[Diagnosis and therapy of erectile impotence with special reference to papaverine]

The introduction of intracorporeal papaverin injections has significantly changed the investigation and treatment of erectile dysfunction. Papaverin acts on the smooth (vascular) muscle cell and induces erection. A good response to papaverin injection excludes major vascular disturbances within the penis. The interpretation of a negative result is more difficult. Depending on the Doppler blood-flow measurements, further radiological investigations (dynamic cavernosography or selective angiography of the pudendal arteries) may be needed. Treatment of impotence with papaverin is most successful in patients with psychogenic disturbances, which are often coincident with minor vascular pathology. Autoinjection is easily learned for long-term treatment by patients with moderate vascular disorders or neurogenic dysfunction. Major vascular disturbances, e.g. occlusion of the penile arteries or marked venous shunt, require surgery by a trained urologist. Papaverin may cause side effects, especially priapism, which may lead to definitive impotence. Careful investigation of erectile disturbances and search for the appropriate papaverin dosage are therefore crucial.