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陰茎湾曲症の原因と手術について

Injection into the corpus cavernosum is suitable for the following people:

  • ・Tried erectile dysfunction (ED) medicine but it was not effective.
  • ・Got ED after surgery for prostate cancer.
  • ・Got ED after becoming diabetic.

Why don’t ED drugs work?

ED medications (Viagra, Levitra, Cialis) do not work for me. Learn more about causes and remedies.
 
When ED medications are not effective, it is necessary to first check if the method of use was appropriate. This may be the case if the drug was taken internally but without sexual stimulation, if the patient was drinking alcohol, if the time of administration was not appropriate, if the drug was taken after eating a meal (especially oily foods), if there were side effects of the drug, or if the dosage was too low. There are also cases of incorrect adaptations, such as impaired libido, ejaculation disorder, or orgasm disorder.

 

Treatment methods other than ED medications

Learn more about what to do when ED medications do not work.
 

When ED medications do not work, other treatment options include: negative pressure erection aids (vacuum devices), prostaglandin E1 injections into the corpus cavernosum (see note), male hormone replacement therapy, penile plasty, vascular surgery, and penile prosthesis grafting surgery.
(Note: Penile corpus cavernosum injections using papaverine are not used by members of the Japanese Society for Sexual Function Society’s Penile Cavernous Body Injection Approval Promotion Committee because of the drug’s tendency to cause persistent erectile dysfunction and fibrosis of the penile cavernous body.
The committee suggests that prostaglandin E1 injections into the penis are the first option when ED drugs fail to work.
Prostaglandin E1 injections into the corpus cavernosum are the first option when ED medications do not work.
It can be used for post-prostate cancer ED, diabetic ED, etc., and allows patients who have given up to have normal sexual intercourse.

 

What is penile corpus cavernosum injection?

Self administered penile corpus cavernosum injection is quite popular in Europe and the United States.
According to reports Prostaglandin E1 is injected into the corpus cavernosum to induce an erection, with an efficacy rate of 82 % (Otto IL et al.).
Prostaglandin E1 is also the least fibrogenic agent of the corpus cavernosum. Prostaglandin E1 is used as the standard of care worldwide, but papaverine, which was used prior to prostaglandin E1, is a drug that is more likely to cause persistent erections and fibrosis of the penile corpus cavernosum. Members of the Japanese Society for Sexual Function Society’s Committee for the Promotion of Approval of Penile Cavernous Injection do not use papaverine.
In Japan, the ICI Approval Promotion Committee of the Japanese Society for Sexual Function is taking the lead in promoting independent research at each facility and lobbying the Ministry of Health, Labor and Welfare. Recently, the drug has been officially approved as a test item, but the indication of the drug for erectile dysfunction has not been approved. Since the drug has not been approved by the government, treatment is performed at your own risk.

What is prostaglandin E1?

Prostaglandin E1 is used for chronic arterial occlusive disease, arteriosclerosis obliterans, and ductus arteriosus-dependent congenital heart disease. It is also a safe medication for penile corpus cavernosum injections when used properly.

 

Penile Injection Methods

The doctor will explain in detail how to prepare the solution during the consultation.

Wipe the side of the penis with an antiseptic wipe.
Stretch the penis with one hand and hold the syringe with the other hand. Then inject from the side of the penis, aiming at a place where there are no blood vessels. The needle is inserted to the base of the penis.
Slowly push the piston and inject the solution. If it is difficult to insert, move the needle back and forth 1~2mm to find a place where it is easier to insert.
Once all of the liquid is injected, pull out the needle and hold the punctured area for at least one minute (until the bleeding stops) to stop the bleeding.
*Take the medical waste to your next visit and dispose of it at the hospital. We ask that you keep the used syringes and ampoules sealed.

 

Are there any side effects?

Side effects of penile cavernous injections include penile pain 50%, persistent erection (>4 hours) 6%, cavernous fibrosis 2%, irregular heartbeat, dizziness, and facial flushing 1%. Although not side effects, many patients also stop due to penile pain and unnaturalness.

 

Complications that vary depending on the cause of ED.

Although it is not a problem because the patient is properly tested during the consultation, this penile corpus cavernosum injection has a rare risk of causing persistent erections, which are erections that last for a sustained period of time. Therefore, it is important to use the drug correctly at the proper dosage.
Patients with post-prostate cancer surgery ED are less likely to have vascular problems and may experience persistent erections. On the other hand, patients with diabetic ED are less likely to have persistent erections because of vascular involvement.

 

If penile injections don’t work… penile prosthesis surgery.

If ED medications do not work, there are various methods of treatment, such as negative pressure erection aids (vacuum devices), penile corpus cavernosum injections of prostaglandin E1, etc. If these ED treatments are ineffective, penile prosthesis implantation surgery may be performed. The last treatment option for erectile dysfunction (ED) is penile prosthesis surgery.
This penile prosthesis procedure is usually performed within the penile corpus cavernosum, the area where blood fills in a normal erection.
There are two types of penile prosthesis: one is a rod-shaped, bendable, non-inflatable type. The other is an inflatable type that is pumped by water transfer.

The non-inflatable type is relatively easy to operate and can be done on a one day surgery under local anesthesia by a specialist. The cost is the cost of the surgery plus the cost of materials. These materials are not approved in Japan and are imported from the U.S. by the doctor, so the actual cost must be paid to the doctor.

Inflatable surgery is performed under general anesthesia with hospitalization. The materials are also expensive, and when combined with the cost of the surgery, it is enough to purchase a car.

If the surgery is successful, intercourse is possible in almost 100% of cases, but if the penis becomes infected, the implant must be removed.

Once penile prosthesis surgery is a last resort type of treatment, once it has been performed there are no other treatment options available.

There are many post-operative problems, so it is necessary to have the surgery performed by a doctor with a proven track record at a well-run facility.

Our doctors have already performed more than 200 surgeries, so there is no need to worry about complications or problems, and patients are able to undergo the procedure with peace of mind.

 

Cost

First visit
5,500 yen
Examination
11,000 yen (first time only)
Test agent
5,500 yen (first time only)
Prescription (1 dose)
5,500 yen

(tax included)

 

Frequently Asked Questions

  • Is ED treatment with penile injections covered by insurance?

    No. Penile cavernosa injections are self-administered treatments and are therefore not covered by insurance and are entirely at your own expense.

  • Are the injections painful?

    The pain varies from person to person. However, many patients benefit from this treatment and have a satisfying sex life.

  • If I cannot get an erection with penile injections, are there other treatments?

    If penile corpus cavernosum injections fail, we recommend penile prosthesis implantation. If it is a rod shaped non-inflatable implant, it is a simple one-day surgery that takes about an hour. Many patients have a satisfactory sexual life.

  • Who should consider using corpus cavernosum self injections?

    Corpus cavernosum self injections are for those who cannot respond to oral medications, those who cannot use oral medications due to pre-existing medical conditions, and those who have had nerves removed due to a total prostatectomy or colorectal surgery.
    It can also be used for postoperative ED due to prostate cancer and ED from diabetes. This treatment is performed prior to penile prosthesis transplantation surgery.

  • Is it always effective?

    Corpus cavernosum injections are highly effective with a reported efficacy rate of 82% and are effective in 50% of patients who do not respond to ED medications.

  • Does the erection occur when there is sexual stimulation after receiving a corpus cavernosum injection?

    Unlike ED drugs, erections with corpus cavernosum injections are not caused by sexual stimulation, but rather by involuntary erections. Adding sexual stimulation can enhances the effect.

  • What are the side effects of corpus cavernosum injections?

    Side effects reported include penile pain 50%, persistent erection (>4 hours) 6%, cavernous fibrosis 2%, and irregular heartbeat, dizziness, facial flushing 1%.
    With the use of prostaglandin E1, penile pain, cavernous fibrosis, and persistent erectile dysfunction are reduced.

  • Is it difficult to learn how to administer corpus cavernosum injections?

    The doctor will explain in detail how to prepare the drug and how to inject it. It is not difficult unless you have a hand injury.

  • Is the corpus cavernosum self injection painful?

    Pain varies from person to person, but pain is minimal because a small amount of the drug is injected with a needle that is as fine as a strand of hair.
    Few patients stop treatment because of pain during injection, and many patients benefit from the treatment.

  • How long do the effects of the corpus cavernosum injections last?

    Erection begins 5-10 minutes after injection and lasts for 60-120 minutes, depending on the individual.

  • What is priapism?

    It is a rare complication that occurs with the use of corpus cavernosum injections. An erection that remains hard for more than 4 hours is called a sustained erection.
    Persistent erections caused by corpus cavernosum injections are venous erections, which are caused by ischemia due to poor blood return in the penile corpus cavernosum,
    The tissues in the corpus cavernosum become ischemic and necrosis begin within 6 hours of the onset of erection. It requires immediate medical attention and is more likely to occur with the use of papaverine than prostaglandin E1.

  • Why are corpus cavernosum injections not covered by insurance?

    It is because the treatment is not yet approved in Japan and is done at your own risk. In Western countries, this treatment has been approved and commonly used.

この記事の執筆医師

永尾光一(東邦大学泌尿器科教授 リプロダクションセンター長)

永尾 光一 先生

東邦大学 医学部教授(泌尿器科学講座)
東邦大学医療センター大森病院 リプロダクションセンター長
東邦大学医療センター大森病院 尿路再建(泌尿器科・形成外科)センター長

昭和大学にて形成外科学を8年間専攻。その後、東邦大学で泌尿器科学を専攻し、形成外科・泌尿器科両方の診療科部長を経験する(2つの基本領域専門医を取得)。得意分野はマイクロサージャリーをはじめとする生殖医学領域の形成外科的手術。泌尿器科医の枠を超えた細やかな手術手技と丁寧な診察で、様々な悩みを抱える患者さんから高い信頼と評価を得ている。

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