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OuadMix Penile Injection: An Initial Urologists Experience

Received: 27 March 2025     Accepted: 8 April 2025     Published: 29 April 2025
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Abstract

Introduction: 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. Methodology: 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. Results: 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. Conclusion: 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.

Published in International Journal of Clinical Urology (Volume 9, Issue 1)
DOI 10.11648/j.ijcu.20250901.22
Page(s) 73-79
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

QuadMix, Radical Prostatectomy, Erectile Dysfunction, Intracavernosal Injection, Phosphodiesterase Type 5 Inhibitor

References
[1] Kenenna Obiatuegwu, Terkaa Atim, Sadiq Abu et al. Correlation between the Severity of Erectile Dysfunction and Prostate Size in Patients with Benign Prostatic Enlargement. Afr J Urol 27, 31 (2021),
[2] Morant S, Bloomfield G, Vat V et al. Increased Sexual Dysfunction in Men with Storage and Voiding Lower Urinary Tract Symptoms. J Sex. Med. 2009; 6 (4): 1103-1110.
[3] Raymond C, Francois G and Culley C. Sexual Dysfunction and Lower Urinary Tract Symptoms Associated Benign Prostatic Hyperplasia. European Urol. 2005; 47 (6): 824-837.
[4] Anthony J. Bella, Tom F. Lue. Male Sexual Dysfunction. In: Smith’s General Urology. Emil A. T, Jack W. M. Ch.38, 17th edition: McGraw Hill (Lange), 2008; 589-610.
[5] Veronelli, A., Masu, A., Ranieri, R. et al. Prevalence of Erectile Dysfunction in Thyroid Disorders: Comparison with Control Subjects and with Obese and Diabetic Patients. Int J Impot Res 18, 111–114 (2006).
[6] Papatsoris A. G, Korantzopoutous P. G. Hypertension, Antihypertensives Therapy and Erectile Dysfunction. Andrology. 2006; 57(1): 47-52.
[7] Rosen R. C. Evaluation of the Patient with Erectile Dysfunction: History, Questionnaires and Physical Examination. Endocrine 2004; 23(2-3): 107-111.
[8] Pastuszak AW. Current Diagnosis and Management of Erectile Dysfunction. Curr Sex Health Rep. 2014 Sep; 6(3): 164-176.
[9] McMahon CG. Current Diagnosis and Management of Erectile Dysfunction. Med J Aust. 2019 Jun; 210(10): 469-476.
[10] Super Quad-Mix 5 ml vial (lyophilized) | Defy Medical
[11] Chung E. A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction. Med Sci (Basel). 2019 Aug 29; 7(9): 91.
[12] Ashraf HF, Yasser E, Hosam H, Shady Z, Rany S. A study of the possible effects of repeated intracorporeal self-injection of vasoactive drugs in patients with elevated end diastolic velocity during pharmacopenile duplex ultrasonography. Cent European J Urol. 2013; 66(2): 210-214.
[13] Al-Adl, A. M., Abdel-Wahab, O., El-Karamany, T., & Aal, A. A. (2011). Combined intracavernous vasoactive drugs and sildenafil citrate in treatment of severe erectile dysfunction not responding to on-demand monotherapy. Arab Journal of Urology, 9(2), 153–158.
[14] Peter GC, Mathias H, Patricia G, Joseph N, John PM. A review of outcomes of an intacavernosal injection therapy programme. BJU int. 2012; 110(11): 1787-1791.
[15] Duncan C, Omran GJ, Teh J, Davis NF, Bolton DM, Lawrentschuk N. Erectile dysfunction: a global review of intracavernosal injectables. World J Urol. 2019 Jun; 37(6): 1007-1014.
[16] Moon KH, Park SY, Kim YW. Obesity and Erectile Dysfunction: From Bench to Clinical Implication. World J Mens Health. 2019 May; 37(2): 138-147.
[17] Opsomer RJ, Wese FX, De Groote P, Van Cangh PJ. The external vacuum device in the management of erectile dysfunction. Acta Urol Belg. 1997 Dec; 65(4): 13-6.
Cite This Article
  • APA Style

    Kenenna, O., Terkaa, A., Felix, M., Christopher, O., Okwudili, A., et al. (2025). OuadMix Penile Injection: An Initial Urologists Experience. International Journal of Clinical Urology, 9(1), 73-79. https://doi.org/10.11648/j.ijcu.20250901.22

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    ACS Style

    Kenenna, O.; Terkaa, A.; Felix, M.; Christopher, O.; Okwudili, A., et al. OuadMix Penile Injection: An Initial Urologists Experience. Int. J. Clin. Urol. 2025, 9(1), 73-79. doi: 10.11648/j.ijcu.20250901.22

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    AMA Style

    Kenenna O, Terkaa A, Felix M, Christopher O, Okwudili A, et al. OuadMix Penile Injection: An Initial Urologists Experience. Int J Clin Urol. 2025;9(1):73-79. doi: 10.11648/j.ijcu.20250901.22

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  • @article{10.11648/j.ijcu.20250901.22,
      author = {Obiatuegwu Kenenna and Atim Terkaa and Magnus Felix and Otabor Christopher and Amu Okwudili and Abu Sadiq},
      title = {OuadMix Penile Injection: An Initial Urologists Experience
    },
      journal = {International Journal of Clinical Urology},
      volume = {9},
      number = {1},
      pages = {73-79},
      doi = {10.11648/j.ijcu.20250901.22},
      url = {https://doi.org/10.11648/j.ijcu.20250901.22},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20250901.22},
      abstract = {Introduction: 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. Methodology: 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. Results: 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. Conclusion: 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.
    },
     year = {2025}
    }
    

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  • TY  - JOUR
    T1  - OuadMix Penile Injection: An Initial Urologists Experience
    
    AU  - Obiatuegwu Kenenna
    AU  - Atim Terkaa
    AU  - Magnus Felix
    AU  - Otabor Christopher
    AU  - Amu Okwudili
    AU  - Abu Sadiq
    Y1  - 2025/04/29
    PY  - 2025
    N1  - https://doi.org/10.11648/j.ijcu.20250901.22
    DO  - 10.11648/j.ijcu.20250901.22
    T2  - International Journal of Clinical Urology
    JF  - International Journal of Clinical Urology
    JO  - International Journal of Clinical Urology
    SP  - 73
    EP  - 79
    PB  - Science Publishing Group
    SN  - 2640-1355
    UR  - https://doi.org/10.11648/j.ijcu.20250901.22
    AB  - Introduction: 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. Methodology: 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. Results: 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. Conclusion: 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.
    
    VL  - 9
    IS  - 1
    ER  - 

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