Penile Rehab: Combo Therapy Most Effective

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Want to share this bit of news with all of you.  The Cleveland Clinic is a fine institution and they seem to be up-to-date on ED.

Their conclusion: “Early intracavernosal injections following RP facilitated early sexual intercourse, patient satisfaction and potentially earlier return of natural erections. Early combination therapy with sildenafil allowed a lower dose of intracavernous injections, minimizing the penile discomfort.”

[Note: Sildenafil = Viagra, Alprostadil = main ingredient in Trimix.]

If you are a man who’s had RP, make sure you follow up with an *ED* doc after 2 months.  If you don’t have one, consult my article, “How to Find A Good ED Doctor”.

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International Journal of Impotence Research
Int J Impot Res. 2006 Sep-Oct;18(5):446-51. Epub 2006 Feb 16.

Early combination therapy: intracavernosal injections and sildenafil following radical prostatectomy increases sexual activity and the return of natural erections.

Nandipati K, Raina R, Agarwal A, Zippe CD.   Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44125, USA. zippec@ccf.org.

Early pharmacological prophylaxis has been reported to increase the return of spontaneous erections following radical prostatectomy (RP).  In this study, we evaluated the role of intracavernosal alprostadil  (PGE1) combined with sildenafil in stimulating early recovery of spontaneous erections following RP. In this prospective study, we included 22 patients who underwent bilateral nerve-sparing RP after October 2004.

Sildenafil dose of 50 mg/day was started at the time of hospital discharge. Of 22 patients, 18 started on PGE1-4 microg (1-8) and four started on low-dose Trimix (20 U) 2-3 times/week. These patients are followed up at regular intervals (3, 6, 9 and 12 months) with abridged version of the International Index for Erectile Function-5 questionnaire.  Patient compliance, return of sexual activity andreturn of natural erection, adverse effects and reasons for discontinuation were recorded. Penile doppler studies were performed during followup visits to assess the vascular status.

After a mean followup of 6 months (3-8 months), 11/22 (50%) patients had return of spontaneous partial erections. Of the 18 PGE1 users, six continued 4 microg PGE1, four increased the dose to 8 microg, six decreased the dose to 2 microg and two patients further reduced the dose to 1 microg.

Of four low-dose Trimix users, three increased the dose to 30 U and one reduced the dose to 15 U. Of 22 patients, 21 were sexually active: 12/21 (57%) with the injections alone and 9/21 (42.9%) with combination therapy (injections (PGE1) and sildenafil). Penile doppler studies revealed arterial insufficiency in 77% (17/22) patients and venous insufficiency in one patient.

* Early intracavernosal injections following RP facilitated early sexual intercourse, patient satisfaction and potentially earlier return of natural erections. Early combination therapy with sildenafil allowed a lower dose of intracavernous injections, minimizing the penile discomfort.

http://www.ncbi.nlm.nih.gov/sites/entrez

By | 2008-02-19T13:23:31+00:00 February 19th, 2008|Healing the Mind, Sexuality and Intimacy|2 Comments

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2 Comments

  1. Bill June 27, 2008 at 8:55 pm

    What do they mean by arterial insufficiency and venous insufficiency? And how does this effect ED?

    In my own experience after my RP with nerve sparing surgery, both alprostadil and viagra were fairly effective. However, there is a significant decrease in my size, length and especially width, which effected the quality of relations to the point where my wife says she cant get pleasure. I have not heard of any research on penil atrophy and was not advised of the possibility prior to surgery. I believe it is a result of diffuse tissue necrosis from swelling and vascular damage during surgery. Do you have any other info on this?

  2. Leah July 1, 2008 at 11:59 am

    Bill,

    I will try to do some research about the issues you brought up and write about it on the blog. So keep an eye out.

    Unfortunately, penile shrinkage does happen in some cases, but I have never heard of a woman complaining about it.

    Maybe you should experiment with a vibrator — my husband and I started using it to good effect (mostly he likes it).

    Leah

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