ED

Question 1

Define ED

Answer 1

1. Male’s inability to attain or maintain penile erection sufficient to complete intercourse
2. Transient periods of impotence are not considered dysfunction

Question 2

When does frequency of ed increase?

Answer 2

Affects men of all ages but frequency increases with age

Question 3

What are the psychologic causes of ed?

Answer 3

1. Performance anxiety
2. Stress
3. Depression

Question 4

What are the physiologic causes of ed?

Answer 4

1. Vascular – atherosclerosis
2. Neurologic – DM
3. Complications of surgery (prostate)
4. Hormonal disorders
   - Liver Dz-↑ estrogen
5. Structural disorders (Peyronie’s disease)
   - Fibrous cavernous sheath-contracture of fascia-pain
   - Causes a bend in the penis with erection
   - Difficulty having an erection
6. Spinal cord trauma

Question 5

What does the release of nitric oxide initiate?

Answer 5

1. Smooth muscle relaxation in penis
2. Blood rushes into erectile tissue
3. Normal phys

Question 6

What is the pathophys of ed?

Answer 6

1. Neurologic dysfunction and vascular disease results in lack of autonomic signal and interferes with vasodilation
2. Blood is shunted around sacs of corpus cavernosum into veins
   - Prevents sacs from filling properly
3. Perfusion of corpus cavernosum also compromised because of partial obstruction of small arteries
4. Anxiety or fear can prevent brain signals from reaching level required to induce erection
5. Medical conditions can block erection arteries or cause scarring of spongy erection tissue
   - Prevents proper blood flow or trapping of blood

Question 7

What are risk factors for ED?

Answer 7

Drug and alcohol use
Smoking
Anxiety / Depression
Diabetes mellitus
Vascular Disease:
-CAD, HTN, dyslipidemia, atherosclerosis
Neurologic disease
Pelvic trauma
Surgery
Irradiation
Medications
-Beta blockers
-Antidepressants
-Opioids

Question 8

What are morning erections indicative of?

Answer 8

Psychogenic cause of ED

Question 9

What are the physical exam findings with ED?

Answer 9

1. Flat vs normal affect
2. Genital anomalies
3. Hypogonadism
4. Neurologic exam
   -Decreased sensation
   -Decreased motor strength
   -Poor rectal tone:
   Autonomic dysfunction
5. Vascular abnormalities
   -Diminished peripheral pulses

Question 10

What are the DS for ED?

Answer 10

1. Testosterone level
Low-low normal (primary vs secondary cause)
Check: FSH
              LH 
2. FBS (fasting blood sugar?)
3. Lipid profile 
4. Prolactin level
5. TSH/FT4:
Rule out metabolic abnormalities

Question 11

what are the oral medical treatment for physiologic causes of ed?

Answer 11

1. Oral phosphodiesterase inhibitors (PDEI)
   A. sildenafil (Viagra)
   B. tadalafil (Cialis) (used for ED and BPH)
   C. vardenafil(Levitra)
   -Increase nitrous oxide
   -Inhibits type 5 phosphodiesterase  vasodilation in corpus cavernosum
   -Sustain blood flow into penis

D. Testosterone supplementation for hypogonadal men (without prostate cancer)

Question 12

What are the injectable trs for the physiologic causes of ED?

Answer 12

1. Prostaglandin injections into penis
   A. Alprostadil (Caverject, Edex)
   -Relaxes arterial smooth muscle→ vasodilation
   -Intra-cavernosal injection, self administered
   -80-90% effective
   -Combination with PDE
   -Muse (intra-urethral tab)

Question 13

What are the device tx. for physiologic causes of ED?

Answer 13

1. Vacuum Erection Device
   A. Creates vacuum chamber around penis  blood is drawn into corpus cavernosum
   B. Once adequate erection achieved, an elastic band is placed around penile shaft to prevent loss of blood and vacuum cylinder is removed

Question 14

What are the prostatic tr of physiologic causes of ED?

Answer 14

1. Penile prosthesis
   A. Prosthetic device is implanted into paired corporal bodies
   B. Can be semi-rigid or inflatable

Question 15

What is a contraindication for phosphodiesterase?

Answer 15

Nitroglycerin (nitrates)