Why a combined intracavernosal injection with trimix and oral sildenafil is reliable therapy in the ultrasonographic evaluation of erectile dysfunction

BJU Int. 2008 Sep;102(8):993-7. doi: 10.1111/j.1464-410X.2008.07712.x. Epub 2008 May 12.


Objective: To evaluate prospectively and compare the clinical response and the change in nucleotides correlating with haemodynamic changes in the cavernosal arteries after an intracavernosal injection (ICI) with vasoactive agents with or without oral sildenafil in men with erectile dysfunction (ED).

Patients and methods: In all, 80 patients with ED were prospectively evaluated by clinical assessments, measuring nucleotides in blood plasma and haemodynamics in cavernosal arteries. All patients had colour Doppler ultrasonography (CDU) twice with an interval of 5 h. First, each patient had CDU after ICI with trimix (0.25 mL) or prostaglandin E1 (PGE1, 5 microg), and the second CDU was after ICI trimix given 1 h after oral placebo (group I), sildenafil 25 mg (group II) or 100 mg (group III) and after ICI with PGE1 at 1 h after oral placebo (group IV) or 100 mg sildenafil (group V). Levels of cGMP and cAMP in peripheral venous and penile cavernosal blood plasma were measured at 15 min after ICI.

Results: The mean peak systolic velocity (PSV) at 5, 10, 15 min, and resistive index at 10 min in the second CDU after ICI with trimix, were significantly increased in group III. The mean (sem) levels of cavernosal cGMP were significantly increased in group III and V, from 1130.1 (313.5) to 2056.7 (580.4) and 1017.0 (214.2) to 1905.2 (915.0) fmol/mL, respectively. cAMP was significantly increased in group V, from 9533.1 (2068.4) to 12150 (3684.2) fmol/mL.

Conclusions: The haemodynamic changes and cGMP and cAMP production in the cavernosum were improved by trimix plus sildenafil more than with than PGE1 plus sildenafil or one ICI with trimix or PGE1. The results suggest that ICI with trimix and sildenafil is the best combination for a pharmacological erection test.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alprostadil / therapeutic use
  • Cyclic AMP / metabolism
  • Cyclic GMP / metabolism
  • Drug Therapy, Combination
  • Helium / administration & dosage*
  • Hemodynamics
  • Humans
  • Impotence, Vasculogenic / diagnostic imaging
  • Impotence, Vasculogenic / drug therapy*
  • Impotence, Vasculogenic / metabolism
  • Injections
  • Male
  • Nitrogen / administration & dosage*
  • Oxygen / administration & dosage*
  • Penile Erection / drug effects*
  • Penis / blood supply
  • Penis / diagnostic imaging
  • Penis / metabolism
  • Phosphodiesterase Inhibitors / administration & dosage*
  • Piperazines / administration & dosage*
  • Prospective Studies
  • Purines / administration & dosage
  • Sildenafil Citrate
  • Sulfones / administration & dosage*
  • Treatment Outcome
  • Ultrasonography
  • Vasodilator Agents / administration & dosage*


  • Phosphodiesterase Inhibitors
  • Piperazines
  • Purines
  • Sulfones
  • Vasodilator Agents
  • Helium
  • trimix
  • Sildenafil Citrate
  • Cyclic AMP
  • Alprostadil
  • Cyclic GMP
  • Nitrogen
  • Oxygen