Beyond Oral Therapies: A Practical Approach to Overcoming Barriers to Intracavernosal Injection Therapy in Clinical Practice.

The objective of this manuscript is to present intracavernous therapy to readers, serving as a model and guide for physicians on how to introduce and manage it in their patients. Furthermore, we propose a strategy designed to ensure maximum safety with minor complications and provide an effective implementation of intracavernosal injection (ICI) therapy for the management of erectile dysfunction (ED). While phosphodiesterase type 5 inhibitors (PDE5i) are recognized as first-line therapy, approximately one-third of patients do not achieve satisfactory clinical outcomes, highlighting the importance of ICI as a highly effective second-line option. This comprehensive review details patient selection, drug formulation, structured patient education, stepwise dose titration, management of adverse events, and longitudinal follow-up. This approach is intended to minimize treatment-related complications, enhance patient confidence and adherence, and optimize long-term therapeutic outcomes. By suggesting a standardized clinical application of ICI therapy, this review aims to address key barriers that currently restrict its broader adoption in routine clinical practice.