Chap 82 ED Flashcards
Describe the mechanism of an erection.
parasympathetic division of the ANS causes NO levels to rise in the trabecular arteries and smooth muscle of penis
vasodilation causes corpora cavernosa to fill
simultaneously the ischiocavernosus and bulbospongiosus muscles compress vein of corpora cavernosus preventing egress of blood.
Describe the blood supply to the penis.
Which artery affects tumescence?
IIA
branch internal pudendal
becomes common penile after
subdivides into coral, cavernosal and bulbourethral
accessory pudendals from EIA, obturator, vesicle, and femoral arteries
cavernosal
What nerve supply is interrupted in AAA surgery?
parasympathetic and visceral afferent nerve fibers
they supply the erectile tissue
How many men suffer from ED post AAA repair?
What are the specific erectile issues?
20-30%
retrograde ejaculate
difficult achieving or maintaining erection
What are the different causes of ED?
psychogenic neurogenic endocrinologic vasculogenic drug induced
What are risk factors for vasculogenic ED?
HNT DM DLP obesity smoking
What are different diagnostic techniques for ED?
nocturnal penile tumescence monitoring (can distinguish psychogenic from vascular)
penile brachial pressure (high inter-observer reliability)
office injection test (seldom performed)
Duplex
induce erection
PSV, EDV, RI of penile artery
pudendal and penile angiography
What are duplex findings suggestive of vascular ED?
PSV 10cm/sec asymmetry
Name different pharmacological tx for ED.
PDE5 inhibitor sildenafil vardenafil tadalafil avanafil
intracavernosal injection
PGE1
phentolamin
papaverine
intraurethral PGE1 suppository
How to PDE5 inhibitors work?
inhibit PDE5 enzyme which degrade cGMP
cGMP in the downstream effector of NO
prolonged cGMP decrease intracellular ca and maintains SM relaxation
What are mechanical and sx tx of ED?
vacuum constriction devices penile implant surgery penile revasclarization (inf epigastric to dorsal artery bypass) ligation of crural vein for veno-occlusive dz
