Intracavernous vasoactive pharmacotherapy: the impact of a new self-injection device

A review on pharmacological options for the treatment of erectile dysfunction: state of the art and new strategies

INTRODUCTION

Erectile dysfunction (ED) affects between 12.9% and 28.1% of men worldwide, presenting a strong aged-correlated prevalence. Several pharmacological treatments are currently available for ED, which can be classified into oral, injection, and topical/intraurethral therapies.

AREAS COVERED

Extensive research on PubMed/MEDLINE until February 2023 was performed. For each of the aforementioned drug classes, available molecules, and formulations, their efficacy and most common adverse events as well as general guidelines on prescription were investigated and extensively described. A glimpse into future directions regarding ED pharmacotherapy is also present.

EXPERT OPINION

In recent years, there have been significant developments in pharmacological treatments for ED. It is essential for physicians to identify the best treatment option for patients based on their preferences and sexual habits. The treatment approach for ED has shifted from a sequential to a parallel paradigm, where all treatment options are available as first-line therapies. While there are promising regenerative therapies for ED, such as shockwaves and platelet-rich plasma injections, pharmacological treatment is still the most effective option for most patients.

Use of a fully automated injector for self-administration of follitropin α in an IVF/ICSI programme

Recombinant FSH (r-FSH) used for ovarian stimulation can currently be self-administered either by a conventional syringe or by a pen device. This randomized controlled trial compares the efficacy and convenience of a new, more sophisticated and fully automated injection device (Softinject(trade mark)) with the conventional syringe for r-FSH self-administration. A total of 300 women needing ovarian stimulation for IVF/intracytoplasmic sperm injection were randomized to the automated injector or the conventional syringe group. Patients of both groups had ovarian stimulation with follitropin alpha after pituitary desensitization with a gonadotrophin-releasing hormone agonist. State anxiety score, overall pain score and pregnancy rate were chosen as the main outcome measures. Patients in the automated injector group showed lower state anxiety (P < 0.01) and overall pain (P < 0.01) scores and a comparable pregnancy rate per started cycle as compared with the conventional syringe group. They needed lower doses of r-FSH (P < 0.05) and their stimulation was shorter (P < 0.05). It is concluded that the use of a fully automated injector for r-FSH self-administration reduces pain and stress as compared with the conventional syringe. This device can be used for any subcutaneously administered drug employed in ovarian stimulation.

Pharmacological management of erectile dysfunction

Erectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men worldwide. Many drugs are now available for treating ED; oral pharmacotherapy represents the first-line option for most patients with ED. Sildenafil, an inhibitor of the enzyme phosphodiesterase type 5, is currently the most widely prescribed oral agent and has a very satisfactory efficacy-safety profile in all patient categories. Apomorphine SL is a dopamine D1- and D2-receptor agonist which has recently been approved for marketing in Europe. It is best selected for treating patients with mild to moderate ED. Vardenafil and tadalafil are new phosphodiesterase type 5 inhibitors which are expected to be approved this year. Both of them have significant positive efficacy-safety profiles. Patients who do not respond to oral pharmacotherapy or who cannot use it are good candidates for intracavernosal and intraurethral therapy. Alprostadil is the most widely used drug, both for injection therapy and for the intraurethral route. The efficacy of second-line treatment is high but the attrition rate remains significant.

The acceptance and satisfaction of Saudi males to vasoactive autoinjection intracavernous therapy, external negative pressure device and penile prosthesis in the treatment of erectile dysfunction

BACKGROUND

The aim of the study was to determine the acceptance and satisfaction of Saudi impotent male patients to intracavernous vasoactive autoinjection therapy, external negative pressure device and penile prosthesis insertion in the treatment of their impotence.

SUBJECTS AND METHODS

The medical records of 210 Saudi patients who presented with erectile dysfunction and were offered intracavernous vasoactive autoinjection therapy, external negative pressure device or penile prostheses for the treatment of their erectile dysfunction were retrospectively analyzed to determine the acceptance and satisfaction of their selected treatment modalities.

RESULTS

Intracavernous vasoactive autoinjection therapy was the most acceptable treatment option, followed by negative pressure device, and then insertion of penile prosthesis. About 11.9% of patients refused all treatment options. Only 40% and 12% of patients who were treated with intracavernous vasoactive autoinjection therapy and external negative pressure device, respectively, were satisfied with their treatment modality. After one year of follow-up, insertion of penile prosthesis had the highest satisfaction rate among the treatment modalities, with 92% and 87% of patients being satisfied at 3 and 12 months' follow-up, respectively.

CONCLUSION

Intracorporeal vasoactive autoinjection therapy had the highest acceptance rate compared with external negative pressure devices and penile prosthesis, however, it had low satisfaction rate and the dropout rate was high. External negative pressure devices are generally poorly accepted and are rarely satisfactory in our patient population. Penile prosthesis insertion is poorly accepted, however, it has the highest satisfaction rate. Such information will allow patients under treatment for impotence and their treating physicians to make better, educated choices on the mode of treatment.

Clinical reliability of multi-drug intracavernous vasoactive pharmacotherapy for diabetic impotence

The aim of this study was to assess the effectiveness and safety of intracavernous injections of a four-drug vasoactive mixture in diabetic patients with organic impotence. A group of 60 diabetic patients with either pure neurogenic, pure vasculogenic or mixed neurovasculogenic impotence were treated with intracavernous injections of a combination of 12.1 mg/ml papaverine hydrochloride, 1.01 mg/ml phentolamine mesylate, 10.1 micrograms/ml prostaglandin E1 and 0.15 mg/ml atropine sulphate ('full-dose' mixture). A mixture of the same drugs but at one-third concentrations ('reduced-dose' mixture) was also used. The mean (+/- SEM) volumes of the full-dose and reduced-dose mixtures used were 0.21 +/- 0.03 ml and 0.31 +/- 0.02 ml, respectively. All the patients were able to sustain a rigid erection at the end of the titration phase of the study. At a mean follow-up of 18 months, 48 patients (80%) were successfully using the mixture, 6 patients (10%) were using the mixture at a dose lower than the initial dose and 6 patients (10%) had dropped out from the injection therapy. No major complications were seen. The association of multiple vasoactive drugs which use different mechanisms of action, thus exerting a pharmacological synergism, is an effective and safe procedure in intracavernous pharmacotherapy for diabetic patients with organic impotence.