ED Flashcards
What is definition of ED?
Inability to attain or maintain an erection sufficient for sexual performance
What are RF for ED?
Same as for CVD
Smoking
Age
Obesity
Sedentary
Dyslipidaemia
However ED itself is independently associated with CVD and especially in young a predictor of Future CV event
What sorts of treatments are widely available for ED?
Oral
Intracavernosal
Intra urethral
Limited role for surgery in end stage disease
Primary care/mens health well placed to offer the standard treatments and address CV/mental health aspects
How is erection achieved?
Complex neuro vascular phenomenon under hormonal control
Arterial dilation
Trabecular smooth muscle relaxation
Activation corporal veno occlusive system
What is first line treatment? How does it work?
Oral therapy with PDE5i
Increase blood flow
Causes smooth muscle relaxation, vasodilation, erection
What are major differences between pde5is?
Sildenafil/vardenafil/avanafil
4hrs half life
Tadalafil
half life 17.5 hours
Least interaction with food
Reported side effects rates vary include flushing headache but no head to head studies comparing the drugs
No interaction etoh
Do pde5i always work?
No 25-50% within 12 mths
Lower in t2dm and prostatectomy
Non responders classified as no response on 8 occasions with sexual stimulation and highest dose
When are pde5i contraindicated?
Nitrates
Poppers
Nicorandil (angina)
Guanyl Cyclase stimulators (riociguat-pulmonary hypertension drug)
May cause catastrophic hypotension if combined-absolute contraindication
Will low testosterone affect response to pde5i?
Yes-so test and treat for it
T regulates expression of pde5 in corpus cavernosum
Do pde5i cause CV risk?
Not in themselves
May improve cv RF
Who needs nitrates?
Few people
3rd line treatment angina and unlike beta blocker or ca blocker no prognostic benefit
Often not used so may be able to stop so can access pde5i
How do VED work?
Cylinder over penis
Air pumped out
Resulting tumescence maintained by construction ring base penis
Can be very effective and induce erection regardless aetiology
Most effective pharmacological rx?
Intracavernous injection eg alprostadil
(2nd line)
Erection after 5-15mins lasting 30-40mins
Many discontinue despite high efficacy
Can cause post injection pain
Does alprostadil require sexual stimulation?
No
What is priapism? Why matters? How to manage?
> 4 hrs
Tissue necrosis and permanent ED
Try
1. Light exercise
2. Aspiration of blood
3. Adrenaline
