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Clin Med III > ED and BPH > Flashcards

ED and BPH Flashcards

1
Q

erectile dysfunction

A
  • inability to attain or maintain sufficiently rigid penis for sexual performance
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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
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3
Q

etiology of ED

A
  • vascular
  • neurogenic
  • hormonal
  • drug induced
  • psychogenic
  • local penis factors: peyronie’s disease, surgery, XRT, pelvic trauma
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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
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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
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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
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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
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8
Q

diagnostic studies for ED

A
  • A1C
  • TSH
  • lipid profile
  • testosterone
  • CBC
  • nocturnal penile tumescence testing (NPT test)
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9
Q

results of nocturnal penile tumescence testing

A
  • normal- psychogenic or hormonal cause of ED

- impaired- vascular or neurogenic cause of ED

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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
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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
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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)
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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
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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
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15
Q

surgical options for ED

A
  • penile prosthesis if failed pharm and vacuum device

- penile revascularization- only if young, nonsmoker, otherwise healthy

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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
Q

dx of BPH

A
  • r/o other pathology
  • UA, SCr, PSA
  • upper tract imaging with US or CT
26
Q

optional testing for BPH dx

A
  • max urinary flow rate- done by urology
  • post void residual volume
  • cystoscopy- not routinely recommended
27
Q

when do you need to refer to urology before tx for BPH

A
  • 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
Q

treatment options for BPH

A
  • watchful waiting
  • behavioral modifications
  • pharm tx
  • minimally invasive therapy
  • conventional surgery
29
Q

what behavioral modifications can be used for BPH

A
  • urinate in seated position
  • reduce diuretics
    avoid fluids before bed and going out
  • double void
  • avoid meds that cause urinary retention or diuretics
30
Q

pharm treatment for BPH

A
  • 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
Q

anticholinergics for BPH

A
  • used predominantly for OAB
  • no elevated post void residuals
  • ADRs- dry mouth, drowsiness, decreased cognitive fn, constipation
32
Q

minimally invasive therapy for BPH

A
  • laser therapy
  • microwave hyperthermia or electrovaporization
  • radiofrequencies
  • TURP*
  • TUIP (transurethral incision of prostate)
33
Q

transurethral resection prostatectomy (TURP)

A
  • conventional tx for BPH

- improves sx and flow rate

34
Q

complications of TURP

A
  • retrograde ejaculation
  • ED
  • urinary incontinence
  • bleeding
  • urethral stricture
  • prostate capsule perf
  • transurethral resection syndrome

Clin Med III (26 decks)

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