Artificial Erection Technique

We routinely use intracavernosal prostaglandin E1 (alprostadil) at a dose of 10 mg when scanning tumors with both ultrasound and MRI. This stretches the tunica albuginea, making defects or invasion easier to see, and it increases contrast between intermediate signal tumor and high signal corpus spongiosum or caverno-sum. For patients with erectile dysfunction, the dose may be increased to 20 mg (especially if it has been used before), and in young patients with normal erections it can be reduced to 5 mg. Sildenafil and manual stimulation have a good result in most patients but the time to onset is longer and they are not as reliable as intrac-avernosal agents.19

The contraindications to intracavernosal alprostadil are penile implants and conditions predisposing to priapism: sickle cell disease, myeloma, and polycythemia. Tumors invading the corpora, anatomical abnormalities, and clotting derangement are only relative contraindications.20 The risk of priapism is small (around 1% in a large group of patients with erectile dysfunction of mixed cause,21 and in 1 out of 9 patients in a small study of penile cancer18), and it can usually be treated by aspiration of blood from the corpora or by the intracavernosal administration of a adren-ergic agents such as phenylephrine.22

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