ERECTILE DYSFUNCTION Flashcards
True or False
Normal male erections are a neurovascular event relying on an intact autonomic and somatic nerve supply to the penis, arterial blood flow supplied by the paired cavernosal arteries, and smooth and striated musculature of the corpora cavernosa and pelvic floor
True
Erections are caused and maintained by what?
- increase in arterial blood flow
- relaxation of smooth muscle within the sinusoids of the corpora cavernosa
- increase in venous resistance
What is the key neurotransmitter that initiates and sustains erections?
Nitric oxide
What is the consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance?
ED
ED can have organic and what other etiologies that can frequently overlap?
psychogenic
Organic erectile dysfunction may be an early sign of what?
cardiovascular disease
Loss of libido may be indicative of what?
androgen deficiency
The most common cause of ED is a decrease in arterial flow resultant from what?
progressive vascular disease
Medications such as what are associated with ED?
- Antihypertensive
- Antidepressants
- Opioids
What is a fibrotic disorder of the tunica albuginea of the penis resulting in the varying degrees of penile pain, curvature, or deformity?
Peyroine disease
What is the loss of seminal emission?
anejaculation
Androgen deficiency by decreasing prostate and seminal vesicle secretions may cause what?
anejaculation
Sympathetic denervation as a result of spinal cord injuries, DM, or pelvic or retroperitoneal surgery or radiation may cause what?
anejaculation
True or False
Severity, intermittency, and timing is an important part of the patient history for ED
True
These are all important lifestyle factors in the patient history of patients with what?
- sexual orientation
- relationship quality
- alcohol
- tobacco
- marijuana
- recreational drugs
- use of porn to maintain arousal
ED
History of these listed below are important portions of the medical history in patients with what?
- Meds
- Dyslipidemia
- HTN
- Depression
- Neuro disease
- Pelvic trauma, surgery, irradiation
- Prostate cancer
- Peyronie disease
ED
True or False
The ability to attain but not maintain an erection may be the first sign of endothelial dysfunction and further cardiovascular risk stratification should be considered
True
What are some labs would you run for an ED patient?
- Lipid profile
a. evaluating for dyslipidemia - Glucose
a. evaluating for DM - Testosterone
a. if abnormalities are found
1. Free testosterone (drawn between 8-10am)
2. Luteinizing hormone
What are good lifestyle modifications that can help with ED and reduce cardiovascular risk factors?
- smoking cessation
- reduced alcohol intake
- diet
- exercise
Men with psychogenic component of ED may benefit from what?
sexual health therapy or counseling
Hormonal replacement is managed by who?
Urology
offered to men with hypogonadism
What oral agents can be given to patients with ED?
Phosophodiesterase-5 inhibitors
- Sildenafil (Viagra)
- Vardenadil (Levitra)
- Tadalafil (Cialis)
- Avanafil (Stendra)
What are some alternative treatments for ED?
- Urethral injectable – Prostaglandin E2
- Vacuum erection device
- Penile prosthetic
- Vascular reconstruction
Should you MEDEVAC a patient with a prolonged penile erection greater than 4 hours?
YES
can result in an ischemic injury of the corpora cavernosa from venous congestion and cessation of arterial inflow
True or False
Ischemic priapism is a medical emergency requiring immediate medical or surgical intervention to avoid irreversible penile damage
True
Where should patients with ED with the following be reffered?
- Priapism (MEDEVAC)
- Initial oral therapy initiation
- Inadequate response to meds
- Unable to tolerate side effects
- Peyronie disease or other penile deformity
- History of pelvic or perineal trauma, surgery, or radiation
Urology
