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Senior - Urology > 5 - ED > Flashcards

5 - ED Flashcards

1
Q

Erections are results of?

A

Neurovascular event

Neurotransmitters

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2
Q

What does the neurovascular event of ED include?

A
  • Intact autonomic and somatic nerve supply to penis
  • arterial blood flow supplied by the paired cavernosal arteries
  • smooth and striated musculature of the corpora cavernosa and pelvic floor
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3
Q

What neuortransmitters are involved in an erection?

A

Nitric oxide (primary)

Others
- acetylocholine, prostaglandins and vasoactive intestinal peptide

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4
Q

Flow chart of erection?

A

Slide 8

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5
Q

Blood flow and muscle action w erection?

A

Increase arterial flow

Relaxtion of smooth muscles in corpora cavernosa

Increase venous resistance

Contraction of bulbocavernosa and ischiocavernous muscles -> further rigidity of penis

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6
Q

Definition of ED?

A

Consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance

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7
Q

Etiology of ED?

A

Organic
Psychogenic

Can be an overlap

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8
Q

Describe psychogenic ED

A

Young men
+ nocturnal/morning erection
Situational ED

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9
Q

Types of psychogenic ED?

A

Generalized
- unresponsive

Situational

  • partner related
  • performance related
  • psychological distress or adjustment related
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10
Q

Types of organic ED?

A 
Neurogenic
Hormonal
Arterial 
Venous 
Drug-induced
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11
Q

How to differentiate psychogenic and organic ED?

A

“Do you get nocturnal erections?”

Yes - psycogenic
No - organic
Dont know - there is a monitor for that

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12
Q

Diseases related to ED?

A

Slide 15

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13
Q

Risk factors for ED?

A
  • men >40
  • DM
  • dyslipidemia
  • HTN
  • psych probs (depression)
  • neurologic disease
  • CKD
  • cardiac/peripheral disease
  • previous prostate cancer
  • pelvic trauma/surgery/irradiation
  • endocrine d/o
  • tobacco
  • alcohol
  • drugs
  • obesity
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14
Q

History q’s for ED?

A

Other sex dysfunction

  • loss of libido (androgen)
  • anejaculation (many diseases)
  • anorgasmia
  • premature ejaculation

Is ED chroinic, occasional, situational

Is problem attaining or maintaining

Diseases

Trauma

Drug, etoh, tobacco

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15
Q

Questionnaire for ED?

A

International index of erectile function (IIEF)

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16
Q

Common meds that cause ED

A 
Antihypertensive 
- B blocker
- thiazide 
- spironolactone
- clonidine
Antidepressants
Opioids
Prostate agents
- doxazosin
- terazosin
17
Q

Rapid onset ED is prob?

A 
Psychogenic
Genitourinary trauma (prostatectomy)
18
Q

Nonsustained erection is prob?

A

Anxiety

Venous leak

19
Q

Complete loss of nocturnal ED is prob?

A

Vascular or neurologic disease

20
Q

Physical exam

A 
Note secondary sex characteristics
\+ gynecomastia
Peripheral vascular exam
Focused neurosensory exam
GU exam
- scarring, plaques
- testicular size/masses
Prostate exam
21
Q

Lab for ED?

A 
Lipids
Glucose
Testosterone 
Prolactin 
TSH
22
Q

What arethe special test?

A
  • Nocturnal penile tumescence testing
  • trial of oral PDE-5
  • direct injection of vasoactive substances into penis (test blood flow)
  • penile duplex doppler
  • penile cavernosography
  • pudendal arteriography
23
Q

Tx for ED?

A 
Lifestyle 
- bla 
- bla
- bla 
They want pills not exercise

PDE-5 inhibitors

24
Q

Adverse effects of PDE-5 inhibitors

A

HOTN
- esp w alpha blockers
Priapism (rare)

25
Q

Contraindications for PDE-5?

A

Contraindicated w nitroglycerine or nitrates

Relative

  • active corinary ischemia
  • heart failure
  • borderline HOTN
  • multi HTN meds
  • CYP450-3A4 (erythromycin, cimetidine, ketaconazole)
26
Q

How to take sildenafil (viagra)?

A

1-4 hrs before sex
Empty stomach
- high fat meal delays absorption

Stimulation is required for erection

27
Q

When do you need to take verdenafil or tadalafil, avanafil?

A

Vardenafil (levitra)

  • 1 hr prior
  • max 1 day

Tadalafil (cialis)

  • 1 hr prior
  • no more than 1 every 2 days
  • last 36hrs

Avanafil (stendra)
- 15 min before

28
Q

Non PDE-5 meds for ED?

A

Vasoactive therapy
- alprostadil (prostaglandin E2)
(injection or urethral suppository)
- hormonal replacement

29
Q

Before hormone replacement you should?

A

Rule out prostate cancer

30
Q

Adjunct devices for ED?

A

Vacuum erection device
Inflatable penile implant
Flexible rod penile implant

31
Q

Vascular disorder ED treatment?

A
  • Trauma-induced focal arterial occulsion
  • congenital venous occlusion

High failure rate

32
Q

You should know how to recognize the signs of ED,

A

Its not hard…

Senior - Urology (7 decks)

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