1986 Volume 77 Issue 6 Pages 954-962
We have been performing the operation of inserting a penile prosthesis as a therapy for organic impotence. Actually, not so many patients in Japan want to be subjected to this procedure, and the development of noninvasive techniques is desirable. Considering this, we examined the possibility of therapeutic application of the intrapenile-cavernous injection of prostaglandin E1 (PGE1), which has a strong dilatating effect on vascular smooth muscles, for organic impotence.
The injection of 20μg of PGE1 dissolved in 2 to 20ml of saline into the penile cavernous body was performed by employing a small gauge Gordh neeedle of 22 to 27G; the effect was detected by an Erectiometer and a thermometer measuring the change of the temperature of the penis. The intraarterial infusion of 20μg of PGE1 dissolved in 20ml of saline was also performed by means of a vascular catheter.
As a result, among 71 patients who received the PGE1 injection into the penile cavernous body, perfect erections were observed in 51 (72%), imperfect erections in nine (13%), only enlargement of the penis in six (8%) and no change in five (7%). In the patients exhibiting perfect erections, the penis enlarged in two to three minutes following the PGE1 injection and this condition persisted for two to three hours. Most of the patients exhibiting almost no erection were those suspected of having penile cavernous body atrophy or vascular deficiencies, or were elderly men. But the fact that PGE1 injection into the penile cavernous body could induce sufficient erection for sexual intercourse even in cases of peripheral nerve injury due to pelvic surgery or organic deficiencies within the central nervous system including the cerebrum and the spine, has proved the future possibility of therapeutic application of PGE1 for organic impotence.
On the other hand, internal pudendal arteriography was performed in a patient with pelvic fracture and two with diabetes mellitus, who did not exhibit perfect erections by the PGE1 injection into the penile cavernous body. In the case of pelvic fracture, the internal pudendal artery was impaired and the penile artery was not filled with the contrast medium. That is to say, due to the complication of vascular impotence, the PGE1 injection into the internal pudendal artery could not raise the temperature of the penis appreciably or reestablish the erection. In both cases of diabetes mellitus, however, the penile artery was sufficiently filled and the PGE1 intraarterial infusion could raise the penile temperature and recover erection, though transitory.
These results lead to the expectation that PGE1 would be applicable in therapy for vascular impotence in the future, after suitable improvement of the methods of administration.
