Erectile Dysfunction and BPH

Question 1

What happens during an erection

Answer 1

• increased arterial flow
• relaxation of smooth musculature in both corpora cavernosa
• increased venous resistance

Question 2

What are some of the causes of erectile dysfunction

Answer 2

• arterial obstruction
• venous leak
• neurogenic (CVA, MS, parkinsons)
• hormonal
• drug induced (opoids, anti HTN)
• psychogenic
• peyronies disease

Question 3

What is the relationship between ED and CAD

Answer 3

erectile dysfunction may be an early sign of CAD or just precedes its development

Question 4

What is peyronie’s disease

Answer 4

penile deformity or curvature caused by fibrosis

Question 5

What causes peyronie’s disease

Answer 5

subtle trauma to penis and subsequent scarring

Question 6

What tool is used to grade ED

Answer 6

SHIM-5

lower the number worse the ED

Question 7

Labs for ED

Answer 7

• CBC
• fasting glucose or A1C
• CMP
• TSH
• lipid profile
• testosterone

Question 8

Studies for diagnosing ED

Answer 8

• nocturnal penile tumescence testing

- duplex doppler imaging or angiography

Question 9

What is a nocturnal penile tumescence test?

Answer 9

at home test that detects number, temescence, rigidity during sleep

Question 10

What does a normal NPT tell you? Abnormal?

Answer 10

normal: psychogenic or hormonal cause
abnormal: vascular or neurogenic cause

Question 11

What is the first line therapy for ED treatment

Answer 11

PDE-5 inhibitors

sildenafil, vardenafil, tadalafil, avanafil

Question 12

How does a vacuum- assisted erection device work

Answer 12

the vacuum pressure increases arterial inflow with use of occlusive rings restricting egress of venous blood

Question 13

What is the downfall of a vacuum- assisted erection device

Answer 13

the occlusive ring may prevent ejaculation d/t pressure on urethra

Question 14

Injection of what into the penis can treat ED

Answer 14

prostaglandin- E1

Question 15

What are the surgical options for the treatment of ED

Answer 15

• penile prostheses

- penile revacularization

Question 16

When is penile revascularization done

Answer 16

in young, non smoking and otherwise healthy men with a recent focal arterial occlusion

Question 17

What is priapism

Answer 17

prolonged erection unresolved by ejaculation

Question 18

What are the complications of priapism

Answer 18

ischemia–>corporal fibrosis and necrosis

Question 19

What causes priapism

Answer 19

• drugs (anti HTN, anti coag, psych, hormones)
• RBC dyscrasia
• spinal cord injury
• ED tx
• malignancy
• cocaine

Question 20

Treatment of priapism

Answer 20

• intracavernosal phenylephrine injection
• aspiration of blood, saline irrigation, alpha adrenergic agonist if needed
• surgical intervention

Question 21

What is BPH

Answer 21

cellular proliferation of the prostate at the central transition zone

Question 22

What does BPH cause

Answer 22

if untreated

• urinary retention
• recurrent UTI
• hydronephrosis
• renal failure

Question 23

How does a patient with BPH present

Answer 23

• storage/irritative LUT sx (urgency, frequency, nocturia, incontinence)
• obstructive LUT sx

Question 24

What tool assesses the severity of sx’s of BPH

Answer 24

american urologic association’s symptoms score

Question 25

Physical exam to diagnose BPH

Answer 25

• DRE
• abdominal exam
• neurologic exam and rectal sphincter tone
• gential exam

Question 26

Labs/imaging for BPH

Answer 26

• urinalysis
• SCr
• PSA
• upper tract imaging (U/S or CT)

Question 27

Other tests that might be helpful but aren’t necessary for diagnosis of BPH

Answer 27

• maximal urinary flow rate
• post void residual volume
• urine cytology
• cystoscopy

Question 28

How to treat BPH if it is uncomplicated? (IPSS <8, no BOO, renal insufficiency, recurrent infection)

Answer 28

behavioral modifications

• pee sitting down
• reduce caffeine, alcohol
• avoid fluids before bed
• double void
• avoid rxs that cause retention

Question 29

Treatment of mild to moderate BPH (IPSS <20 w/o refractory retention or BPH induced kidney disease, bladder calculi, gross hematuria)

Answer 29

alpha 1a blockers

terazosin, doxazosin, tamulosin, alfuzosin, silodosin

Question 30

What is the second line tx to alpha blockers

Answer 30

5-alpha-reductase inhibitors

finasteride, dutasteride

Question 31

HOw do 5-alpha-reductase-inhibitors work

Answer 31

blocks conversion of testosterone to dihydrotestosterone–> reduction in size of prostate

Question 32

Which patietns benefit most from 5-alpha-reductase-inhibitors

Answer 32

men with large prostates

>40 ml

Question 33

How do you treat severe BPH (IPSS>20, poor response to monotherapy, prostate >40)

Answer 33

alpha blocker and 5-alpha reductase

Question 34

What is phytotherapy

Answer 34

use of plants or plant extracts for medical purposes

Question 35

What things are used for phytotherapy in BPH

Answer 35

• saw palmetto berry
• beta sitosterol
• cernilton
• pygeum africanum

Question 36

What minimally invasive surgical techniques are there for BPH treatment

Answer 36

• laser
• microwave hyperthermia or electrovaporization
• radiofrequencies

Question 37

What are the conventional BPH surgical therapy options

Answer 37

• transurethral resection prostatectomy (TURP)
• transurethral incision of prostate (TUIP)
• open simple prostatectomy