54235 Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine)

Name of the Procedure:

Injection of corpora cavernosa with pharmacologic agent(s)
(Common names: Penile injection therapy, Intracavernosal injection, ICI)

Summary

This procedure involves injecting medication directly into the penile corpora cavernosa to help achieve or maintain an erection. It is often used to treat erectile dysfunction (ED) that does not respond to oral medications.

Purpose

The primary goal is to promote erections in men who have erectile dysfunction, allowing for satisfactory sexual intercourse. The expected outcome is improved erectile function and sexual performance.

Indications

• Chronic erectile dysfunction unresponsive to oral medications (e.g., sildenafil, tadalafil).
• Psychogenic erectile dysfunction.
• Neurogenic erectile dysfunction, often due to spinal cord injury or surgery.
• Assessment of penile vascular function during diagnostic testing for ED.

Preparation

• Patients should receive instructions on how to perform the injection technique correctly.
• Avoid anticoagulant medication as instructed by the healthcare provider to minimize bleeding risk.
• Perform a sensitivity test for the pharmacologic agents if there is a history of allergy.
• Any diagnostic tests such as penile Doppler ultrasound may be conducted prior to initial treatment.

Procedure Description

1. Equipment: Syringe, fine needle, alcohol wipes, and the pharmacologic agent(s) like papaverine or phentolamine.
2. Preparation: Clean the injection site (usually the sides of the penile shaft) with an alcohol wipe.
3. Injection: The healthcare provider or patient (trained beforehand) inserts the needle into the corpora cavernosa and slowly injects the medication. Proper techniques to avoid vein insertion are taught to minimize complications.
4. Post-Injection: Apply gentle pressure to the injection site for a few minutes to prevent bruising. The patient is usually monitored to ensure the formation of an erection and to check for any adverse reactions.

Duration

The procedure typically takes 5-10 minutes, with the erection developing within 5-20 minutes after injection.

Setting

This procedure can be performed in an outpatient clinic, urologist’s office, or at home (after proper training).

Personnel

• Urologist or trained medical professional.
• Sometimes performed by the patient themselves after proper education and training by a healthcare provider.

Risks and Complications

• Common: Bruising at the injection site, mild pain or discomfort.
• Less common: Penile fibrosis, priapism (prolonged erection), bleeding or hematoma.
• Management: Applying pressure reduces minor bleeding; if priapism occurs, seek immediate medical attention.

Benefits

• Improved ability to achieve and maintain erections.
• Enhanced sexual performance and satisfaction.
• Immediate effect compared to oral medications.

Recovery

• Resume normal activities immediately after the procedure.
• Follow-up appointments may be needed to monitor response and adjust dosage.
• Periodic reassessment of technique and medication effectiveness as needed.

Alternatives

• Oral ED medications (e.g., sildenafil, tadalafil).
• Vacuum erection devices.
• Penile prosthesis implantation.
• Penile suppositories or urethral pellets.
• Lifestyle modifications.
• Comparing options: Oral medications are less invasive but may be less effective in some patients. Surgical options are more invasive but offer permanent solutions.

Patient Experience

• During: A quick sting or discomfort at the injection site.
• After: Firm erection within minutes, slight risk of prolonged erection; discomfort should subside quickly.
• Pain management: Over-the-counter pain relievers if needed, though typically not required. Comfort measures like warm compress can help with mild discomfort post-injection.