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Vasoactive drugs may also be injected intracavernosally. Such therapy represents an important second-line therapy for erectile dysfunction. It is the most effective pharmacologic treatment but has a high dropout rate because of the associated pain and apprehension involved. Phentolamine is an -blocker that was used in initial studies; its efficacy is poor, but it may be used in combination with other agents. Papaverine is a nonspecific PDE inhibitor and was the first effective intracavernosal therapy for erectile dysfunction. Currently, intracavernosal alprostadil therapy is preferred; it is more effective than other agents and produces fewer side effects. In a comparison study comparing alprostadil, a papaverine–phentolamine combination and papaverine alone, rates of success (ability to achieve and maintain an erection) of 72%, 61% and 31% were reported respectively.54 No patients in the alprostadil group experienced priapism, as compared with 2% and 4% of patients in the combination therapy and papaverine-only groups respectively. On the other hand, patients who used alprostadil were the only ones to report penile pain. For patients who do not respond to or do not tolerate alprostadil monotherapy, a triple mixture of papaverine, phentolamine and alprostadil may be prescribed. Such combination therapy has been shown to be more effective and, because of a lower dose of alprostadil, results in less pain.62 Complications of intracavernosal injections include pain, priapism and fibrotic changes at injection sites.
Reviewed by the doctors at the Glickman Urological Institute at The Cleveland Clinic.
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Stress: Stress can be job-related, money-related, or the result of marital problems, among other factors.
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Q. What about the problem of prolonged erection?
Impotence Drugs Don't Harm Vision: Study
Men are sterilized with a vasectomy. The man's vas deferens (sperm ducts) are closed off so sperm can't get through.
Cialis works a bit faster (within about 15 minutes), and the effects last much longer -- up to 36 hours in some cases.
Sildenafil (Viagra) was the first oral phosphodiesterase type 5 (PDE5) inhibitor approved by the FDA in the United States for the treatment of erectile dysfunction (it is not approved for women). Sildenafil inhibits PDE5, which is an enzyme that destroys cGMP. By inhibiting the destruction of cGMP by PDE5, sildenafil allows cGMP to accumulate. The cGMP in turn prolongs relaxation of the smooth muscle of the corpora cavernosa. Relaxation of the corpora cavernosa smooth muscle allows blood to flow into the penis resulting in increased engorgement of the penis. In short, sildenafil increases blood flow into the penis and decreases blood flow out of the penis.
If the Seat Fits
A. It works for 70 to 80 percent of all men suffering from ED, with highest success rates in men with non-vascular causes of ED (psychogenic, hormonal, neurogenic). After undergoing a radical prostatectomy, some men experience pain and burning when injecting the medicine, (alprostadil). Only 1 to 5 percent of men have this reaction, but it's enough to prevent them from using the drug again.
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angiographic embolization, erectile dysfunction, high-flow priapism, perineal injury
You may have a referral to a urologist, a doctor who specializes in treating this condition, for more tests. You may already have a trial prescription for Viagra or similar drugs. Whatever you're doing next, the most important thing to remember is that you aren't in this alone.
There is insufficient information on the safety of vardenafil in men with the following conditions:
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Call your doctor immediately or go to an emergency room if medication for erection problems give you an unwanted erection that lasts more than 4 hours. Permanent impotence or other lasting damage to your penis may result from this condition.
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Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight, and avoiding exercise are possible causes of ED.
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