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Andrology > Erectile Dysfunction > Flashcards

Erectile Dysfunction Flashcards

1
Q

Sildenafil side effects 9

A 
Headache
Nasal congestion
Dyspepsia
Flushing
Rash
Headache
Flushing
Dyspepsia
Abnormal vision
Nasal congestion
Back pain
Myalgia
Dizziness/nausea
Rash

Epistaxis
Insomnia
Erythema
Diarrhea

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2
Q

When to treat low testosterone

A

treat when T less than 8nmol/L and with symptoms
recheck when less than 12 nmol/L
normal range 10-30 nmol/L

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3
Q

SHIM
score no ED, severe ED
total score
5 questions

A

out of 25
22-25 no ED
1-7 severe ED
12-16 mild to mod ED
5 questions
in last 6 months
how would you rate your confidence that you could get and keep an erection
how often hard enough penetration
how often maintain ereciton after penetration
how difficult maintain until completion intercourse
how often satisfied with sexual intercourse

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4
Q

action of NO and cGMP

A

cavernosal nerve
releases NO from endothelium
SM relaxation, dilates arterioles
initiates erection

NO stimulates production cGMP 
this activates protein kinase G
opens K channels, closes Ca channels
low intracellular ca
causes SM relaxation
SM contracts when cGMP degraded by PDE
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5
Q

how to take IC injection
max dose
time between doses
caverjet alprostadil starting dose

A 
max 3 times a week
24 hours between doses caverjet
starting dose 2.5mcg
usual dose 5-20 mcg
max dose 60mcg
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6
Q

cream alprostadil

A

cream vitaros

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7
Q

pellet alprostadil

A

MUSE

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8
Q

response rate to PDE5i after RARP

A

35-75% after nerve sparing

0-15% after non nerve sparing

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9
Q

how to take sildenafil

A 
most efficacious 50mg
1 hour before sexual activity
no heavy meals
onset 30 mins to 1 hour
half life 3 hours
lasts up to 12 hours in blood stream
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10
Q

tadalafil

A 
most well tolerated
5mg dose, other doses 10mg, 20mg
30 mins before sex
peak 30 mins
c max 2 hours
t1/2 17.5 hours
lasts up to 36 hours
NOt affected by food
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11
Q

vardenafil

A 
10mg initial dose
5mg dose if on alpha blocker, up to max 20mg
usual dose 10mg
25-60 mins before sex
effective 30 mins
half life 4 hours
affected by food, avoid fatty meal
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12
Q

action of alprostadil

A

Vasodilatation by increasing levels of cAMP

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13
Q

side effects of alprostadil

A

penile pain
long erections 5%
priapism 1%
fibrosis 2%

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14
Q 
assessment ED
history 
nature
sexual
PMH
Drug
Other
A 
nature of complaint
PE? ejaculatory?
which context?
morning and nightime rigidity
curvature

chronology
primary / secondary
gradual or suddent onset

sexual relationship, frequency, who is partner

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15
Q

causes of ED groups

A 
arteriogenic
neurogenic
penile
hormonal
drugs
other
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16
Q

arteriogenic causes

A 
htn
pvd
metabolic syndrome
smoking
pelvic dxr
diabetes
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17
Q

neurogenic causes

A 
MS
SCI
peripheral neuropathy
pelvic surgery
stroke
cauda equina
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18
Q

hormonal

A

hypogondism
prolactin, pit tumour
hypopit
hypo or hyperthyroid

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19
Q

mixed causes

A

renal or liver disease

OSA

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20
Q

drugs causes

A 
anti hypertensives
anti depressants
anti psychotics
anti androgens
recreational
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21
Q

which antihypertensives cause more ED

which improves ED

A

beta blockers
thiazide

ARB may improve
alpha blocker may improve

ca channel no great effect
ACE i neutral

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22
Q

mechanism of erection

A 
3 things
caernosal nerve
NO stimulates guanylyl cyclase in SM cell, which converts GTP to cGMP
which stimulates protein kinase G
stimulates K channel and inhibits Ca channel
decreases IC calcium stop Ca coming in
increases K going out
SM relaxation
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23
Q

EAU focused examination -4

A

penile deformities
prostatic disease
signs of hypogonadism
cardiovascular and neurological status

24
Q

EAU investigation

A

testosterone early morning
lipid
blood glucose
if above 2 not done in last 6 months

25
Q

definition diabetes

A

if fasting blood glucose 7 or more

or HBA1C more than 6.5%

26
Q

lipid profile

A

total cholesterol more than 4

LDL cholesterol more than 2 mmol/L

27
Q

hypertension definition

A

BP more than 140/80

28
Q

low testosterone what to do if under 12

A 
repeat total T
measure albumin nad SHBG
calculate free T
LH and FSH
PSA
lipids
FBC, LFT
29
Q

free T treatment threshold

A

0.225 nmol/l

30
Q

if total T less than 8 extra tests

A 
check LH and FSH
check prolactin
check PSA
FBC
LFT
Lipids
31
Q

symptoms of prolactinoma

A

ED
gynaecomastia
galactorrhoea

32
Q

colour doppler result

A

PSV peak systolic velocity should be more than 30 cm /sec

33
Q

initial management ED

A

EAU
identify and treat curable causes
lifestyle changes and risk factor modifications
provide education to patient and partner

BP tablets
lose weight
lipid and BP management
education

34
Q

efficacy of PDE5i

A

generally 2/3 will respond

avanafil not as effective

35
Q 
frequency of 
headache
flushing
indigestion
stuffy nose
blue vision
backache
A 
headache 10-20%
flushing 10-20%
indigestion 5-10%
stuffy nose 3-5%
blue vision sildenafil rare
backahe tadalafil 5%
36
Q

cmax and half life of sildenafil vs tadalafil

A

sildenafil
cmax 1.6 hours, half life 4 hours
tadalafil
cmax is 2 hours, half life 17.5 hours

37
Q

action of CYP34A and PDE5i

A

inhibitors increase levels of PDE5i
ketoconazole, protease ihibitors
inducers decrease levels of PDE5i
rifampicin, phenytoin, carbamazepine

38
Q

contradindication PDE5i

A 
taking nitrates
hereditary retinal degeneration
non arterior ION
avoid if SBP <90
recent unstable angina
39
Q

cautions sildenafil

A 
peptic ulcer
autonomic dysfunction
bleeding
anatomical deformity
priapism risk
SCD
multiple myeloma
leukaemia
40
Q

cons of injection therapy

A 
expensive
lack sponaneity
pain, fibrosis, priapism
high drop out
invasive
41
Q

CI to injection

A

priapism risk
SCD

can use in PD but not in original trial
can use with anticoagulation but not in licence

42
Q

size of needle with IC injection

A

28G needle

43
Q

side effects alprostadil

A

1/3 will get burning pain in penis
1% priapism
2% fibrosis risk

44
Q

golden rules of alprostadil

A

read information
4 hour rule
max 3 times a week - risk fibrosis
as small a dose as possible

45
Q

instructions MUSE

A 
pass urine
put pellet in urethra
massage
walk around 
constriction ring
46
Q

response to MUSE

A

30-50% in those not tried tablets before

47
Q

side effects MUSE

A

pain 3%
urethral bleeding rare
can get syncope which is not effect of injections

48
Q

dose of MUSE

A

1000mcg

larger dose vs injection 20 mcg

49
Q

cons of vacuum device

A 
erection only to ring
blue appearance, cool
quality of erection
pivoting
discolouration
bruising
blocks ejaculation
needs manual dexterity
50
Q

names of penile prosthesis
malleable
2 piece
3 piece

A 
malleable tactra from Boston
2 piece AMS Ambicor
3 piece
AMS 700 Boston
Coloplast Titan
51
Q

malleable
pros 4
cons 3

A 
pros
easy insertion
easy use
low mechanical failure
moudable

cons
always rigid
lower rigidity
maybe higher erosion rate

52
Q

IPP
pros 3
cons 3

A

best rigidity
increase girth and maybe length
best flaccidity

cons
mechanical failure
hard to insert
manual dexterity

53
Q

couselling for IPP

A 
see with partner
see twice
last resort
irreversible
expectations of erection
GIRTH good, increased
LENGTH - not as same as normal erection, will only be as long as SPL
RIGIDITY - good but no engorgement
SENSATION and ejaculation normal
GLANS - none
54
Q

risks IPP

A

perioperative
injury organs structures 1/50 to 1/250
coroporal rupture

early
haematoma
infection 1-3 % in virgin case
revision complex 6-10%
pain - within 4-6 weeks may be subclinical infection
wrong size - concord deformity 2-10%
late
mechanical failure within 10 years can result in uncontrolled self inflation 5%
lasts 10-15 years
erosion <5%
auto inflation
55
Q

virgin IPP vs complex IPP infection rate

A

1-2% vs 6-10%

complex meaning revision or fibrosis or priapism

Andrology (6 decks)

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