Pharmacotest and dose selection
At the first visit, the doctor administers the starting dose and after 10-15 minutes evaluates the erection - its rigidity and duration, and, if necessary, performs Doppler of the vessels at the peak. This determines the type of disorder and the working dose. Then the patient is taught self-injections: the drug is injected into the side surface of the penis 5–15 minutes before intimacy, the erection lasts 30–60 minutes and does not depend on mood. The cost of the drug is not included in the price of the procedure. Limitations: no more than 2-3 times a week, mandatory dosage compliance to avoid priapism.
Erectile dysfunction treatment ladder
The first line is PDE-5 inhibitors (tablets) and correction of the causes: testosterone, diabetes, blood pressure, smoking. The second is intracavernosal injections of vasoactive drugs and vacuum devices, which give an erection in 80-90% of men, including those for whom pills do not help. The third is surgery: in case of proven venous leakage in young patients - ligation of the veins, in all other cases - penile prosthesis. Diagnosis begins with ultrasound with Doppler against the background of a pharmacological test, which distinguishes between arterial, venous and psychogenic ED.
Intracavernous therapy
Injection of a drug (papaverine, phentolamine, alprostadil/vasaprostan) into the corpus cavernosum causes an erection within 5–15 minutes, regardless of arousal. The first injection is performed in the clinic as a dose titration test, then the patient is taught self-administration before sexual intercourse (up to 2-3 times a week). The risk is a prolonged erection (priapism) in case of an overdose, so the doctor selects the dose.
