[Non-surgical treatment of impotence]

Non-surgical treatment of impotence comprises psychotherapy, drug oral administration and injection, drug intracavernous injection and penile vacuum extraction. Concerning psychotherapy, functional impotence is indicated, but urologists find difficulty in treating patients by themselves, thus requiring the co-operation of a psychiatrist, psychosomatic physician, psychologist and others. Concerning drug therapy, functional impotence is the main target, but is practically unbenefit with the reserve of endocrinally effective hormone. For drug intracavernous injection, papaverine hydrochloride and prostaglandin E1 are mainly used. At our Department, 51 patients have so far had successful self-injections according to this method. However, the self-injection requires strict control of drugs, syringes, etc. and proper selection of indicated cases and that includes an incidence of priapism of ca. 10%, making it necessary to take quick countermeasures. This method is targeted mainly for organic impotence, but is also indicated partially dysfunctional impotence. Penile vacuum extraction is indicated for all kinds of impotence and has no side effect, but is actually too expensive (ca. 130,000 yen) though noteworthy.