Adverse reactions of intracavernosal injection and the treatment of erectile dysfunction with topical vasoactive drugs

241.

Adverse reactions of intracavernosal injection

Although intracavernosal injection of vasoactive drugs is not currently a first-line treatment, it is simple, fast-acting, and effective, making it an effective treatment option when non-invasive treatments fail.

However, it can cause certain complications and side effects, which should be noted.

Mainly:

(1) Persistent penile erection, that is, an erection that lasts for more than 4 hours after the injection of the drug without subsiding, is the most important complication.

It is commonly seen in the following situations: neurogenic erectile dysfunction, excessive dosage, younger age, and those with previously good erectile function, as well as those who engage in repeated sexual activity.

(2) Superficial hematoma or skin ecchymosis is mostly caused by the needle being too thick or the operation being too rough, which punctures the subcutaneous blood vessels or the white membrane of the cavernous body, causing blood to seep out. It can usually be absorbed on its own. Injection should not continue until the hematoma disappears.

Each injection should be performed with a carefully selected needle and the procedure should be followed by applying slight pressure to the injection site for 3 minutes afterward.

(3) Foreskin edema does not require special treatment and usually subsides on its own after 6 to 8 hours.

(4) Urethral bleeding is often caused by puncturing the urethra too deeply, causing the medication to enter the corpus spongiosum, which can subside on its own quickly.

(5) Pain at the injection site and transient hypotension may be due to the rapid entry of the drug into the systemic blood circulation, causing vasodilation and a decrease in blood pressure.

If it occurs, lie down and rest immediately. It will improve on its own without special treatment.

(6) Infection, mainly caused by improper aseptic technique, such as cavernous body inflammation, should be treated with anti-infection therapy once it occurs.

(7) The ratio of cavernous body fibers often occurs at the base of the penis and may be related to repeated injections.

PGE₁, however, rarely occurs.

In terms of treatment, apart from local physical therapy, the only way to solve sexual problems with corpus cavernosum fibrosis is with a penile prosthesis.

242.

New Advances in Intracavernosal Injection for the Treatment of Erectile Dysfunction

Intracavernosal injection therapy for erectile dysfunction is widely used due to its simplicity and rapid effectiveness.

However, there are certain complications.

To this end, medical staff have continuously improved operating methods and injection routes. There are two important advancements: one is the self-injection pen, which consists of an injection syringe pre-filled with medication and a driving device. The doctor pre-selects and determines the injection dose and adjusts the rubber cap at the front end, then the needle is exposed and can be used directly for injection. The predetermined dose is dispensed only once.

Secondly, there is the silicone rubber balloon. To avoid having to puncture the corpora cavernosa every time, some people have made silicone rubber balloons with drainage tubes. The balloon is implanted in the groin, and the drainage tube is placed in the corpora cavernosa. When needed, the medication is injected into the balloon, and pressing the balloon will allow the medication to enter the penis and cause an erection.

243.

Topical vasoactive drugs for the treatment of erectile dysfunction

Non-invasive treatment for erectile dysfunction has always been a pursuit. Treatment through the penile skin or urethral mucosa, along with oral medication, is currently the most common non-invasive treatment.

(1) Through penile skin route: Topical medications for erectile dysfunction applied to the penile skin include nitroglycerin patches or emulsions, aminophylline, prostate E₁ emulsions, etc. The medications must meet the following conditions: lipid soluble, easily penetrate the skin; not absorbed by subcutaneous blood vessels and carried to the whole body; need to penetrate Buck's fascia and tunica albuginea, or flow retrogradely from subcutaneous veins to the corpora cavernosa of the penis.

It is generally used 15 minutes before sexual intercourse.

More suitable for psychogenic erectile dysfunction, with no obvious toxic side effects, currently under trial.

Some drugs have severe systemic reactions or cause adverse reactions after being absorbed through the female vagina, and whether they can be effectively used in clinical practice remains to be determined.

(2) Transurethral drug therapy: After administration via the urethra, the drug passes through the urethral mucosa and enters the urethral cavernous vein. Since they are connected to the penile cavernous vein, the drug flows back through the urethra to the smooth muscle of the cavernous body to exert its therapeutic effect.

However, the amount administered via the urethra will increase significantly.

Alprostadil is currently approved for clinical use. It causes penile erection within 15 minutes of administration and lasts for 30 to 60 minutes.

The efficacy rates are similar across different etiologies and are not affected by age.

Common adverse reactions include penile pain, low blood pressure, minor urethral injury, and dizziness.

No complications such as priapism, urethral stricture, or fibrosis of the corpus cavernosum were observed.

244.

Traditional Chinese Medicine Treatment of Erectile Dysfunction

Erectile dysfunction can be classified as either deficiency or excess, and cannot be generalized. Treatment should be tailored to the specific symptoms.

(1) Deficiency of fire in the gate of life: Symptoms include weakness and lack of yang, soreness and weakness of the waist and knees, fatigue, aversion to cold and cold limbs, pale complexion, tinnitus and hair loss, loose teeth, pale tongue, white coating, and deep and thready pulse.

Treatment principle: Warm the kidneys and strengthen yang.

Prescription: Modified Yougui Wan.

The medicinal ingredients include Rehmannia glutinosa (processed), Dioscorea opposita, Cornus officinalis, Eucommia ulmoides, Cuscuta chinensis, Cinnamomum cassia, Aconitum carmichaelii (processed), Epimedium brevicornu, Curculigo orchioides, Yangqi stone, Codonopsis pilosula, Morinda officinalis, and deer antler glue.

(2) Deficiency of both heart and spleen: Symptoms include impotence, loss of appetite, fatigue, lethargy, restless sleep, insomnia with many dreams, sallow complexion, palpitations, pale tongue, thin white coating, and weak pulse.

Treatment principle: Nourish the heart and spleen.

Prescription: Modified Gui Pi Tang.

The medicinal ingredients include Codonopsis pilosula, Atractylodes macrocephala, Poria cocos, Astragalus membranaceus, Longan aril, Ziziphus jujuba var. spinosa, Angelica sinensis (fried), Psoralea corylifolia, Cuscuta chinensis, Polygala tenuifolia, Aucklandia lappa, and Glycyrrhiza uralensis (processed).

(3) Liver dysfunction: Symptoms include penile atrophy and inability to erect, accompanied by mental distress, sighing, depression, rib pain, palpitations, irritability, poor appetite, red tongue, thin coating, and wiry pulse.

Treatment principle: Soothe the liver and relieve depression.

Prescription: Modified Xiaoyao San and Chaihu Shugan Tang.

The medicinal ingredients include Bupleurum chinense, Paeonia lactiflora, Atractylodes macrocephala, Poria cocos, Angelica sinensis, Aucklandia lappa, Glycyrrhiza uralensis (processed), Cyperus rotundus, Citrus reticulata peel, Melia toosendan, Yangqishi (a type of mineral), Lycium barbarum, and Psoralea corylifolia.

(4) Yin deficiency with fire excess: Symptoms include impotence or weak erection.

Accompanied by soreness and weakness in the lower back and knees, premature ejaculation, nocturnal emission, palpitations, night sweats, hot flashes in the palms, soles, and chest, red tongue with little coating, and a thready and rapid pulse.

Treatment principle: Nourish Yin and clear heat.

Prescription: Modified Zhi Bai Di Huang Wan.

The medicinal ingredients include Poria cocos, Dioscorea opposita, Rehmannia glutinosa, Paeonia suffruticosa, Cornus officinalis, Anemarrhena asphodeloides, Phellodendron chinense, Alisma plantago-aquatica, Lycium chinense root bark, Trionyx sinensis, and Ostrea gigas.

(5) Damp-heat accumulation in the lower body: Symptoms include impotence or easy erection but weak erection.

Symptoms include genital dampness or itching and pain, lower back and leg soreness, fatigue, dribbling after urination, dark and scanty urine, incomplete bowel movements, red tongue with yellow and greasy coating, and slippery and rapid pulse.

Treatment principle: Clear heat and promote diuresis.

Prescription: Modified Longdan Xiegan Decoction.

The medicinal ingredients include Anemarrhena asphodeloides, Phellodendron chinense, Alisma plantago-aquatica, Gentiana scabra, Bupleurum chinense, Scutellaria baicalensis, Gardenia jasminoides, Plantago asiatica, Akebia trifoliata, Poria cocos, Stephania tetrandra, Coix lacryma-jobi, Atractylodes lancea, and Glycyrrhiza uralensis.

(6) Fear injures the heart and kidneys: Symptoms include sudden fright, sudden impotence, lethargy, restless sleep, insomnia and dreamlessness, depression, mental distress, timidity and suspicion, palpitations, weakness and soreness in the lower back and knees, pale tongue, thin coating, and thready or weak pulse.

Treatment principle: Calm the mind and nourish the kidneys.

Prescription: Modified Dabu Yuanjian or Tianwang Buxin Dan.

The medicinal ingredients include Rehmannia glutinosa (processed), Lycium barbarum, Codonopsis pilosula, Eucommia ulmoides, Dioscorea opposita, Poria cocos, Longan aril, Ziziphus jujuba var. spinosa, Polygala tenuifolia, and Acorus tatarinowii.

(7) Kidney deficiency and blood stasis: Symptoms include impotence that is difficult to achieve and does not heal for a long time, or worsens after taking tonics, rough skin, dull and pale complexion, lower abdominal and perineal distension and discomfort, lethargy, weakness and soreness in the waist and knees, dark purple tongue, or petechiae or varicose veins, and deep, thready and hesitant pulse.

Treatment principle: Calm the mind and nourish the kidneys.

Prescription: Modified Dabu Yuanjian or Tianwang Buxin Dan.

The medicinal ingredients include Rehmannia glutinosa (processed), Codonopsis pilosula, Lycium barbarum, Eucommia ulmoides, Dioscorea opposita, Poria cocos, Longan aril, Ziziphus jujuba var. spinosa, Polygala tenuifolia, and Acorus tatarinowii.

245.

Common Chinese patent medicines for treating erectile dysfunction

(1) Kidney Qi Pill: It can be used to both tonify and purge, and it can benefit the kidneys and strengthen yang.

Long-term use can enhance physical fitness, improve the body's immunity, increase sexual arousal, and achieve the goal of treating erectile dysfunction.

Take 1 pill each time, twice a day.

(2) Guilingjisan: strengthens kidney yang and replenishes essence.

Take one packet each time, twice a day.

(3) Liuwei Dihuang Pills: Nourishes the liver and kidneys, and is used for liver and kidney yin deficiency.

Take 1 pill each time, twice a day.

(4) Xiaoyao San: Soothes the liver and relieves depression, nourishes blood and softens the liver.

Take 0.5 to 1 sachet each time, twice a day.

246.

Commonly used traditional Chinese medicine prescriptions for treating erectile dysfunction

(1) Xingyang Powder: equal parts of sulfur, Cnidium monnieri, and Curculigo orchioides.

Grind into a very fine powder and mix well.

Take 10 grams each time, twice a day, with warm water.

(2) Yangchun medicine: 100g each of Epimedium, Rehmannia glutinosa, Yangqi stone, and Guanggou kidney paste; 200g each of Cuscuta chinensis and processed Polygonum multiflorum; 50g each of Astragalus membranaceus, sheep penis, and Cistanche deserticola; 20g of mink glue; and 10g of deer antler.

The above-mentioned drugs are ground into powder, mixed evenly, made into granules, and then filled into capsules, with each capsule containing 0.22 grams of the drug.

Take 2-3 capsules 3 times a day.

One month constitutes one course of treatment.

Used for various types of erectile dysfunction.

(3) Deer penis: Talcum powder is dried and ground into powder.

Take 6 grams three times a day.

(4) One bull penis, 25 grams of leek seeds, 15 grams each of epimedium and dodder seed.

Grind the ingredients into a fine powder and mix well.

Take one spoonful with rice wine every night.