Prostaglandin E1 versus mixture of prostaglandin E1, papaverine and phentolamine in nonresponders to high papaverine plus phentolamine doses.

Purpose: We evaluated the efficacy of 40 micrograms/ml, prostaglandin E1 versus a combination of 17.64 mg./ml. papaverine hydrochloride, 0.58 mg./ml. phentolamine mesylate and 5.8 micrograms/ml. prostaglandin E1 (3-drug mixture).

Materials And Methods: A total of 32 patients randomly received 1 ml. of either medication by the intracavernous route. All patients had presented with erectile dysfunction longer than 6 months in duration and had failed to respond to high doses of papaverine (60 mg.) plus phentolamine (1 mg).

Results: Of 32 patients 7 (22%) responded to prostaglandin E1 and 16 (50%) to the 3-drug mixture, achieving erections allowing penetration (grade E4 or E5, p < 0.05). Pain was reported by 41% of the patients receiving prostaglandin E1 and 12.5% administered the 3-drug mixture.

Conclusions: The 3-drug mixture may be regarded as more effective than prostaglandin E1 alone in inducing an erectile response with a decreased incidence of pain.