Intracavernous injections of papaverine and phentolamine: correlation with penile brachial index.

Eighty-two patients were evaluated for erectile failure with a comprehensive history, physical examination, hormonal testing, noninvasive Doppler examination (PBI), and nocturnal penile tumescence (NPT). After these studies all patients received intracavernous injection with a combination of papaverine (50 mg) and phentolamine (1.66 mg), and both tumescence and rigidity were monitored. Rigidity response was compared with the PBI. The number of patients with a poor rigidity response in each PBI category were: 3 of 5 with a PBI of less than 0.6 (vasculogenic), 7 of 11 with a PBI of 0.6-0.75 (ambiguous), and 25 of 66 with a PBI of 0.75-1.0 (normal). These results indicate only a marginally significant association between PBI and intracavernous injection. The procedure was safe with no long-term sequelae from injection observed, and no surgical intervention was required. Complications of injections included reversible priapism in 11 patients (13.4%), transient dizziness in 10 patients (12.2%), and hematoma in 5 patients (6.2%). This study suggests that intracavernous injection with a drug combination may be a more sensitive screening test for vasculogenic impotence than noninvasive Doppler studies because it more closely simulates the erectile response.