Cavernositis following intracavernous injection of vasoactive drugs

Intracavernous injection is one of the most common treatments of erectile dysfunction. Infectious complications are rare, but hazardous. We report the case of a 44-year-old to stress the importance of patient supervision and drug prescription.

[Response to intracavernous administration of 3 different drugs in the same group of patients with erectile dysfunction]

OBJECTIVE

To compare the subjective and objective penile rigidity in the same group of patients with erectile dysfunction after intracavernous injection of different vasoactive drugs.

METHODS

91 impotent males were randomly assigned to three groups of intracavernous injection: A: 20 micrograms PGE1 B: 30 mg papaverine hydrochloride + 1 mg phentolamine (bimix), and C: 10 micrograms PGE1 + 15 mg papaverine hydrochloride + 0.5 mg phentolamine (trimix). Each patient was scheduled to receive the three modalities of intracavernous injection randomly with an interval of 7-10 days between injections. Penile rigidity equal to or more than 60% was considered positive. Subjective and objective penile rigidity were evaluated with callipers by the same observer.

RESULTS

82 patients completed the study and 9 dropped out after prolonged erection with one of the ICI modalities. Rigidity after treatment with C (66 +/- 15%) was significantly superior to that of B (59 +/- 15%, p = 0.0001) and A (60 +/- 13%, p = 0.0115). No differences were observed between A and B (p = 0.4644). Analysis of only the positive response showed significant differences between A and C, but not between C and B (p = 0.3323). Differences were not found between the response to PGE1 (A) and bimix (B) (p = 0.1275). The order of application of the drug had no effect on response (p = 0.026).

CONCLUSIONS

A higher percentage of positive response in patients with erectile dysfunction was achieved with the trimix modality. Choice of more potent ICI regimens can improve the diagnostic and/or therapeutic efficacy in males that do not respond to PGE1 alone.

[TESE-ICSI in the treatment of secretory azoospermia secondary to cryptorchism. Report of a clinical case]

The pathogenic role of cryptorchism in male infertility is still controversial. To report a case of a 34-year-old patient consulted for primary infertility with a history of 2 years associated with prepubertal bilateral orchidopexy for cryptorchidism. The fertility studies demonstrated azoospermia and normal sperm volume. Testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) were performed with success. Cryptorchism can cause primary obstructive infertility. Testicular sperm aspiration (TESA) is an alternative when spermatogenesis is preserved. In this patient TESE-ICSI was performed with success.