Pathophysiology of Erectile Dysfunction and Benign Prostatic Hyperplasia

Question 1

What is the definition of an Erectile Dysfunction?

Answer 1

Inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse

Question 2

What qualifies as ED?

Answer 2

3 months of failing to achieve erections

Question 3

What co-morbidities can cause ED?

Answer 3

1. Obesity
2. Dyslipidemia
3. Metabolic Syndrome
4. Tobacco Use

Question 4

What is the Corpora Cavernosa?

Answer 4

Two cylinders of erectile tissue (top of penis)

Question 5

What is the Corpus Spongiosum?

Answer 5

Surrounds the urethra (bottom of penis) and expands to form the glands

Question 6

What NT helps blood flow into the penis via vasodilation?

Answer 6

ACh

Question 7

What are the steps to achieve an erection?

Answer 7

1. Bloodflow increases and fills the copra sinusoids
2. Those filled corpora then compress subtunical venules to decrease outflow of blood

Question 8

What are the 2 possible pathways ACh facilitates erection?

Answer 8

1. Improves NO production
2. Increases cAMP

Question 9

What is the primary pathway for an erection?

Answer 9

NO activated cGMP = decrease Ca2+ = relaxed muscle

Question 10

What is the secondary pathway for an erection?

Answer 10

Increase cAMP = muscle relaxation

Question 11

What is the MAIN NT for erections?

Answer 11

NO

Question 12

What metabolizes cGMP?

Answer 12

Phosphodiesterase type 5 aka PDE 5 in the corpora cavernosa

Question 13

Where do the spinal cord cholinergic nerves connect to for sexual stimulation?

Answer 13

Corpora Vasculature

Question 14

What is the role of NE in erections?

Answer 14

Vasoconstrictor, = detumescence

Question 15

Does testosterone help with ED?

Answer 15

NO, but it does help with libido

Question 16

What are the 2 physiologic functions of testosterone?

Answer 16

Stimulate Libido and Increase Muscle Mass

Question 17

What is the normal concentration of testosterone?

Answer 17

300-1100 ng/dL

Question 18

Is testosterone a primary mediatory of erectile dysfunction?

Answer 18

NO

Question 19

What is Secondary ED?

Answer 19

Patient has hypogonadism and decreased libido

Question 20

What is Organic ED?

Answer 20

Etiology is vascular, neurologic, and/or hormonal
Main Cause

Question 21

What is Pyschogenic ED?

Answer 21

No organic causes and the patient does not respond to psychogenic stimuli

Question 22

What is one disease that could inhibit blood flow into the corpora cavernosa? (vascular organic)

Answer 22

HTN, ASCVD, PVD

Question 23

What is one disease that could impair spinal cord nerve conduction? (neurologic organic)

Answer 23

MS, Injury, Stroke, PD

Question 24

What is one disease that could block peripheral nerve conduction? (neurologic organic)

Answer 24

DM

Question 25

What are lifestyle factors that can cause ED?

Answer 25

Alcohol abuse, smoking, obesity, and physical inactivity

Question 26

What are causes of ED associated with damage?

Answer 26

Old age, DM, renal failure, heart disease, HTN, ASCVD, and hypothyroidism

Question 27

How can Antihypertensives cause ED? What are examples?

Answer 27

Reduced arterial flow into corpora Diuretics and BB

Question 28

How can Dopamine Antagonists cause ED?

Answer 28

Inhibit prolactin inhibitory factor, increasing prolactin levels

Question 29

How can Anticholinergics cause ED? What are examples?

Answer 29

Anticholinergic Activity Anti-Parkinson's

Question 30

How can Estrogen or Antiandrogenic Drugs cause ED? What are some examples?

Answer 30

Suppress testosterone mediated stimulation of libido Digoxin and Spironolactone

Question 31

How can CNS Depressants cause ED? What are some examples?

Answer 31

Suppresses psychogenic stimuli Narcotics and Benzos

Question 32

What other drugs cause ED?

Answer 32

Lithium Gemfibrozil Clofibrate Finasteride Dutasteride

Question 33

What is Benign Prostatic Hyperplasia?

Answer 33

Enlargement of the prostate gland

Question 34

What is the normal prostate weight?

Answer 34

15-20 grams

Question 35

What is the anatomy of the prostate?

Answer 35

Small gland located below the bladder that surrounds the urethra

Question 36

What is the primary function of the prostate?

Answer 36

To secrete fluids that make up 20-40% of the ejaculate

Question 37

What are the 3 prostate tissues?

Answer 37

1. Epithelial Glandular 2. Stromal 3. Capsule

Question 38

What is the function of the epithelial glandular?

Answer 38

Produce secretions

Question 39

What is the function of the stromal?

Answer 39

Smooth muscle with lots of ALPHA-1 RECEPTORS, activated by NE to cause smooth muscle contraction = decreases bladder emptying

Question 40

What is the function of the capsule?

Answer 40

Connective smooth muscle with ALPHA-1 Receptors

Question 41

What metabolizes testosterone?

Answer 41

5-alpha-reductase

Question 42

What is DHT and it's role in the prostate?

Answer 42

Dihydrotestosterone an active metabolite of TST, facilitates prostate growth, and much for potent in the prostate

Question 43

What are the two types of Lower Urinary Tract Symptoms LUTS?

Answer 43

1. Obstructive 2. Irritative

Question 44

What are the Obstructive Symptoms?

Answer 44

Reduction in bladder emptying (weak stream, low flow rate, incomplete/slow emptying) Full Bladder feeling after voiding

Question 45

What are the Irritative Symptoms?

Answer 45

Over sensation of bladder muscles from long-standing = Nocturia Bladder cannot void = retention and UTIs

Question 46

How do you know if a BPH medication is working?

Answer 46

If the AUA score improves by 3 points

Question 47

What is the physical exam for BPH?

Answer 47

Digital Rectal Exam DRE

Question 48

What is classified as Mild BPH?

Answer 48

<7

Question 49

What is classified as Moderate BPH?

Answer 49

8-19 LUTS

Question 50

What is classified as Severe BPH?

Answer 50

>20 UTI, Insufficiency, Bladder stones