Dr.

Paulo Bastos
Titular da Sociedade Brasileira de Urologia

Histria

1982 - Ronald Virag injeta papaverina no pnis de

pacientes para estudar artrias penianas e
provoca acidentalmente uma ereo

1983 - Brindley: auto-injeo com

fenoxibenzamina.

1985 - Zorniotti e Lefleur: papaverina /

fentolamina.

1986 Adaikan/Ishii: resultados com PGE-1.

1991 - Bennett: papaverina / fentolamina / PGE-1.

Drogas vasoativas

Substncias qumicas injetadas nos corpos

cavernosos que reproduzem, modulam ou
modificam os estmulos
neutrotransmissores no pnis

Produzem:

Mudanas hemodinmicas/morfolgicas
Relaxamento do msculo liso
Bloqueio do tnus adrenrgico
Utilizadas para diagnstico (ereo
farmacoinduzida) e tratamento de DE

Indicaes

Diagnsticas
Avaliao do sistema vascular peniano
Dinamizar outros procedimentos diagnsticos

(Doppler)
Avaliar as alteraes morfolgicas do pnis
(doena de Peyronie)

Teraputicas:
Contraindicaes ou no respondedores ao

tratamento oral
Reabilitao peniana ps prostatectomia radical

Principais substncias

Papaverina
Alcalide extrado do pio
Inibio no seletiva das PDE com

relaxamento da musculatura lisa

Prostaglandina E1
cido graxo natural
Relaxa musculatura lisa e artrias helicinais

dos corpos cavernosos (Caverjet,

Aplicav)

Principais substncias

Fentolamina
Antagonista alfa-adrenrgico
Relaxa musculatura lisa (sozinho no

promove ereo, apenas intumescimento)

Clorpromazina
Neurolptico do grupo das fenotiazinas
Ao semelhante a fentolamina

Contraindicaes
Coagulopatias severas
Doenas psiquitricas severas
Priapismo
Obesidade
Falta de habilidade manual
Doenas cardiovasculares instveis

Complicaes

Locais:
Priapismo (<1%), mais comum na

investigao diagnstica, proporcional a

dose injetada
Equimoses e hematomas

Locais tardias:
Reaes inflamatrias locais, hematomas,

trauma repetido levando a fibrose peniana

Causas de abandono da terapia

Dor
Resposta inadequada
Ereo prolongada levando a medo
Retorno das erees espontneas
Discrdias conjugais (parceira no
cooperativa)

Principais formulaes

PGE1 10mcg + fentolamina 1mcg/ml

Papaverina 30mg + fentolamina 0,5mg/ml

PGE1 8mcg + clorpromazina 0,5mg/ml

Papaverina 30mg + clorpromazina 0,5mg/ml

PGE1 10mcg + papaverina 30mg +

fentolamina 1mg/ml

Aplicao
Fazer a primeira aplicao no consultrio
Orientar o paciente a lavar as mos,
aspirar o medicamento do frasco na
quantidade adequada
Puncionar o pnis lateralmente ao longo
da haste peniana no atingindo vasos
visveis
Aps o trmino, retirar a agulha e
comprimir o local
No mximo 3 aplicaes por semana, com
intervalos mnimos de 24 horas

Aplicao

O treinamento no consultrio dever ser

repetido quantas vezes for necessrio,
at a compreenso do paciente

Dispositivos para auto-injeo

Erectile function after nerve-sparing radical

prostatectomy: Concepts for rehabilitation in Germany
Eur Urol Suppl 2013;12;e127

RESULTS: Until today 262 urologists completed and returned

the questionnaire. The distribution was: urologists in hospitals
n=110, outpatient/ambulatory n=148, with 24% performing
surgical treatment, and urologist in rehabilitation hospitals n=4.
Overall 50% of the urologists are performing radical
prostatectomy on a regular basis. The question about the
rehabilitation concept showed 39 different treatments within
this group. To increase EF after nsRP PDE5-inhibitors were
mostly administered (88%): 45% on demand vs. 55% on a
daily or regular basis 3 times/week.

The use of penile injection therapy, MUSE or VCD was 32%,

6% and 30% respectively. In 56% the treatment started within
the first weeks after surgery and was performed until the patient
regained potency in 46%. Only 14% of the urologists didnt
chose any active kind of rehabilitation treatment for EF
recovery after nsRP.

Erectile function after nerve-sparing radical

prostatectomy: Concepts for rehabilitation in Germany
Eur Urol Suppl 2013;12;e127

CONCLUSIONS: Lots of different

therapeutic concepts are currently
performed in Germany to increase EF
recovery after nsRP. The use of PDE5inhibitors is the most chosen treatment
option. Despite the published data
regarding effectiveness the optimal
treatment seems to be still unknown.