Sexual Medicine Flashcards
Major arterial supply to penis
pudendal artery
Mechanism of erections
Release of _____
____ in cAMP & cGMP
____ in intracellular Ca++
smooth muscle ____
Release of NO
Increases cAMP & cGMP
Decreases Ca++
Smooth muscle relaxation
Duplex penile doppler u/s
Normal values
Peak systolic > ___
End diastolic < ___
Peak systolic > 30
End diastolic < 5
Venous leak ED leads to ____ end diastolic velocities
HIGH (>5)
PDE-5 mechanism
Inhibits degradation of ____
inhibits cGMP degradation into GMP
Take Viagra (sildenafil) ____ food
Take Cialis (tadalafil) ___ food
Viagra –> NO FOOD
Cialis–> okay for food
Duration of action for Cialis (tadalafil)
36 hrs
Duration of active for Viagra/Levitra (sildenafil/vardenafil)
4-6 hrs
Protease inhibitors increase the _____ of PDE-5is
concentration (2-3x as potent)
Separate alpha blocker & PDE-5i by ___ hrs to avoid cumulative hypotension
4 hrs
PDE-5i side effects
Headache Facial flushing GERD Nasal congestion Diplopia, blurred vision, chromatopsia
Trimix components & mechanisms
___ : cAMP activator
___ : PDE inhibitor
___ : alpha blocker
PGE-1 : cAMP activator
Papaverine : PDE inhibitor
Phentolamine : alpha blocker
Psych med that is a contrindication to Trimix
MAOI
cannot give phenylephrine to reverse possible priapism*
Pain with ICIs is due to ___ hypersensitivity
PGE-1
Intra-urethral suppositories can cause ___ bleeding, priapism, and penile pain
urethral
Vacuum contraindications
Anti-coagulation
Poor penile sensation
Poor cognition
Infected IPP board answer for management
EXPLANT everything
During IPP, you must abort if _____ perforation
urethral
Ischemic priapism
___ flow
veno___
low flow
veno-occlusive (smooth muscle paralysis)
Non-ischemic priapism
___ flow
___
high flow
arterial (cavernous artery to cavernosal fistula)
Cause of Priapisms
ICI
Cocaine
Hematologic cancer
Cause of Priapisms
ICI
Cocaine
Hematologic cancer
1 diagnostic test for priapism
Corporal blood gas
Purpose of distal penile shunt in priapism
return oxygenated blood to penis
rigidity may not improve
Last line treatment of non-ischemic priapism
Embolization
Xiaflex
Curvature between ___ & ___
Must have intact ____
30-90 degrees
erectile function
Biggest risk of intralesional collagenase for peyronie’s
penile fracture
Treatment of patient with Peyronie’s & severe ED OR peyronie’s with hinging
IPP
___ nerve is responsible for ejaculate explusion
pudendal
Sensory stimulation of _____ nerve stimulates ejaculation
dorsal penile nerve
Majority of ejaculate is contributed by ___ & ____
epididymis & vas deferens