Erectile dysfunction

Question 1

What are the common risk factors that should be asked about during the workup of ED

Answer 1

Common risk factors for ED include vascular disease, tobacco use, neurologic disease, endocrinopathies, medication-related side effects, and psychosocial issues.

Question 2

What should the physical exam focus on during the workup of ED?

Answer 2

Blood pressure
BMI
Secondary sex characteristics
Genital exam.

Question 3

What are the validated questionaires for ED?

Answer 3

Erection hardness score (EHS)
Sexual health inventory for Men (SHIM)
International index of erectile function (IIEF)
Male sexual health questionaire.

Question 4

What should every physician counsel patients on when managing their ED?

Answer 4

Association with CVD. 25% increased risk of CVD when someone has ED.

Question 5

What is the definition of testosterone deficiency?

Answer 5

Testosterone <300ng/dl

with signs and symptoms

Question 6

What is the recommended lab testing for men with ED according to AUA guidelines?

Answer 6

Morning testosterone.

At least two morning testosterone values if abnormal for confirmation.

Question 7

What are the indications for specialized evaluations for ED?

Answer 7

1 Young
2 Family history of CVD
3 Pelvic trauma
4 Failure of previous ED therapies
5 Liklihood of psychogenic etiology
6 Lifelong ED
7 Peyronies disease

Question 8

How can psychogenic ED be differentiated?

Answer 8

Nocturnal penile tumescence and rigidity testing.

Question 9

How can penile vascular function be evaluated?

Answer 9

In office ICI or penile duplex ultrasound (gold standard)

Question 10

How is penile duplex ultrasound interpreted?

Answer 10

PSV < 30 indicates arterial insufficiency

EDV > 5cm/s indicates veno-occlusive dysfunction.

Resistive index (PSV-EDV/PSV) <0.80 is normal veno occlusive function

Question 11

What 2nd/3rd line diagnostics for vascular function are available?

Answer 11

Cavernosometry

Question 12

How is cavernosometry interpreted?

Answer 12

Intracorporeal pressure of >60mmHg
Pressure to maintain errection <35ml/min
<45mmHg/30sec pressure decay
brachial artery inflow gradient <30mmHg

Question 13

What should be offered along with any treatment for ED?

Answer 13

Mental health referral

Question 14

What should be the first management recommendation for ED per the AUA guidelines?

Answer 14

Behavioral modification such as diet or exercise for reversible comorbidities.

Question 15

What is the first line treatment for ED per the AUA guidelines?

Answer 15

Phosphodiesterase inhibitors

Question 16

What is the MOA for PDE5i?

Answer 16

PDE5i inhibit the phosphodiesterase type 5 enzyme from breaking down cyclic guanasine monophosphate (cGMP). This inhibition results in an increase in the concentration of penile cavernosal cGMP that then causes smooth muscle relaxation in the corpus cavernosum vasculature resulting in increased erection hardness and duration

Question 17

What are the contraindications to PDE5i use?

Answer 17

1. Nitrate containing medications.
2. Hepatic impairment (use with caution)
3. Renal impairment (use with caution)