to Jacques Buvat.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Buvat, J., Buvat-Herbaut, M., Lemaire, A. et al. Les injections intracaverneuses de prostaglandine E1: un reel progres dans l’efficacite et la securite des injections intracaverneuses. Androl. 1, 78–82 (1991) doi:10.1007/BF03034178

Download citation

Key-words

  • Impotence
  • Intracavernosal injection
  • Pabaverine
  • Phentolamine
  • Phenoxybenzamine
  • Prostaglandin E1
  • Complications
  • Prolonged erection
  • Fibrosis

Mots clés

  • Impuissance
  • injection intracaverneuse
  • Papavérine
  • Phentolamine
  • Phenoxybenzamine
  • Prostaglandine E1
  • Complications
  • Erection prolongée
  • Fibrose