Erectile Dysfunction

Question 1

Workup of ED

Answer 1

Thorough history
Physical Exam
SHIM
Selected labs (particularly morning T, maybe A1c)
Counsel about CV risk factors

Question 2

SHIM interpretation

Answer 2

22+ no ED
17-21 mild
12-16 mild-to-moderate ED
8-11 moderate ED
5-7 severe ED (5 looks like S)

Question 3

IIEF interpretation

Answer 3

26+normal
18-25 mild ED
11-17 moderate ED
<10 severe ED

Question 4

Does ED increase risk of CVD?

Answer 4

Yes - 25% extra risk

Question 5

Indications for penile doppler

Answer 5

Organic vs non-organic
Assess arterial function
Assess for venous leak unlikely to respond to most treatments
Young men

Question 6

PSV cutoff for penile doppler

Answer 6

30

Question 7

PDE5i side effects

Answer 7

dyspepsia, headache, flushing, back pain, visual change, dizziness

Question 8

Initial counseling for ED

Answer 8

Offer sex therapy
Discuss CVD risk
Counsel on lifestyle changes

Question 9

PDE5i contraindications

Answer 9

Nitrates

Question 10

NAION rate

Answer 10

3 in 100,000, correlation is not causation

Question 11

PDE5i counseling

Answer 11

stimulation still needed
More than one trial needed

Question 12

VED risks and benefits

Answer 12

Should use a device with a limiter
80% satisfied
Bruising
Loss of sensitivity

Question 13

Risks and benefits of ICI

Answer 13

Only alprostafil is approved for ICI
Trimix - 30 papaverine + 1 phentolamine + 20 alprostadil
Peyronie’s
Priapism
Pain
In office test

Question 14

Papaverine

Answer 14

arterial vasodilator

Question 15

phentolamine

Answer 15

beta antagonist

Question 16

alprostadil

Answer 16

prostaglandin