Intracavernosal Complications

Intracavernosal injection therapy should be used cautiously in patients at risk of priapism (e.g., sickle cell disease or lymphoproliferative disorders) and bleeding complications secondary to injections. 

Penile pain Penile pain after intracavernosal administration was reported. In the majority of the cases, penile pain was rated mild or moderate in intensity. Hematoma/Ecchymosis In most cases, hematoma/ecchymosis was judged to be a complication of a faulty injection technique. 

Orally active agents used in the treatment of ED are more affected by aging and disease processes than are those injected intracavernosally. In addition, alterations in hepatic metabolism and/or renal clearance in the elderly man (see Chapter 6) influence the frequency of appearance of adverse reactions between several coadministered drugs in the treatment of ED. For example, the concomitant use of sildenafil and nitroglycerin is contraindicated by cardiovascular complications. Also, the use of testosterone in the presence of androgen-dependent tumors may promote tumor growth. 

A variety of techniques have been suggested for delivery of vasoactive drugs in patients with erectile dysfunction undergoing color Doppler evaluation. While the most commonly used method is intracavernosal injection, other modalities such as transurethral and transdermal drug delivery have been considered, in the attempt to reduce the invasive character of the study, and risk of possible complications. 

The intracavernosal injection is performed on the lateral aspect of the penis at the proximal or medial third of the shaft (Fig. 6.1). Commonly, a 30-G needle is used and the puncture is performed away from the dorsal nerves of the penis. Intra-spongiosal or intraurethral injection should be carefully avoided. Incorrect puncture can produce pain, particularly if performed near the dorsal nerves, or urethral pain/heat, if the product has been injected into the corpus spongiosum. Subcutaneous injections cause less pain and local swelling, but no erection. These complications are more frequently observed in patients at the beginning of self-injection. 

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