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Prolonged erections (pharmacologically induced erections over 6 hours) are the most inconvenient side effects encountered in the diagnosis and therapy of erectile dysfunction with intracavernous injection of vasoactive drugs. Out of a total of 29 prolonged erections, 26 were seen after diagnostic use in 300 patients and 3 after therapeutic application in more than 4800 protocolled autoinjection of a standardized vasoactive solution (papaverine hydrochloride 15 mg/ml and phentolamine mesylate 0.5 mg/ml). In 25 of these 29 prolonged erections intracavernous injections of the alpha-receptor stimulant metaraminol was done and led to flaccidity in all cases. Another patient with a papaverine-induced erection lasting 26 h did not respond to intracavernous metaraminol and required puncture and aspiration; he lost spontaneous erectability and cavernosal response to vasoactive drugs. Metaraminol was also injected intracavernosally in a further 32 patients with pharmacologically induced full erections: flaccidity was obtained in all patients.

Incidence, pathophysiology and treatment of prolonged erections