Combined intracavernous vasoactive drugs and sildenafil citrate in treatment of severe erectile dysfunction not responding to on-demand monotherapy

To investigate the effect of chronic use of sildenafil and intracavernous injection (ICI) with trimix in n not responding to on-demand monotherapy with sildenafil or ICI ith prostaglandin-E1 (PGE1). Patients and methods: The studyincluded 40 patients with erectile dysfunction (ED), with amean SD) age of 50.7 (11.3) years and unresponsive to on-demand sildenafil or ICI with PGE1 as onotherapy. They were assessed using the Sexual Health in Men (SHIM)-5 score for ED severity, penile olour Doppler ultrasonography (CDUS) for peak systolic velocity (PSV), end-diastolic velocity (EDV) nd resistance index (RI) with an ICI test using 0.25 mL of trimix of papaverine, PGE1 and hentolamine. Testosterone, prolactin and cholesterol levels were assessed. Patients received 25 mgsildenafil daily or 8 weeks, combined with twice weekly ICI with 0.25 mL of trimix. After treatment, the Erection rdness Score (EHS), penile CDUS with ICI and ED Inventory of Treatment Satisfaction were ssessed. Results: The mean (SD) SHIM-5 score before treatment was 8.3 (0.5) in 15 of the 40 men and 6.3 0.4) in 25. Penile haemodynamics were normal in five (13%), showed arterial insufficiency in five 13%), venous occlusive disease in 26 (65%) and mixed vascular in four (10%). There was an mproved SHIM-5 score in 28 (70%) patients, as shown by their haemodynamic values, duration of rection and EHS with therapy, and 66% satisfaction with treatment. Adverse effects (penile pain, eadache, facial flushing, dyspepsia, nasal congestion, dizziness) were reported in 17 patients 43%). Conclusion: Chronic use of trimix plus daily low-dose sildenafil improved penile haemodynamics n these patients with ED not responding to on-demand phosphodiesterase-5 inhibitors or ICI ith PGE1 monotherapy