背景:5型磷酸二酯酶(PDE5)抑制剂标记指出,这些药物不应与其他勃起药物联合使用,以免发生阴茎异常勃起。
目的:在我们的前列腺癌根治术(RP)后阴茎注射计划中,我们探讨了男性阴茎异常勃起和长时间勃起的风险,这些计划使用常规的PDE5抑制剂和海绵体内注射(ICIs)作为其康复计划的一部分。
方法:研究队列包括接受阴茎注射治疗的男性,他们(1)每天服用他达拉非5毫克或在非注射日服用西地那非25毫克,(2)有一个RP,(3)在阴茎注射训练时定期使用各自的PDE5抑制剂,和(4)遵守有关阴茎注射使用的程序说明。人口统计,合并症详细信息,PDE5抑制剂剂量和利用率,收集注射剂量和利用率数据。所有患者都接受了办公室注射训练,并使用了三混(罂粟碱/酚妥拉明/前列腺素E1)作为海绵体内药物。
结果:阴茎异常勃起定义为患者自我报告的穿透硬度勃起持续时间≥4小时,而延长勃起被定义为持续≥2小时的穿透硬度勃起。
结果:对112名他达拉非使用者和364名西地那非使用者进行了比较。RP后的平均年龄和持续时间为62±14岁和5.2±12个月,分别,他达拉非组和西地那非组之间没有差异。平均三混剂量为他达拉非24单位和西地那非31±37单位(P<0.05)。112名他达拉非使用者中有2名(1.7%)出现阴茎异常勃起,364名西地那非使用者中有5名(1.4%)出现阴茎异常勃起(P=0.47)。排除那些在任何情况下都会经历阴茎异常勃起的男人,在112名他达拉非使用者中,有7名(6.3%)和364名西地那非使用者中,有12名(3.3%)(P<.01).总共53%的这些长期勃起发生在家庭的前6次注射中(他达拉非和西地那非组之间没有差异)。
结论:我们强调需要继续监测和教育正确的注射技术,以最大限度地降低ICI和PDE5抑制剂联合治疗中不良事件的风险。
■这项研究的患者群体相对较多,随访时间相当长。此外,严格的训练,教育,以及对参与者的监控,以及使用阴茎异常勃起和长时间勃起的正式定义,提高了结果的准确性和可靠性。然而,有一些限制,比如社会可取性,混杂因素,和回忆偏见。
结论:在男性将ICI与他达拉非或西地那非联合使用的ICI项目中,阴茎异常勃起的发生率没有显着差异。然而,他达拉非患者的勃起时间延长率较高,发现这主要发生在滴定阶段的早期。
BACKGROUND: Phosphodiesterase type 5 (PDE5) inhibitor labeling states that these agents should not be used in conjunction with other erectogenic medications for fear of priapism occurring.
OBJECTIVE: We explored the risk of priapism and prolonged erections in men in our post-radical prostatectomy (RP) penile injection program who were using regular PDE5 inhibitor and intracavernosal injections (ICIs) as part of their rehabilitation program.
METHODS: The study cohort included men on penile injection therapy who (1) were taking tadalafil 5 mg daily or taking sildenafil 25 mg on noninjection days, (2) had an RP, (3) were using their respective PDE5 inhibitor regularly at the time of penile injection training, and (4) complied with the program instructions regarding penile injection use. Demographics, comorbidity details, PDE5 inhibitor dose and utilization, and injection dose and utilization data were collected. All patients underwent in-office injection training and used trimix (papaverine/phentolamine/prostaglandin E1) as the intracavernosal medication.
RESULTS: Priapism was defined as a patient self-reported penetration hardness erection ≥4 hours in duration, while prolonged erection was defined as a penetration hardness erection lasting ≥2 hours.
RESULTS: A total of 112 tadalafil users and 364 sildenafil users were compared. Mean age and duration post-RP were 62 ± 14 years and 5.2 ± 12 months, respectively, and there was no difference between tadalafil and sildenafil groups. The mean trimix dose was tadalafil 24 ± 24 units and sildenafil 31 ± 37 units (P < .05). Priapism occurred in 2 (1.7%) of 112 tadalafil users and 5 (1.4%) of 364 sildenafil users (P = .47). Excluding those men experiencing priapism on any occasion, those with any reported penetration hardness erection lasting ≥2 hours were 7 (6.3%) of 112 tadalafil users and 12 (3.3%) of 364 sildenafil users (P < .01). A total of 53% of these prolonged erections occurred within the first 6 injections at home (no difference between tadalafil and sildenafil groups).
CONCLUSIONS: We emphasize the need for continued monitoring and education on proper injection techniques to minimize the risk of adverse events in ICI and PDE5 inhibitor combination therapy.
UNASSIGNED: This study has a relatively large patient population with a considerable follow-up time. Additionally, the rigorous training, education, and monitoring of the participants, as well as the use of formal definitions for priapism and prolonged erections, enhances the accuracy and reliability of the results. However, there are some limitations, such as social desirability, confounding factors, and recall bias.
CONCLUSIONS: There is no significant difference in the incidence of priapism in an ICI program in which men combine ICI with tadalafil or sildenafil. However, tadalafil patients had a higher rate of prolonged erections, which was found to occur mostly early during the titration phase.