ED and BPH Flashcards
Erectile dysfunction
Found in 10-25% of middle-aged and elderly men. Classified as failure to initiate (psychological, endocrinologic, neurologic), failure to fill (arteriogenic) or failure to store (veno-occlusive dysfunction).
Risk factors include:
1) DM
2) Atherosclerosis
3) Meds (B blockers, SSRIs, TCAs, diuretics)
4) HTN
5) Heart disease
6) Surgery or radiation for prostate cancer
7) Spinal cord injury
History and exam for ED
1) Ask about risk factors (diabetes, peripheral vascular disease), med use, recent life changes, and psych stressors
2) Distinction btw psych and organic ED is based on the presence of nocturnal or early-morning erections (if present, it is nonorganic) and on situation dependence (occurring with only 1 partner)
3) Evaluate for neurologic dysfunction (anal tone, lower extremity sensation) and for hypogonadism (small testes, loss of secondary sex characteristics)
Dx of ED
1) Testosterone and gonadotropin levels may be abnormal
2) Check prolactin levels, as elevated prolactin can cause decreased androgen activity
Tx for ED
1) Patients with psych ED may benefit from psychotherapy involving discussion and exercises with the partner
2) Oral sildenafil, vardenafil and tadalafil are phosphodiesterase 5 inhibitors that result in prolonged action of cGMP mediated smooth muscle relaxation and increased blood flow in the corpora cavernosa
3) Testosterone is a useful therapy for patients with hypogonadism of testicular or pituitary origin. It is discouraged for patients with normal testosterone levels.
4) Vacuum pumps, intracavernosal prostaglandin injections and surgical implantation of semirigid or inflatable penile prostheses are alternatives for patients who fail PDE5 therapy
Nitrates are a contraindication to sildenafil. Combined effect of low BP can lead to myocardial ischemia.
BPH
Enlargement of the prostate that is a normal part of the aging process and is seen in over 80% of men by age 80. Most commonly presents in men over 50.
BPH can result in urinary retention, recurrent UTIs, bladder and renal calculi, hydro, and kidney damage over time
History and exam for BPH
1) Obstructive symptoms: hesitancy, weak stream, intermittent stream, incomplete emptying, urinary retention, bladder fullness
2) Irritative symptoms: Nocturia, daytime frequency, urge incontinence, opening hematuria
3) On DRE, prostate is uniformly enlarged with rubbery texture. If prostate is hard or has irregular lesions, cancer should be suspected.
Dx of BPH
1) DRE to screen for masses. If findings are suspicious, evaluate for prostate cancer
2) Obtain UA and UCx to rule out infection and hematuria
3) Measure creatinine levels to rule out obstructive uropathy and renal insufficiency
4) PSA testing and cystoscopy are not recommended for longitudinal BPH monitoring
**BPH most commonly occurs in central (periurethral) zone of the prostate and may not be detected on DRE.
Tx for BPH
1) Medical: Alpha blockers (terazosin) relax muscle in prostate and bladder neck, as well as 5alpha reductase inhibitors (finasteride), which inhibit the production of dihydrotestosterone.
2) TURP or open prostatectomy is appropriate for patients with moderate to severe symptoms
