Erectile Dysfunction Flashcards
What are questions you want to ask for ED history?
when did it start, rigidity, attaining or maintaining erection, situation - with partner or with masturbation, degree of bother, any curvature, night and morning erections, prior treatments, worsening?
What physical exam for ED?
check pulses, resting BP, overall health - obesity, sedentary. gynecomastia, genital exam - lesions, penile plaques, flaccid stretched penile length, testicle size, DRE (for BCR - to check neural integrity - absence is NOT consider diagnostic)
What lab tests?
None are absolutely indicated, but strong consideration for testosterone (morning), HgbA1c, and lipid test
What else needs to be incorporated into history taking?
The psychosocial - as will need to incorporate a sex therapist or psychiatrist
What questionnaires?
SHIM (low score, below 7 is severe) or IIEF or EHS
satisfaction, hard enough for penetration, how often hard enough for penetration, difficulty in maintaining, confidence,
Go over cardiac risk stratification for ED
Low - revascularized or no issues moving around - can go forward with treatment
Intermediate - > 2 week MI to 8 weeks, had MI without revasc, has atherosclerosis signs - stress test, then restratify
High - very recent MI, high risk arrhythmia or defibrillator that activates often, poor fib - referral to cardiologist
What are specialized testing available?
Nocturnal Penile Tumescence
ICI with PDUS
Biosthemiometry
selective internal pudendal arteriography
On PDUS, what are the numbers you are looking for
PSV < 30 = arterial
EDV > 5 = venous leak
Again, what should be included for every male with ED as part of tx plan.
Sex therapy
What is first line of treatment for ED?
Lifestyle and behavioral changes.
Diet, exercise, weight loss, sleep, avoid bad habits (smoking, alcohol)
What are contraindications for PDE5i?
Nitrates
Also consideration of meds that are CYP3A4 - HIV, anti-HTN meds
pts with severe liver disease - contraindicated
What are side effects of PDE5i?
Headache, flushing, heart palpitations, myalgias, visual disturbances, nasal congestion, dizziness, back pain, dyspepsia
Very small potential for NAION
daily dosing does seem to have lower AE (not good data that more dosing = better efficacy)
How does testosterone help?
Data has shown that it augments PDE5i use, but doesn’t help as monotherapy
what are ae of muse?
pain, dysuria, urethral trauma
even though rare, still have to counsel on priapism
what are four meds used in ICI?
alprastodil, papaverine, phentolamine, atropine
Which one causes most pain with injection?
papaverine
What are AE for penile prosthesis?
penile edema, hematoma, pain, urethral injury, corporal injury, change in penile shape, urinary retention, infection, erosion, mechanical failureha
what are some AE for penile revascularization?
glans hyperemia, anastomosis occlusion, penile numbness, infection, penile shortening, hematoma
