ED and BPH Flashcards
1
Q
erectile dysfunction
A
- inability to attain or maintain sufficiently rigid penis for sexual performance
2
Q
process of normal erection
A
- increased arterial flow
- relaxation of SM in corpora cavernosa
- increased venous resistance
- muscle contraction -> increased penis rigidity > SBP
3
Q
etiology of ED
A
- vascular
- neurogenic
- hormonal
- drug induced
- psychogenic
- local penis factors: peyronie’s disease, surgery, XRT, pelvic trauma
4
Q
what is peyronie’s disease
A
- penile deformity or curvature of varying degree
- fibrotic disorder
- etiology from subtle trauma to penis and subsequent scarring
5
Q
ED and CAD
A
- may be early sign of CAD
- dev from same pathophys and share many RF
- endothelial dysfn from decreased NO -> impaired arterial vasodilation
- ED without obvious cause MUST be screened for CAD, esp before pharm tx
6
Q
components of hx for ED
A
- sexual hx- libido, desire, function, satisfaction
- assess rapidity of onset
- assess for interpersonal conflict
- consider partner interview
- what is erectile reserve- spontaneous erections during sleep or in AM
- consider RF- smoking, etoh, drug use
7
Q
PE for ED assessment
A
- vitals, obesity
- assess secondary sex chara
- assess genitalia, cremasteric reflex, penile plaques
- PVD assessment and CV exam
- visual defects? possible pituitary tumor
8
Q
diagnostic studies for ED
A
- A1C
- TSH
- lipid profile
- testosterone
- CBC
- nocturnal penile tumescence testing (NPT test)
9
Q
results of nocturnal penile tumescence testing
A
- normal- psychogenic or hormonal cause of ED
- impaired- vascular or neurogenic cause of ED
10
Q
treatment for ED
A
- ID and treat CV RF
- want to increase libido and/or improve ability to acquire/sustain erection
- address psych issues
- testosterone replacement- best with PDE5 inhibitors
- medications
- vacuum devices
- penile impalnt
11
Q
medications to treat ED
A
- PDE-5 inhibitors- first line
- 5 alpha reductase inhibitors
- SSRI for psych issues- may worsen sx
- penile self injection/ intraurethral admin of prostaglandin E1
12
Q
PDE-5 inhibitors
A
- first line tx for ED
- NO induced vasodilation
- absolute c/i with nitrates
- relative c/i with alpha adrenergic antagonists
- sildenafil, verdenafil, tadalafil (cialis, dosed daily)
13
Q
vacuum assisted erection devices
A
- vacuum pressure increases arterial inflow, occlusive ring restricts outflow
- occlusive ring may prevent ejaculation
- usu first option as 2nd line tx
- device applied for 20-30 min
14
Q
penile self injection/ transurethral injection
A
- inj of prstaglandin E1 directly into corporus cavernosa
- acts as SM vasodilator
- increased inflow to penis -> engorged penis -> compressed veins
- requires considerable pt edu
- penile pain common ADR
15
Q
surgical options for ED
A
- penile prosthesis if failed pharm and vacuum device
- penile revascularization- only if young, nonsmoker, otherwise healthy
16
Q
priapism
A
- prolonged erection > 4-6 hours unresolved by ejaculation
- urologic emergency
- most commonly due to low flow (blood cannot get out) and is painful
17
Q
etiology of priapism
A
- antiHTN- CCB, hydralazine, prazosin
- anticoags
- psychotropics- SSRI, haldol, trazadone
- hormone tx
- RBC dyscrasia
- SC injury
- any ED tx
- malignancy
- cocaine
18
Q
treatment for priapism
A
- pseudafed
- intracavernosal phenylephrine inj
- aspiration of corpora cavernosa (may need saline)
- diluted solution phenylephrine for irrigation
- surgical intervention
19
Q
BPH
A
- cellular proliferation at central transition zone
- prevalence and sx increase with age in hormonally dep way
- NOT a RF for prostate cancer
20
Q
what can happen if BPH is not treated
A
- urinary retention
- recurrent UTI
- hydronephrosis
- renal failure
21
Q
BPH sx categories
A
- storage/ irritative sx
- obstructive sx
22
Q
storage/ irritative sx assoc with BPH
A
- urgency
- frequency
- nocturia
- incontinence
23
Q
obstructive sx assoc with BPH
A
- hesitancy
- decreased force or caliber of stream
- splitting or spraying of stream
- dribbling post void
- straining to urinate
- unable to completely empty bladder
24
Q
what is the AUA score
A
- assesses severity of sx of BPH
- used before starting therapy
25
dx of BPH
- r/o other pathology
- UA, SCr, PSA
- upper tract imaging with US or CT
26
optional testing for BPH dx
- max urinary flow rate- done by urology
- post void residual volume
- cystoscopy- not routinely recommended
27
when do you need to refer to urology before tx for BPH
- hydronephrosis
- renal insufficeincy
- urinary retention
- recurrent UTI
- sx in setting of autonomic or severe peripheral neuropathy
- following invasive tx for urethra or prostate
- < 45 years old
- abnormal DRE
- hematuria without UTI, incontinence
- severe sx with AUA score > 20
28
treatment options for BPH
- watchful waiting
- behavioral modifications
- pharm tx
- minimally invasive therapy
- conventional surgery
29
what behavioral modifications can be used for BPH
- urinate in seated position
- reduce diuretics
avoid fluids before bed and going out
- double void
- avoid meds that cause urinary retention or diuretics
30
pharm treatment for BPH
- alpha blockers- first line
- 5 alpha reductase inhibitors- second line
- PDE-5 inhibitors
- anticholinergics
- combo of alpha blocker + 5 alpha reductase inhibitors have best response
31
anticholinergics for BPH
- used predominantly for OAB
- no elevated post void residuals
- ADRs- dry mouth, drowsiness, decreased cognitive fn, constipation
32
minimally invasive therapy for BPH
- laser therapy
- microwave hyperthermia or electrovaporization
- radiofrequencies
- TURP*
- TUIP (transurethral incision of prostate)
33
transurethral resection prostatectomy (TURP)
- conventional tx for BPH
| - improves sx and flow rate
34
complications of TURP
- retrograde ejaculation
- ED
- urinary incontinence
- bleeding
- urethral stricture
- prostate capsule perf
- transurethral resection syndrome
