While gently stretching the penis , the applicator can be placed within the urethra (Fig. 16.2); at this point, it is safe to press the release button at the top of the applicator to deposit the medication within the urethra (Fig. 16.3). Hold in this position for 5 s and then gently rock the device side to side to help release the pellet from the applicator. Avoid excessive motion as it may cause damage to the urethra . The applicator can now be removed but make sure the penis remains pointing upward.

The applicator should be examined to make sure the medication is no longer attached. If there is still some medication present, the applicator may be reinserted and the previous steps repeated. The patient should then be instructed to stretch the penis and massage between the hands in a rolling motion for at least 10 s but a few minutes may help further. If there is discomfort or burning, it may help to continue massaging for at least 30–60 s.

The applicator can be placed back in its protective covering and foil wrapper and disposed of in the trash. The patient should remain standing, walking, or seated for at least 10 min after insertion to facilitate opening of the spongiosal -cavernosal venous channels required for medication transfer. Erection, if this occurs, should be happened within 20 min.