Dr. Gholami California Urologist




Penile Injection Therapy

This information sheet is supplied to you to tell you about the treatment that you are about to undergo or
may be considering. Please read it carefully before giving your consent. You should take this document
home with you for future reference.

What is Penile Injection Therapy?

Penile Injection Therapy has been used for several years to stimulate erections in men with erectile dysfunction. It has also been used by men with poor erections due to diabetes and other medical problems for many years and the technique is simple and has few complications. It will restore the ability to obtain erections to most men following prostate cancer surgery.

What drugs are used ?

Various drugs have been found to be capable of stimulating erections when injected into the erectile tissue of the penis (the corpora). No single agent is guaranteed to be effective in all cases. However, Papaverine is widely used and accepted. Another drug which is becoming more widely used is Prostaglandin E1 (also known as Caverject). We recommend Trimix(which is a triple medication therapy including Papaverine, prostaglandin E1 and phenotolamine).

How do these drugs work and how long is the effect?

Both these drugs have their effect by causing dilatation (widening) of the blood vessels to the penis. The erection usually starts between 5 to 10 minutes after the injection and the erection usually lasts between 1 and 2 hours.

What about the Dose of the drugs?

Although a wide range of dosages have been tried, the lowest effective dose for any individual is recommended. This dose can only be ascertained on a ‘trial and error’ basis by injecting different doses of the drug until the optimal response is obtained.

How often can the injections be used?

Self injection into the penis may be performed a maximum of two to three times per week. Never more than once in any 24 hour period.

What are the Side Effects?

All drugs have some side effects and these may vary according to the dosage used and the sensitivity of the individual to the substance. Prolonged Erection (Priapism)

  • An erection lasting for more than 4 hours has occurred in some cases following penile injection.
    Sometimes this is due to people injecting themselves with excessive doses of the drug. Occasionally it can happen at the first injection because of the persons sensitivity to the drug.
  • If this happens it may be necessary for a doctor to give an injection of a different drug to counteract
    this effect. If the counteracting drug is given within 5-6 hours of the original injection it will usually reverse the effect and no long term harm will result.
  • If medical advice is not sought within 6 hours there may be more difficulty reversing the erection
    and surgery is sometimes required. In a few of these instances, irreversible total loss of erections may occur.
  • It is therefore extremely important that you are aware of this danger. If you find that the erection
    lasts for more than 3 hours it is essential that you follow the instructions provided in this information sheet.
  • In order to reduce the risk of this occurring the initial dose of the drug will be very low. Higher
    doses will only be given following further. consultation with one of the doctors. Do not proceed
    to using a higher dose until you have sought advice. Bruising at the site of the injection

  • This may be tender for a few days and further injection must not be given until there is no sign of
    any bruising.
  • Bruising can usually be avoided or minimized by using the correct technique and by applying continuous pressure over the injection site for 2-3 minutes after withdrawing the needle or until bleeding stops.
  • Patients on anticoagulant drugs (Warfarin, Aspirin etc) and those with blood clotting disorders should remind the Doctor of this before commencing therapy.

Fibrosis in the penile tissue

  • Occasionally after long term use of injection therapy, fibrosis (thickening or hardening) in the erectile tissues of the penis may occur.
  • This occurs only rarely so the risk is probably very small.
  • However, be aware of the possibility and if you suspect anything like this may be happening to
    you report it to your Doctor.

How are the injections performed?

All self administered injections should be performed in the sitting or lying position and in a sterile fashion.
You will be taught the technique. A little apprehension is natural at first but as you become familiar with the technique it will become easier. You will only be supplied with the necessary drugs, syringes and needles for home use when you have demonstrated satisfactorily that you are competent to draw up and inject the correct dose of drug safely. It may take from 2-6 visits before you reach this stage.

You will be required to return for regular follow up visits whilst using this drug.
A new syringe and needle must be used each time. The unused contents of drug ampoules must be discarded immediately by flushing down a sink or toilet. Glass ampoules, needles and syringes must be disposed of in a sensible and responsible manner to avoid injury to others, for example the garbage collector

What should you tell your partner?

All patients are strongly advised to take their sexual partners fully into their confidence when on this program. This is not the time to be secretive about what you are doing. Be honest and open with your partner and gain their support.

What to do if an erection lasts more than 3 hours?

If an erection is painful or persists for more than 3 hours the following treatment should be commenced.

  1. Have a hot shower
  2. Exercise. This can easily be achieved by pushing in your wheelchair for approximately 20 minutes.
  3. Take 60mg of Sudafed. (This means you should purchase a packet of Sudafed before you use the injection at home and always have it with you when using the injections).

If the erection does not subside within half an hour, contact our on call physician and/or go to the nearest Emergency Department.Lap Davinci Prostatectomy, Laparoscopic Urologic Surgery, Vasectomy, Laser Prostate Surgery