to the editor: Penile hypotonia caused by congenital spinal cord conditions or spinal cord injuries is a common complication and presents as a problem during the placement of a condom catheter in patients who are incontinent.

A 35-year-old man with neurogenic incontinence caused by cerebral palsy had persistent problems with the use of condom catheters because of penile hypotonia. The patient was prescribed 50 mg of sildenafil 30 minutes before the placement of the condom catheter. Follow-up revealed that he was more successful in the placement and maintenance of the catheter and had a documented decrease in the number of episodes of cystitis and genital irritation as compared with the results before the administration of sildenafil.

If used with caution and in patients without underlying heart disease, sildenafil (Viagra) may be an option for some patients who are experiencing problems with condom catheter placement because of penile hypotonia. This may prevent the use of more invasive techniques like indwelling catheter placement and suprapubic cystostomy, which is associated with increased risks, such as bleeding and infection. A search of the literature did not reveal any studies using sildenafil and the placement of condom catheters.

The high cost and possible lack of prescription benefits to cover sildenafil may preclude frequent use; however, our experience suggests that sildenafil may be useful for difficult catheterizations in men with penile hypotonia.