Urol. praxi, 2012; 13(1): 30-32

Experience with combined intrecavernous therapy of erectile dysfunction - combination of three vasoactive drugs

PharmDr.Dalibor Černý¹, MUDr.Jiří Poněšický, FEBU², Mgr.Pavla Lerchová³, Mgr.Hana Baštářová³, MUDr.Ivan Kolombo, FEBU², PharmDr.Milada Halačová, Ph.D.², MUDr.Michal Toběrný, MBA¹

¹ Oddělení klinické farmacie, Nemocnice Na Homolce, Praha

² Oddělení všeobecné chirurgie, Nemocnice Na Homolce, Praha

³ Ústavní lékárna, Fakultní Nemocnice Na Bulovce, Praha

Treatment of erectile dysfunction (ED) in patients with impaired penile innervation, e.g. following radical prostatectomy, remains a

pressing issue in a number of patients. Current treatment (first-line therapy) of erectile dysfunction is mostly based on the use of phosphodiesterase

type 5 inhibitors (PDE5i), i.e. sildenafil, tadalafil, vardenafil, etc. Given its mechanism of action, this treatment, however,

requires at least a partial preservation of penile innervation allowing for conduction of impulses to occur during sexual stimulation.

The paper presents a case of a 48-year-old patient after radical prostatectomy for cancer in whom treatment with PDE5 inhibitors alone

failed to have a beneficial effect; therefore, it was necessary to commence treatment with local vasodilation (second-line therapy) using

intracavernous alprostadil (prostaglandin E1). The dose was titrated from 20 to 60 μg, but resulted in semi-erection only which allowed

vaginal penetration, however, it was painful and uncomfortable for the patient. Therefore, a decision was made based on the experience

published in the literature to try a fixed intracavernous combination of alprostadil 20 μg + papaverine 20 mg + phentolamine 1.5

mg, which showed to be very effective in this patient. When prescribing the above-mentioned combinations, however, a problem was

encountered of commercial unavailability of papaverine and phentolamine in the market in this country. Thus, the aim of the paper is,

among other things, to provide practical recommendations on how to proceed in the case above.

Keywords: erectile dysfunction, combined intracavernous therapy, radical prostatectomy

Published: February 15, 2012  Show citation