OuadMix Penile Injection: An Initial Urologists Experience

<i>Introduction</i>: QuadMix is considered to be one of the most powerful class of anti-erectile dysfunction agents and superior to all forms of intracavernosal injections especially in men with permanent/severe erectile dysfunction (ED) that has defiled oral therapy. QuadMix consists of papaverine HCl, phentolamine mesylate, prostaglandin E1 and atropine sulfate designed to act synergistically with satisfactory endpoint. We report our preliminary experience with QuadMIX in the management of permanent/severe ED. <i>Methodology</i>: This is a prospective study which was carried out between July 2020 to June 2022. Two questionnaires (a proforma and IIEF-5) were administered to all patients presenting with ED to objectively assess the etiology, risk factors and severity of ED without bias. Only patients who met the inclusion criteria were recruited for the study and informed consent was obtained. Individual test dose was calculated and the patients were subsequently trained on self-injection using an autoinjector. Two capsules of phenylephrine were also given to the patients to keep with them with appropriate instructions. Data obtained were analyzed using Statistical Package for Social Sciences version 20.0. P value of less than 0.005 was considered statistically significant. <i>Results</i>: Sixty patients were enrolled for the study. All patient had either permanent ED or severe ED. Thirty percent had radical prostatectomy surgery. Ten percent had trauma with pelvic bone involvement while 31.66%, 3.34% and 25% had comorbid conditions (diabetes mellitus and hypertension), prolonged priapism and no obvious organic etiology respectively. Forty percent of the patients failed to achieve satisfactory erection on oral medication while 60% had no erection despite taking phosphodiesterase type 5 inhibitors (PDE5i). All patients had tumescence for satisfactory sexual intercourse within 10 mins following administration of QuadMix. Fifty eight patients (96.67%) had spontaneous detumescence after ejaculation. Only 2 patients (3.34%) had priapism. One was reversed with ejaculation, use of ice pack around the perineum and caps phenylephrine while the second patient had intracavernosal aspiration to achieve detumescence. <i>Conclusion</i>: QuadMix is an effective and safe agent in the treatment of permanent and severe ED in patients with comorbid condition. It also improves quality of life (QoL) and sexual performance in patient who has had permanent ED following radical prostatectomy.