Introduction
Self-injection therapy is one of the many options available for the treatment of impotence. It involves the patient or their partner injecting a drug directly into the side of the penis to create an erection. The erection created is natural and usually begins 5-15 minutes after the injection. Not all patients respond to this type of treatment, but those who do have an erection that lasts 30 to 120 minutes. The injections are given through a small needle and use a very small amount of medicine. The injections are relatively painless and are easily taught to patients in one or two visits with the doctor.
Drugs used today include: prostaglandin ( PGE-1 or Prostin or Alpoprostadil or Caverject ), papaverine hydrochloride and phentolamine (Regitine). All of these drugs have been approved by the FDA for uses other than the treatment of impotence. Only prostaglandin has been approved by the FDA for the treatment of impotence. Papaverine and phentolamine have not yet been approved by the FDA for this specific purpose, although these two drugs were originally used for self-injection therapy. However, considerable experience has been gained by urologists over the past decade, and the three drugs mentioned above are considered safe for self-injection treatment.
Risks
All drugs have potential risks and side effects, and risks exist with all of these drugs and injections. These may include the possibility of bleeding or bruising during the injection, and a small risk of infection. One of the most common risks is the development of a prolonged erection or priapism (more than four hours). An episode of priapism may require a trip to the doctor or the emergency room to receive other medications to combat the self-injection medications and to relieve the prolonged erection. Priapism occurs in a small percentage of patients. The patient should be aware that an erection that lasts longer than four hours should be treated by a doctor. Another possible complication is the development of permanent scars on the penis. Medications can irritate the tissues of the penis, and scarring is more often seen in patients who abuse medications and use them too often. The scarring could create difficulty getting an erection, even with additional medication. If the scars were severe, placement of a penile prosthesis may be difficult, if that option was in later plans. Even rarer is the development of other medical problems. Papaverine has been known to cause changes in liver function tests that go away when the drug is no longer in the body.
Disadvantages of Self-Injection Treatment
Self-injection treatment requires the patient or their partner to learn how to inject directly into the penis. The patient should return to the doctor for follow-up visits, especially in the early stages of treatment. Patients cannot use the injections too often for fear of developing scarring, and self-injection therapy should be limited to once every four to seven days (depending on type of medication and initial response).
Injections are relatively expensive and average costs depend on drug combinations. An injection can cost from 8 to 10 euros.
Not all patients are eligible for self-injection therapy. A percentage of patients will not develop good erections, and another group of patients may develop erections that do not go away, making them poor candidates for continued use of this drug.
Advantages
The major advantage of self-injection therapy is that the erection created is similar to spontaneous body erections. The erection usually lasts 30 to 120 minutes, which is enough time for pleasurable intercourse. Self-injection therapy does not interfere with the development of an orgasm or ejaculation. Self-injection therapy is less expensive than the implant. Self-injection therapy can be used by the patient at their discretion and at any time with minimal preparation. The treatment does not require surgery and is very painless.
Summary
If you decide to start the program with self-injection, we will bring you back to the office for trial doses, to see which medication and how much is most appropriate and effective for you. After establishing the dose, we will teach you how to take the medicine from the vial, and how to safely inject it into the penis. You can bring a partner to watch, although absolutely not necessary if you have good dexterity and good eyesight. We will have you read, understand and sign a consent form. The form will mention the different risks of medications and injections. We will go over all of these risks and conditions in detail during the educational program. If you have any questions about self-injection therapy, please don't hesitate to ask us.