Erectile Dysfunction Therapy, Penile Shockwave Therapy

Penile Injection therapy

Penile injections with alprostadil (trade name caverject) revolutionised the treatment of impotence. Caverject works in about 70-80% of men with impotence even when tablets are unsuccessful. It produces an erection about 10minutes after the injection which can last between 20minutes and 2 hours. The dose varies from patient to patient and usually two or three goes are necessary to find the correct dose for each individual. We teach patients how to perform the injections themselves.

Important points about alprostadil

The needle used for the injection is extremely fine and the majority of patients are surprised at how painless the procedure actually is.

Some patients find that their erections return spontaneously once they have used the injections. This may be because they no longer have any "performance anxiety", or it may be the result of encouraging blood flow back to normal levels.

Since January 2014 there has been a shortage of caverject due to manufacturing problems. Caverject dual chamber packs will not be available for at least two years. Standard caverject packs are available but the supply is intermittent.

A small volume of caverject is injected into the penile shaft using a very fine needle.

The injection is placed to the left or right of the midline, and more to the front than the back of the penis

Complications to be aware of

Bruising may occur at the injection site or along the penile skin. However this is not serious and like any bruise diappears after a couple of days.

About 15% of patients experience an aching discomfort in the penis for some hours after the injection.

Prolonged use may result in small scars forming in the erectile tissue of the penis which may reduce the effectiveness of the injection, or can lead to curvature of ther penis during erection. Despite the manufacturers guidelines that the injection can be performed again within 24 hours, and upto three times a week we would recommend that it was used no more than three times in two weeks to allow the injection sites to heal.

Very occasionally (fewer than 1 in 200 patients) the injection can work too well and a prolonged erection can occur - that is one lasting for more than 6 hours (priapism). If this occurs it is important to attend the nearest A/E department so that an antidote can be injected. It is sometimes necessary to admit patients for this. Prolonged rigid erections lasting 8-10hours or more are likelyto cause permanent damage to the penis.

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ED Clinic

Penile Injection therapy

Complications to be aware of

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