Satisfaction Profiles in Men Using Intracavernosal Injection Therapy

Introduction. Intracavernosal injection therapy (ICI) is a well-established second-line therapy used in the treatment of erectile dysfunction (ED). Controversy exists as to whether oral phosphodiesterase type 5 inhibitors (PDE5i) or injection therapy lead to higher satisfaction. Aim. This study addressed ICI satisfaction in a modern cohort of patients in the PDE5i era. Methods. Patients on ICI for at least 6 months were included in our study. Patients were administered the International Index of Erectile Function (IIEF) at the initial visit. On subsequent visits, patients were administered the IIEF and the Erection Hardness Scale (EHS). Main Outcome Measures. Study end points were change in baseline scores in the satisfaction domains (SD) of the IIEF, type of injection medication used, and predictors of satisfaction. Multiple logistic regressions were performed for predictors of satisfaction. Results. One hundred twenty-two patients met inclusion criterion. Mean time to follow-up was 25±12 months (range 6-106 months). Sixty-five percent of patients continued injections at the time of follow-up. When SD scores were examined, intercourse SD scores increased from 4.8±1.7 at baseline to 12.3±3.1 (P<0.01); overall SD scores increased from 4.1±1.8 to 7.2±2.0 (P<0.05). On multivariate analysis, predictors of satisfaction included older age (odds ratio [OR]=2.1), younger partner age (OR=2.5), clinically significant increase in the erectile function domain score (OR=3.1), and attainment of a "fully rigid" erection (EHS 4) (OR=6.8). Conclusions. We have evaluated satisfaction in a modern cohort of ICI patients. While dropout rates are significant, for those patients who continue to inject, we have found high levels of satisfaction using the IIEF, the gold standard for evaluation of erectile function. On multivariate analysis, we found that older age, younger partner age, and fully rigid erections were predictors of increased satisfaction. ICI remains a robust second-line therapy in the treatment of ED even in the era of PDE5i.