Erectile Dysfunction

Question 1

Nervous control of erection and ejaculation

Answer 1

point and shoot:

• parasympathetic-S2,3,4>erection
• sympathetic-T11-L2>ejaculation

Question 2

Causes of erectile dysfunction (11)

Answer 2

caused by endothelial dysfunction:

• DM
• obesity
• HTN
• dyslipidaemia
• atherosclerosis
• hypogonadism
• insulin resistance
• metabolic syndrome
• trauma/surgery
• peyronie’s: fibrous plaques in tunica albuguinea, 30% have fibrosis at other sites e.g. dupuytren’s. Rx w. Nesbit procedure
• drugs: BB, TCAs, SSRIs, statins, anti-histamines, benzos, oestrogens, parkinson’s meds, finasteride

Question 3

Associations of erectile dysfunction (10)

Answer 3

main:

• HTN
• ischaemic heart disease: ED can be early indicator
• DM: 50% go on to develop it

others:

• neurological causes
• smoking
• dyslipidaemia
• hypogonadism
• LUTS
• severe distress
• obesity

Question 4

Hx questions for ED (5)

Answer 4

duration of onset

previous surgery/trauma/RT

do they get morning erections?

HTN/DM/cardiovascular RFs

DHx

Question 5

Examination for erectile dysfunction (5)

Answer 5

look for Peryonie’s

neuro exam

examine testes

DRE to assess prostate

bulbospongiousus reflex:

• squeeze glans
• look for contraction of anal sphincter and bulbospongiosus
• indicates intact S2/3/4

Question 6

Ix for erectile dysfunction (6)

Answer 6

fasting blood sugar

fasting lipid profile

hormones:

• testosterone
• SHBG
• cFT:circulating free testosterone
• BAT: bioavailable testosterone

LH, FSH, Prolactin

Thyroid profile

PSA

Question 7

Medical Mx of ED (3)

Answer 7

PDE5-i:

• sildenafil: viagra
• tadalafil
• vardenafil

Question 8

SEs of PDE5-i (5)

Answer 8

priapism

blue discoloration of vision

headaches

flushes

heart burn

Question 9

CI of PDE5-i

Answer 9

GTN and nicorandil: vasodilators

Question 10

2nd line Mx of ED and SEs (3)

Answer 10

cavaject-PGE1 injection into side of penis before requiring erection

may cause dizziness

greater risk of priapism

Question 11

3rd line Mx of ED and SEs (2)

Answer 11

intraurethral aloprostadil-dissolved prostaglandin tablet inserted into urethra

greater risk of priapism

Question 12

4th line Mx of ED

Answer 12

vaccum device:

-tube w. plunger, puts ring at base of penis

Question 13

5th line Mx of ED

Answer 13

inflatable tube w. small pump in scrotum. needs replacing every 10-12yrs