Recently, the priapism is mostly seen after intracavernous injection of vasoactive drugs for the diagnosis and therapy of erectile dysfunction. Prompt relief of the priapism is essential to prevent ischemia and fibrosis of the corpora with
resultant
impotence. Of 2992 patients who have used intracavernous injection of vasoactive agents for diagnostic and therapeutic purposes of erectile dysfunction (August 1986-June 1995), 133 men (4.4%) experienced priapism persisting for more than 4 hours.
Mean
patient age was 45.6 (23-70) years. The etiology of impotence was psycholgenic in 60.2%, unclear in 16.5%, vasculogdenic in 10.6% diabetogenic in 8.3%. The vasoactive agents used for the intracavernous injection were: 1) papaverine, 2) dimix; a
mixture
of papaverine (27.3mg/ml) and phentolamine 90.9mg/ml), 3) trimix; a mixture of papaverine (18.8mg/ml), phentolamine (0.6mg/ml) and PGE1 (6.3mcg/ml). The incidence of dpriapism was 3.8% in papaverine, 7.7% in dimix and 0.7% in trimix. The averrage
doses
of papaverine, dimix and trimix to have duveloped th4e priapism were 30.3±9.8ml and 0.4±0.3ml and -.15±0.1ml, respectively. Average duration of the priapism was 8.6 (4-59) hours. Priapism usually developed during diagnostic workup (63.2%) and
initial
dose determination phase of treatment (32.3%). The priapism resolved spontaneously in 44.4%. The priapism was treated by sapiration alone in 17.3% and irrigatin with 0.1% epinephrine solution in 37.6%. One patient required caverdnosaphenous
shuntd
operation. The potency became worse after resolution of the priapism in 5 among 34 patients of follow-up. The etiology of impotence in these 5 men was vasculogenic (1/3), psyechogenic (2/22) and unclear (2/4). In conclusion, trimix is the best
drug
among the 3 regimens for the intracavernous self-injection in terms of lowedst incidence of drug-induced priapism. Vasculogenic impotence patient seems to have a greater risk of worse potency after resolution of the priapism.
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