Steve,
I understand where you coming from because many men are starting to
have injections quite soon after surgery with good success.  It makes
sense that getting erections is good and it seems that the injections
will give  someone a fuller and deeper erection that goes into your
body and not the hinged effect of a vacuum device.

I ran across a couple of articles which are copied below.  The first is
from John Hopkins which states that normal population has a rate of 26
out of 100000 men and in a study from Walsh a small group was studied
and found to have 3 out of 64 with it.  (1000 fold increase).  The
article is also  in the Phoenix 5 website.  There not sure of the
causes but in the second article from Adam Healthcare Center it
describes  that injections were a cause of "Scarring of the penis
(Peyronies disease), which is most likely to occur with injections."

Also from the Prostate Cancer Coalition has a website that describes
Tips for Penile Injections and lists questions
(http://www.pcacoalition.org/treatment_info/penileinjections.php)

Questions that deal with injections
Q7. Are there long term side effects to the use of injections? What
are they?
A7. One possible side effect is development of curvature in the erect
penis, which can be painful and interfere with intercourse. This is
called Peyronie's Disease. It is caused by a buildup of plaque or scar
tissue inside the penis in the lining of the corpora cavernosum. These
are the two sponge-like cylinders running the length of the penis into
which the medication is injected. It is relatively rare (about 3%) and
can be treated. (You can minimize the risk by learning to inject
correctly...this is not difficult.)
Q46. After using the injections for a while my erections have developed
a curvature. What's happening?
A46. The injections may have caused some scar tissue to have formed.
This condition is called Peyronie's disease. Talk to your doctor about
causes and treatment.

Q47. Does this curvature develop for all men using injections?
A47. No, only 3-8 percent of men.
Q50. Can just one injection cause Peyronie's?
A50. Possible, if too much medication injected or injected incorrectly.

If anyone is thinking about injecting, this website seems to a good
website to read.

I think when Urologists look at the data they either become for
injections or against them - even  reading the same data.  The idea
that I would try other treatment for a year didn't seem like a bad idea
and that usually within a year the problem will hopefully be gone
anyway.  In the above paragraphs 3% to 8% seems pretty high to me and
not relatively rare.  Turn it around and to some the idea that 92 to
97% won't get it seems acceptable.  (Especially when the focus is
getting an erection.)

J. Hopkins News Letter
Volume V * Number1 * Winter 2000

--------------------------------------------------------------------------------

Peyronie's Disease is a disorder of the connective tissue within the
penis that can cause curvature during erection. It's fairly rare --
diagnosed in only 26 out of 100,000 men each year, most of them in
their fiffies and sixties. But Hopkins urologists have spotted what
they believe may be a small yet significant trend: Peyronie's Disease
seems to be more common in men who have had a radical prostatectomy. Is
this just coincidence? The age group is roughly the same. Or does the
procedure itself -- or a man's recovery from it--somehow contribute to
development of the disease?

"Peyronie's Disease is like arthritis of the penis," says urologist
Jonathan P Jarow, M.D., who specializes in treatment of erectile
disorders. "When you get scar tissue deposited in the connective tissue
of your joints, you get arthritis. It's a similar problem in the
penis," Sometimes this buildup of scar tissue causes a telltale bend,
or curvature in the penis (which appears only during erection). It may
also manifest itself as palpable or painful lumps -- which may be
terrifying for a man to discover. "Many men worry that they have penile
cancer," says Jarow, "but we can tell just by examining them exactly
what it is." He hastens to reassure his patients that although the
disorder may be annoying, it is not life-threatening: "Men aren't going
to live any longer or shorter because of it."

Although nobody knows what causes Payments's disease, scientists
believe that it's related to a series of minor injuries -- or, as Jarow
explains, "wear and tear." One theory "is that it's due to repetitive,
minimal trauma to the penis from buckling that occurs when you're
attempting sexual relations with an incomplete erection, and that this
repetitive trauma leads to buildup of scar tissue." Peyronie's disease
appears to be more common among men who have erectile dysfunction,
notes Jarow. "It's not clear whether it's secondary to some of the
treatments, such as vacuum erection devices, or injection therapy, or
whether it's due to having erection problems to begin with, and is
independent of the treatment."

In a new study, led by Jarow and Patrick C. Walsh, M.D., that will
include 100 patients, 3 out of 64 radical prostatectomy patients so far
have developed "rapid appearance of new-onset Peyronie's disease" after
surgery, says Jarow. "This sounds very low. But if you compare that to
the incidence of Peyronie's disease in the general population, it's
1,000-fold greater.

In some men there may be an inherited component to Peyronie's disease (
as there is with other tissue disorders); Jarow is seeking men with a
family history of the disease in hopes of finding genetic proof "What
makes us so interested in the radical prostatectomy patients and we are
just beginning to investigate this -- is that, hopefully, if we can
understand the mechanism behind Peyronie's disease in this setting, we
may be able to prevent it in men undergoing radical prostatectomy in
the future, as well as in other men."

The good news is that Peyronie's disease does not progress forever. "In
some men (fewer than 20 percent), it goes away by itself," says Jarow.
"For most people, it eventually stabilizes. The pain goes away. The
lump becomes less prominent, and the curvature lessens. In just about
everybody, the disease process, the deposition of scar tissue, stops
with time."

Men who were fully potent when the disease began generally remain so,
Jarow notes. "In other words, erection problems -- specifically
problems with rigidity -- are a rare end result of Peyronies disease in
general." But most men who have had a radical prostatectomy have at
least some temporary trouble with erection; thus, treatment depends on
a man's specific symptoms. "If a man's problem is curvature -- if the
penis is bent so he cannot engage in sexual activity, or it's
uncomfortable to his partner -- then we can do an outpatient surgical
procedure to straighten the penis," says Jarow. "If, however, he has
significant curvature that prevents sexual relations and problems with
rigidity, then he's treated with insertion of a penile prosthesis
combined with penile straightening," also an outpatient procedure. If a
man simply has erection problems but no serious curvature, he is
"treated like anyone else with an erection problem, starting with
pills, then shots, then the vacuum device, then if necessary, a penile
prosthesis."

We are trying to learn more about this condition in men who have
undergone a radical prostatectomy. If you have Peyronies' disease and
would like to help us, or to find out more about this work, please
write to Dr. Jarow at The James Buchanan Brady Urological Institute,
The Johns Hopkins Medical Institutions, Baltimore, MD 21287-2101.

FURTHER READING
Jarow, J.P. and Lowe, EC., "Penile Trauma: An Etiologic Factor in
Peyronie's Disease and Erectile Dysfunction," Journal of Urology, Vol.
158, pp. 1388-1390. 1997.

--http://adam.about.com/reports/000015_9.htm

Description
An in-depth report on the causes, diagnosis, treatment, and prevention
of erectile dysfunction.

Injections or Topical Treatments
Penile injections have now largely been replaced by oral medications,
specifically sildenafil. Nevertheless, injection and topical (skin)
therapies employ various agents that have properties that help achieve
erection, even in many men who do not succeed with sildenafil. The
standard agents used in injections or topical administration include
the following:

Alprostadil.
Phentolamine.
Papaverine.
Although any or all of these agents are very effective, injections or
other invasive methods of administration are awkward and uncomfortable.
Topical forms of some of these agents are showing promise.

Treatments Using Alprostadil
Alprostadil is derived from a natural substance, prostaglandin E1, and
acts by opening blood vessels. It is an effective treatment for some
men. It can be administered in three ways:

By injection into the erectile tissue of the penis (Caverject, Edex).
By a device that administers the drug through the urethra (MUSE
system).
In a topical cream (Topiglan, Alprox-TD) applied directly to the penis.
Studies are suggesting that this approach may prove to be effective and
very acceptable. FDA approval is pending at this time.
Candidates. Regardless of how it is administered, alprostadil works in
many men with a wide range of medical disorders related to erectile
dysfunction, including the following:

Diabetes.
Prostate cancer treatments. Early use of alprostadil injections after
treatment, particularly when followed by oral Viagra, may be very
helpful for men being treated for prostate cancer.
Men who are taking nitrates.
Injury.
Alprostadil is not an appropriate choice for the following individuals:

Men with severe circulatory or nerve damage.
Men with bleeding abnormalities or men who are taking medications that
thin the blood, such as heparin or warfarin.
Men with penile implants.
Side Effects of Most Alprostadil Methods . Certain side effects are
common to all methods of administration, although they may differ in
severity depending on how the drug is given:

Pain and burning at the application site. In one study half of the men
who injected alprostadil experienced some burning and pain at the
injection site. (Such effects from the cream are mild to moderate in
intensity.)
Scarring of the penis (Peyronies disease), which is most likely to
occur with injections.
Sudden, low blood pressure. Symptoms include dizziness,
lightheadedness, and fainting. If these symptoms occur, the man should
lie down immediately with his legs raised.
Priapism (prolonged erection). Possible with any method, but less
chance with the MUSE system than with injections. If priapism occurs,
applying ice for ten-minute periods to the inner thigh may help reduce
blood flow. Erections that last four hours or longer require emergency
care.
Women partners may experience vaginal burning or itching. The drug may
have toxic effects if it reaches the fetus in pregnant women, so men
should not use alprostadil for intercourse with pregnant women without
the use of a condom or other barrier contraceptive device.
In addition, each method has other specific side effects.

Injected Alprostadil. Injected alprostadil (Caverject, Edex) employs a
very small needle that the man injects into the erectile tissue of his
penis. About 80% of men describe the pain of administering the
injection as being very mild. Edex is a newer and less expensive form
of injected alprostadil. In one 12-month study of 894 patients, Edex
injections achieved erections in 95% of attempts. There is some
evidence that the agent may have long-term benefits on smooth muscles.
Some men have even reported return to spontaneous erections after
long-term use, although objective evidence has not confirmed these
findings.

The drug should not be injected more than three times a week or more
than once within a 24-hour period.

Specific reports of the severity of side effects using injections
include the following:

Pain and burning at the injection site. Half of men reported this side
effect in one study. To help prevent this side effect, experts in one
study recommended a lower starting dose of 2.5 micrograms with
subsequent doses increasing by increments of 2.5 until an erection is
achieved. In this study there were only two episodes of pain out of 138
injections. (Usually, patients start with a dose of 20 micrograms.)
Priapism. Studies report that up to 4% of men using injection therapy
experienced erections lasting more than four hours, but most cases
resolve without treatment.
Scarring (Peyronies disease). This occurs in almost 8% of men who use
injection therapy for more than a year. Treatment can be resumed when
the condition resolves.
In spite of its general success, self-injection therapy has a high
dropout rate and is less likely to be used now that oral treatments are
available. The primary reasons for dropping out are the following:

Loss of interest in the procedure.
Partner objection or relationship breakup.
Cost.
Spontaneous improvement in erections.
Side effects (reported as being severe enough to withdraw by 10% of men
in one study).
Lack of effectiveness (14% in one study).
MUSE System. The MUSE system delivers alprostadil through the urethra.
It works in the following way:

The device is a thin plastic tube with a button at the top.
The man inserts the tube into his urethral opening right after
urination. (Urinating or urine leakage right after administration may
reduce the amount of medication.)
He presses the button, which releases a pellet containing alprostadil.
The man rolls his penis between his hands for 10 to 30 seconds to
evenly distribute the drug. To avoid discomfort, the man should keep
the penis as straight as possible during administration.
The man should be upright, either sitting, standing or walking for
about 10 minutes after administration. By that time, he should have
achieved an erection that lasts between 30 to 60 minutes. (If a man
lies on his back too soon after administration, blood flow to the penis
may decrease and the erection may be lost.)
The erection may continue after orgasm.
Reported success rates have been around 50% but range widely. A 2001
study reported higher success rates with sildenafil (Viagra), and in
another study, only 18% of men requested additional refills. Some
experts believe that these less than optimal results may be due to the
physicians failure to educate patients and their partners adequately
about the procedure.

Specific reports of side effects using the MUSE system include the
following:

Burning in the urethra. Up to 31% of MUSE administrations result in a
burning sensation in the urethra that can last five to 15 minutes. This
pain is generally mild to moderate, however, and is not a primary
reason for discontinuing.
Penile pain. Some pain in the penis occurs in about a quarter to a
third of cases; it is usually mild.
Low blood pressure. About 3% of patients experience low blood pressure,
which can cause dizziness or fainting.
Drug interactions. Taking certain cold and allergy remedies may offset
the effects of the MUSE-administered drug.
Other side effects. Other side effects include minor bleeding or
spotting, redness in the penis, and aching in the testicles, legs, and
area around the anus.
The MUSE system should not be used more than twice a day and is not
appropriate for men with abnormal penis anatomy.

Topical Cream. Alprostadil is being developed as a topical cream or gel
(Topiglan, Alprox-TD). The cream is applied to the tip of the penis 15
minutes before intercourse. Studies are reporting an efficacy rate of
40% to 75% and no significant side effects, although some men report a
temporary burning sensation at the application site. The consequences
to the female partner are not known.

Injections Using Papaverine and Phentolamine
Until the introduction of alprostadil, the two drugs used for injection
therapy had been papaverine (Pavabid, Cerespan) and phentolamine
(Regitine). Adverse reactions are usually minor but include pain,
ulcers, and prolonged erections (priapism), which sometimes require a
needle to withdraw blood or another drug to reverse the process. In a
2000 study, a combination of these two drugs produced a much higher
drop out than alprostadil alone or a triple combination of all three.