CUA 2015 ED GL Flashcards
what informations should be obtained in history?
History of ED( onset, duration etc) , desire, arousal, orgasm, ejaculation Sexual desire, relationship issues, stressors genital pain and shape lifestyle factors( smoking etc) comorbid conditions pelvic surgery medications psychiatric illness
what should physical exam include
genital anatomy and related abnormalities, endocrine signs, comorbidities,
What tests should be performed in patients with ED?
fasting glucose, lipid profile, select cases also a hormone profile
Who should you test for lowT? what test>
Men with ED and hypoactive desire, delayed ejaculation, reduction of ejaculate volume, incomplete response to PDE5 inhibitors, known diabetes ‘check morning total and bioavailable testosterone
In men with diabetes physician should
FU annual review of sexual function and check testosterone levels
How is nocturnal penile tumescence and rigidity testing done?
at least 2 nights, measuring 2 to 5 overnight erections. A functional erectile mechanism is indicated by an erectile event of 60% rigidity recorded on the tip of the penis lasting for 10 minutes Not available in Canada, greatest utility is for medicolegal reasons etc
In duplex US of the penis what is normal peak systolic flow and resistance index?
peak systolic flow>30cm/second and RI>0.8
Who should have cavernosography?
If US is abnormal and patient is a candidate for vascular reconstructive surgery
What is penile arteriography good for?
For cases of high flow priapism or planned vascular bypass
what is an acceptable substitute for measured bioavailable testosterone
calculated one based on morning total T, SHBG, albumin
what can you measure in neuro-physiological testing?
Sacral Reflex Arc- limited utility
Compare and contrast the properties/ SE of Sidenafil, Tadalafil and Verdanafil?
