Erectile Dysfunction and BPH Flashcards
What happens during an erection
- increased arterial flow
- relaxation of smooth musculature in both corpora cavernosa
- increased venous resistance
What are some of the causes of erectile dysfunction
- arterial obstruction
- venous leak
- neurogenic (CVA, MS, parkinsons)
- hormonal
- drug induced (opoids, anti HTN)
- psychogenic
- peyronies disease
What is the relationship between ED and CAD
erectile dysfunction may be an early sign of CAD or just precedes its development
What is peyronie’s disease
penile deformity or curvature caused by fibrosis
What causes peyronie’s disease
subtle trauma to penis and subsequent scarring
What tool is used to grade ED
SHIM-5
lower the number worse the ED
Labs for ED
- CBC
- fasting glucose or A1C
- CMP
- TSH
- lipid profile
- testosterone
Studies for diagnosing ED
- nocturnal penile tumescence testing
- duplex doppler imaging or angiography
What is a nocturnal penile tumescence test?
at home test that detects number, temescence, rigidity during sleep
What does a normal NPT tell you? Abnormal?
normal: psychogenic or hormonal cause
abnormal: vascular or neurogenic cause
What is the first line therapy for ED treatment
PDE-5 inhibitors
sildenafil, vardenafil, tadalafil, avanafil
How does a vacuum- assisted erection device work
the vacuum pressure increases arterial inflow with use of occlusive rings restricting egress of venous blood
What is the downfall of a vacuum- assisted erection device
the occlusive ring may prevent ejaculation d/t pressure on urethra
Injection of what into the penis can treat ED
prostaglandin- E1
What are the surgical options for the treatment of ED
- penile prostheses
- penile revacularization
When is penile revascularization done
in young, non smoking and otherwise healthy men with a recent focal arterial occlusion
What is priapism
prolonged erection unresolved by ejaculation
What are the complications of priapism
ischemia–>corporal fibrosis and necrosis
What causes priapism
- drugs (anti HTN, anti coag, psych, hormones)
- RBC dyscrasia
- spinal cord injury
- ED tx
- malignancy
- cocaine
Treatment of priapism
- intracavernosal phenylephrine injection
- aspiration of blood, saline irrigation, alpha adrenergic agonist if needed
- surgical intervention
What is BPH
cellular proliferation of the prostate at the central transition zone
What does BPH cause
if untreated
- urinary retention
- recurrent UTI
- hydronephrosis
- renal failure
How does a patient with BPH present
- storage/irritative LUT sx (urgency, frequency, nocturia, incontinence)
- obstructive LUT sx
What tool assesses the severity of sx’s of BPH
american urologic association’s symptoms score
Physical exam to diagnose BPH
- DRE
- abdominal exam
- neurologic exam and rectal sphincter tone
- gential exam
Labs/imaging for BPH
- urinalysis
- SCr
- PSA
- upper tract imaging (U/S or CT)
Other tests that might be helpful but aren’t necessary for diagnosis of BPH
- maximal urinary flow rate
- post void residual volume
- urine cytology
- cystoscopy
How to treat BPH if it is uncomplicated? (IPSS <8, no BOO, renal insufficiency, recurrent infection)
behavioral modifications
- pee sitting down
- reduce caffeine, alcohol
- avoid fluids before bed
- double void
- avoid rxs that cause retention
Treatment of mild to moderate BPH (IPSS <20 w/o refractory retention or BPH induced kidney disease, bladder calculi, gross hematuria)
alpha 1a blockers
terazosin, doxazosin, tamulosin, alfuzosin, silodosin
What is the second line tx to alpha blockers
5-alpha-reductase inhibitors
finasteride, dutasteride
HOw do 5-alpha-reductase-inhibitors work
blocks conversion of testosterone to dihydrotestosterone–> reduction in size of prostate
Which patietns benefit most from 5-alpha-reductase-inhibitors
men with large prostates
>40 ml
How do you treat severe BPH (IPSS>20, poor response to monotherapy, prostate >40)
alpha blocker and 5-alpha reductase
What is phytotherapy
use of plants or plant extracts for medical purposes
What things are used for phytotherapy in BPH
- saw palmetto berry
- beta sitosterol
- cernilton
- pygeum africanum
What minimally invasive surgical techniques are there for BPH treatment
- laser
- microwave hyperthermia or electrovaporization
- radiofrequencies
What are the conventional BPH surgical therapy options
- transurethral resection prostatectomy (TURP)
- transurethral incision of prostate (TUIP)
- open simple prostatectomy
