Search For a Provider Facebook Twitter Instagram YouTube ES View the Patient Toolkit

Conditions: Spinal Cord Injury

Treating Spinal Cord Injury

There are many different treatments for men experiencing ED from spinal cord injury. Effective treatment varies greatly depending on the type and severity of the spinal cord injury. Additionally, men with spinal cord injuries may have special concerns or problems with their use. Therefore it is very important to consult your doctor or urologist to decide on the best treatment option for you.

Treatments that have been successful in treating ED for men with spinal cord injuries are:

Oral Medication: Currently, there are three oral medications (pill taken by mouth) approved for use by the U.S. Food and Drug Administration (FDA) for the treatment of ED: sildenafil citrate (Viagra®), vardenafil hydrochloride (Levitra®) and tadalafil (Cialis®).

All of these therapies, also known as phosphodiesterase-5 inhibitors (PDE5i), create an erection by increasing blood flow into the penis. Although all work in the same way to help men gain an erection, there are differences between each that should be discussed with your doctor in order to choose which drug therapy is best. Some differences between these drug therapies are: dosing, longevity of effectiveness, interaction with other medications, and side effects. When taken properly, these medications have been found to improve erections in more than 80 percent of patients.

Some of the failures in patients who do not respond to these medications are attributable to inappropriate medication usage (not paying attention to ‘instructions for use’), use of less than maximum dose, too few attempts.

Use of the orally administered PDE5i medications listed has become the first-line treatment for ED. Additionally; all three oral medicines have comparable rates of side effects. [Link to PDE5i section]

Penile Injection Therapy: Injection treatments involve the injection of medication into the base or side of the penis. The injected medication causes blood vessels within the penis to widen, or dilate, which increases blood flow to the penis and causes an erection. Injection therapy typically uses a combination of two or three drugs prescribed by a doctor, called a “bi-mix” or “tri-mix”. The most common drugs are Papavarine, Phentolamine and alprostadil. Although the thought of an injection can be unpleasant, injection is a quick and easy technique to learn and for most men the procedure’s sensation is no more than a pinch. Another benefit is that most men who do not respond to the oral drug therapies listed above find injection therapies to be effective in the treatment of ED.

Urethral Suppositories: Transurethral agents, also called intra-urethral agents, are ED treatments whose mode of administration is insertion into the urine channel, known as the urethra. The only FDA-approved urethral suppository is called MUSE® (Medicated Urethral System for Erection), which contains the drug alprostadil (also used in the injectable drugs, Caverject and Edex).

Once MUSE is inserted and absorbed into the tissue immediately surrounding the urethra (the corpus spongiosum) it is transferred into the erectile chambers (corpora cavernosa) via small veins. The medicine then causes the erectile tissue within the penis to relax and allows blood flow into the penis to increase. This increased blood flow causes an erection. [Link to MUSE section]

Vacuum Erection Devices (VED): Also called vacuum constriction devices (VCD), are also very common because they are not invasive. The VED/VCD is a vacuum pump that causes blood to be drawn into the penis in order to create an erection. This is done by placing the penis into the vacuum cylinder and pumping air out of the cylinder. The erection is maintained by placing a constriction ring around the base of the penis. This ring also prevents urinary leakage that some men with spinal cord injuries experience. Both battery-operated model and hand pump models are available.

Some of the above treatment options may provide limitations to men with limited hand functioning due to their spinal cord injury. Therefore, assistance may be required, as in the case with injection therapy and penile suppositories, or certain options may not be possible, like having to use the battery operated vacuum devices rather than the hand operated ones.

Penile Implant: Penile prostheses, or penile implants, are an important treatment option for men with ED who have an established medical cause for ED, fail to respond to non-surgical treatments (such as oral medications, vacuum devices, injection therapy etc.) and who are motivated to have surgery to improve erectile function. Penile implant requires a permanent surgical procedure that cannot be reversed so it is important that men talk to their doctor about the advantages and possible drawbacks of having the procedure.

This procedure replaces the spongy tissue (corpora cavernosum) inside the penis that normally fills with blood to create an erection with rigid, semi-rigid, or inflatable cylinders (depending on which type of penile implant is chosen). In all penile prostheses, the surgically inserted components are totally concealed within the body. After a penile implant, when a man desires an erection, he is able to produce a rigid erection on demand that enables him to have sexual relations. Penile implants do not typically lengthen the penis.

It is best to talk to the treating physician or a urologist before any treatment since men with spinal cord injury may have special concerns in choosing the best treatment for ED. A man’s level of injury, possible treatment side-effects, other medical conditions and current medications need to be considered when deciding which treatment option is best.

Related Stories