Using Penile Injections to Treat Erectile Dysfunction

[madman]

‎Better Man Clinics Podcast: Better Sex: Using Penile Injections to Treat Erectile Dysfunction on Apple Podcasts

‎Show Better Man Clinics Podcast, Ep Better Sex: Using Penile Injections to Treat Erectile Dysfunction - May 21, 2023

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In this episode we discuss penile injections for erectile dysfunction, For most guys, treating erectile dysfunction means taking a pill. But what do they do if the pills do not work or if they are not able to take the pills because of certain medical conditions or other medications they are taking? For many such guys, a reasonable next step has been to try penile injections. But how do these injections work? What exactly is involved with administering them? Do they hurt? What kind of risks and side effects are involved? And, of course, do they actually work?

To answer these questions and many more, we turned to a true expert. Dr. Arthur Burnett is a professor of urology at the Johns Hopkins School of Medicine. Dr. Burnett is the director of the Male Consultation Clinic at Johns Hopkins Hospital, a clinician-scientist at the James Buchanan Brady Urological Institute, and director of the Basic Science Laboratory in Neurourology at the Johns Hopkins School of Medicine. Dr. Burnett received his undergraduate degree in biology from Princeton University and his medical degree at the Johns Hopkins University School of Medicine. He completed his internship and residency in surgery, and subsequently residency and fellowship in urology at The Johns Hopkins Hospital. Upon completion of his urology residency, he received an American Foundation of Urologic Disease New Investigator Award to continue research work into the regulatory mechanisms of penile erection. He has maintained an active laboratory in neurourology since that time.

Dr. Burnett is recognized for being a world-authority in the science and medicine of erectile dysfunction. He contributed original discoveries of the nitric oxide biochemical mechanisms in erectile tissue, which paved the way for the clinical development of oral medications to treat erectile dysfunction such as Viagra. Dr. Burnett has written more than 150 original peer-reviewed articles, along with numerous additional articles, editorials, and book chapters, relating to his biomedical research and clinical activities. He is also the author of a brand new book entitled The Manhood Rx: Every Man’s Guide to Improving Sexual Health and Overall Wellness.

 

[madman]

Intracavernosal injection therapy in erectile dysfunction

Current status of intracavernosal injection therapy in erectile dysfunction (2023) Bobo W. Elena, Melchiode Zachary, Pavaluri Haritha, Bobo A. Graham & Hellstrom J.G. Wayne Abstract Introduction Erectile dysfunction (ED) is defined as the inability to attain and/or maintain a penile...

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Everything You Need to Know About Erectile Dysfunction

This week’s guest is Dr. Arthur “Bud” Burnett, a professor of urology at the John Hopkins School of Medicine. Dr. Burnett is a world-renowned authority on Erectile Dysfunction and has contributed original discovery of Nitric Oxide biochemical mechanisms in erectile tissue. His work has...

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[Nelson Vergel]

Video: How to Inject Trimix

Trimix is a mixture of two prostaglandins (phentolamine and alprostadil) plus papaverine (a vasodilator medication) that increase blood flow to the penis and cause strong and lasting erections, with or without sexual stimulation. These compounds appear to act together to increase arterial...

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[Nelson Vergel]

Penis Injections for Hard Erections: TRIMIX

Trimix or Quadmix—Available by prescription from compounding pharmacies. These are mixtures of prostaglandins and papaverine that increase blood flow and retention into the penis. Prostaglandins are mediators and have a variety of strong physiological effects, such as regulating the contraction...

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[madman]

Love this!

10:20-16:04 (ICI vs oral PDE5i)


Pay close attention.

29:10-32:41 (ICIs potential side effects/risks)

*bruising/swelling (uncommon) - if injection technique is done well

*scarring (relatively uncommon) - may relate to how frequently a man injects and may also relate to just different men having tendencies to develop scarring but it may still be anywhere of <5% at most may be in the 1-2% range develop a kind of thickening effect may be some scarring effects in the penis that can occur

*priapism (largely preventable) - with counseling, demonstrations in the office, proper dosing, patients need to be educated well


37:35-39:50 (combination therapy ICI with oral PDE5i)

*the concern here is that the oral medication the so called PDE5i (sildenafil, tadalafil, vardenafil, avanafil) all these oral medications really are very similar to one of the injectable drugs called papaverine and if your using Trimix you are more or less are already maxing out the mechanism by which these oral therapies would work

*so really its almost like a redundant treatment that its already maxed out with the high level injections where by oral therapies would unlikely offer anything additionally to that treatment regiment

 

[madman]

Is 4−6 Hours of Prolonged Erection the Time Point of Irreversible Tissue Injury?

https://academic.oup.com/smr/article-abstract/10/4/660/7016888?redirectedFrom=fulltext&login=false Priapism or Prolonged Erection: Is 4−6 Hours of Cavernous Ischemia the Time Point of Irreversible Tissue Injury? (2022) Snir Dekalo, MD, Noah Stern, MD, Gregory A. Broderick, MD, and Gerald Brock...

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*Based on our extensive review of animal models and clinical reports of ischemic priapism, understanding that many clinical papers used secondary references and espoused concepts out of the dogma, rather than scientific evidence or fact, we believe that a prudent clinician will initiate the reversal of ischemic priapism as early as possible, around the 4-hour mark. The important question that remains largely unanswered to this day, is when does the onset of nonreversible injury first begin in most cases of ischemic priapism? While there does not exist clear evidence in the medical literature to define that timepoint precisely, based on our review of the literature, we believe it is beyond 6 hours and may extend to 12 hours in some men. (Table 1, 2, 3)

 

[Nelson Vergel]

How to prevent prolonged erections (Priapism) caused by trimix

HOW TO PREVENT PRIAPISM CAUSED BY TRIMIX What is priapism: Priapism is an erection which lasts more than 4 hours and is unrelieved by ejaculation. This condition is a true urological emergency and early treatment allows the best chance for functional recovery. Failure to manage this issue can...

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[Ribeye]

Is 4−6 Hours of Prolonged Erection the Time Point of Irreversible Tissue Injury?

https://academic.oup.com/smr/article-abstract/10/4/660/7016888?redirectedFrom=fulltext&login=false Priapism or Prolonged Erection: Is 4−6 Hours of Cavernous Ischemia the Time Point of Irreversible Tissue Injury? (2022) Snir Dekalo, MD, Noah Stern, MD, Gregory A. Broderick, MD, and Gerald Brock...

www.excelmale.com

*Based on our extensive review of animal models and clinical reports of ischemic priapism, understanding that many clinical papers used secondary references and espoused concepts out of the dogma, rather than scientific evidence or fact, we believe that a prudent clinician will initiate the reversal of ischemic priapism as early as possible, around the 4-hour mark. The important question that remains largely unanswered to this day, is when does the onset of nonreversible injury first begin in most cases of ischemic priapism? While there does not exist clear evidence in the medical literature to define that timepoint precisely, based on our review of the literature, we believe it is beyond 6 hours and may extend to 12 hours in some men. (Table 1, 2, 3)

As explained to me by Dr. Rubin, there are priapism's and there are PRIAPISM'S. Meaning, a warm, but hard penis, is one thing, a COLD but hard penis is much more of an emergency. A warm penis indicates continuous blood flow into the penis which is much less risk for damage. Nonetheless, she still recommends getting help before 6 hours. It makes good sense to me, because I cannot judge if damage is or will occur and it's not something you want to risk.

 

[Ribeye]

Love this!

10:20-16:04 (ICI vs oral PDE5i)


Pay close attention.

29:10-32:41 (ICIs potential side effects/risks)

*bruising/swelling (uncommon) - if injection technique is done well

*scarring (relatively uncommon) - may relate to how frequently a man injects and may also relate to just different men having tendencies to develop scarring but it may still be anywhere of <5% at most may be in the 1-2% range develop a kind of thickening effect may be some scarring effects in the penis that can occur

*priapism (largely preventable) - with counseling, demonstrations in the office, proper dosing, patients need to be educated well


37:35-39:50 (combination therapy ICI with oral PDE5i)

*the concern here is that the oral medication the so called PDE5i (sildenafil, tadalafil, vardenafil, avanafil) all these oral medications really are very similar to one of the injectable drugs called papaverine and if your using Trimix you are more or less are already maxing out the mechanism by which these oral therapies would work

*so really its almost like a redundant treatment that its already maxed out with the high level injections where by oral therapies would unlikely offer anything additionally to that treatment regiment

there are so many possible variables to this! How much is/does one inject? what dose of oral PDE5i inhibitor is one taking? Does daily dose of Cialis make more of a difference? Is there a synergistic effect of taking an ICI and PDE5i together? I am not aware its ever been actually been studied? Even so, there are several other active components to the ICI than papervine that are obviously valuable and helpful. And if one is injecting even three times a week, daily tadalafil is still a good option for other medical reasons like BPH, and helping to restore nocturnal erections and morning wood on a daily basis....Unless there is a real risk, of potential problems, the cost of tadalafil has come down so much, why throw the baby out with the bathwater? Of course, you could always stop your tadalafil and see what differences occur and then decide if it's worth it....but don't give up the morning wood, that's very important.

 

[madman]

there are so many possible variables to this! How much is/does one inject? what dose of oral PDE5i inhibitor is one taking? Does daily dose of Cialis make more of a difference? Is there a synergistic effect of taking an ICI and PDE5i together? I am not aware its ever been actually been studied? Even so, there are several other active components to the ICI than papervine that are obviously valuable and helpful. And if one is injecting even three times a week, daily tadalafil is still a good option for other medical reasons like BPH, and helping to restore nocturnal erections and morning wood on a daily basis....Unless there is a real risk, of potential problems, the cost of tadalafil has come down so much, why throw the baby out with the bathwater? Of course, you could always stop your tadalafil and see what differences occur and then decide if it's worth it....but don't give up the morning wood, that's very important.

He is talking about using on demand PDE5i + high level ICI especially in cases of maximal ICI therapy.

*if your using Trimix you more or less are already maxing out the mechanism by which these oral therapies would work


I would put more weight behind combination therapy with dual short- and long-acting PDE5 inhibitors (daily low dose Tadalafil + on demand PDE5i).

Even then almost everyone should be using daily low dose tadalafil as there are numerous benefits.

 

[Ribeye]

He is talking about using on demand PDE5i + high level ICI especially in cases of maximal ICI therapy.

*if your using Trimix you more or less are already maxing out the mechanism by which these oral therapies would work


I would put more weight behind combination therapy with dual short- and long-acting PDE5 inhibitors (daily low dose Tadalafil + on demand PDE5i).

Even then almost everyone should be using daily low dose tadalafil as there are numerous benefits.

I take daily Tadalafil 10 mg. It makes a huge difference considering the severity, degree of ED I had prior to starting this journey. But, ICI clearly takes the setting from possible but difficult to easy. That means steady state tadalafil is probably about 15 mg equvalent. Yet I know clearly I benefit from both meds. I am not saying the author is wrong, I would just want to see a clinical study showing no benefit to Tadalifil or viagra even for on demand use with ICI. There may well even be a safety benefit to everyday use of PDE5 drugs if you start low dose, titrations up gradually with ICI to avoid any risk of priapism. But that would also hold true for on demand use. Until there is clinical data to guide us, all we can do is carefully make our best decision and adjust from there.

 

[madman]

I take daily Tadalafil 10 mg. It makes a huge difference considering the severity, degree of ED I had prior to starting this journey. But, ICI clearly takes the setting from possible but difficult to easy. That means steady state tadalafil is probably about 15 mg equvalent. Yet I know clearly I benefit from both meds. I am not saying the author is wrong, I would just want to see a clinical study showing no benefit to Tadalifil or viagra even for on demand use with ICI. There may well even be a safety benefit to everyday use of PDE5 drugs if you start low dose, titrations up gradually with ICI to avoid any risk of priapism. But that would also hold true for on demand use. Until there is clinical data to guide us, all we can do is carefully make our best decision and adjust from there.

20:38-23:07
Can you take injections on top of daily low-dose viagra/cialis?

Penile Injections Expert | FAQS

Summary In this video, sexologist and nurse practitioner Melissa Hadley Barrett discusses penile injection therapy and its benefits for men post-prostatectomy. She addresses common questions about the therapy, including its effectiveness for nerve recovery and the difference between injections...

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