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moving on to injections, Cialis has become unreliable and sildenafil doesn't work any more.

Urologist suggested moving to injections, specifically to start with Alprostadil.

I was wondering about its efficacy vs. cialis - does it give an erection independent of arousal?

Also, how long does the erection from it tend to last? I know it differs from person to person, but just want an estimate - it seems one hour is what most report?

do you just inject on one side? how does it then spread to both cavernosal chambers?

will be starting just on alprostadil - is it necessarily "worse" than e.g. bimix or trimix?

I’m Assuming you reside in the USA with my response.

Alprostadil is the only FDA approved injection and the reason most urologist will start you off with it. It’s available through regular drug stores like CVS or Walgreens and covered by some better prescription plans. It’s also the most pricey option if you don’t have good prescription coverage. I personally experienced a burning sensation with straight Alprostadil and switched to Trimix early on.

Trimix, Bimini quadmix are not FDA approved. They all come from compounding pharmacies and are not covered by insurance that I know of.although you can us HSA dollars if that’s available to you.

Your urologist should provide you with full instructions on usage and ultimately you will need to do some experimental work to find the right product and dosage for you.

Never used Alprostadil, but I used Trimix and Quadmix for several years until they failed. If you get a good injection in the right spot an erection can last 1-3 hours. And regardless of your state of arousal an injection will give you an erection. After orgasm my erections tended to go down when I was using injections to a semi-hard state. Even the next morning it would still be a bit chubby. It's best to change sides each time you inject. How it gets to both sides I'm not sure, but it does. Hope the injections work out for you.
For me the Trimix just started to fail even with a very high dose. The high doses caused a lot of soreness. Quadmix only worked for me for a short time before failures started.