Andrology Flashcards
Sertoli cells of the testis function
spermatogenesis
Leydig cells of the testis function
testosterone production
Erectile dysfunction definition
persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance
3 cylindrical structures of the penis
2x corpus cavernosa
corpus spongiosum
Mechanism of erection
dilation of arterioles and arteries - increased blood flow
trapping of blood by the expanding sinusoids
compression of the subtunical venous - reducing venous outflow
stretching of the tunica - occludes emissary veins - decreases venous outflow
contraction of ischiocavernosus muscles
Phases of erectile process
flaccid phase
latent (filling) phase
tumescent phase
full erection phase
rigid erection phase
detumescence phase
Organic erectile dysfunction characteristics
gradual onset
global - can never get an erection
poor non-coital erection
Psychogenic erectile dysfunction characteristics
acute onset
situational
rigid non-coital erection (eg. morning)
long history of psychosexual problem
anxiety and fear
Erectile dysfunction risk factors
smoking
blood pressure
cholesterol
diabetes
Treatment of erectile dysfunction
PDE5 inhibitors (eg. sildenafil)
Alprostadil
Psychotherapy
Surgical implants
What intracavernosal agents can be given for erectile dysfunction?
PGE1 (alprostadil)
papaverine (non-selective PDE5 inhibitor)
phentolamine (alpha blocker)
Which patients cannot be given sildenafil?
patients on nitrates
PDE5 inhibitors side effects
vasomotor effects
headaches
flushing
Penile prosthesis side effects
infection
erosion
mechanical malfunction
Define varicocele
tortuous dilatation of pampiniform plexus
What side is varicocele more common on?
left
(vertical drainage into renal vein)
Drugs that can impair male fertility
impaired spermatogenesis - sulfasalazine, nitrofurantoin, methotrexate, colchicine
pituitary suppression - testosterone injections, GnRH analogues
anti-androgenic effects - cimetidine, spironolactone
ejaculation failure - alpha blockers, antidepressants, phenothiazines
erectile dysfunction - beta blockers, thiazide diuretics, metoclopramide
drugs of abuse - anabolic steroids, cocaine, heroin, cannabis
What condition is priapism more common in?
sickle cell
Priapism treatments
corporal aspiration
ice pack
alpha blockers/phenylephedrine
shunts
penile prosthesis if all fails
What is Peyronie’s disease?
benign lesion of penis leading to curvature of erect penile shaft due to formation of fibrous tissue plaques within the tunica albugenia
What is a vasectomy?
removal of a small section of vas from both sides with interposition of tissue between the divided ends to prevent recanalisation
What is mandatory after a vasectomy?
post-vasectomy semen analysis (PVSA)
confirms azoospermia - at this point alternative contraception can be discarded
