Urology

Question 1

What is the first-line pharmacotherapy for erectile dysfunction (ED)?

Answer 1

Phosphodiesterase type 5 (PDE5) inhibitors.

Question 2

True or False: Alprostadil is an oral medication used to treat erectile dysfunction.

Answer 2

False.

Question 3

Fill in the blank: The mechanism of action for PDE5 inhibitors involves the enhancement of __________ levels in the corpus cavernosum.

Answer 3

cGMP.

Question 4

Which of the following is NOT a common PDE5 inhibitor: A) Sildenafil B) Tadalafil C) Alprostadil?

Answer 4

C) Alprostadil.

Question 5

What should be assessed before prescribing ED medications?

Answer 5

Cardiovascular health and potential drug interactions.

Question 6

List the PDE5i medications for ED with their posologie

Which lasts longest? Which can be used daily?

Answer 6

Viagra (Sildenafil) 25-50mg (max 100/24h) 30-60min before sex

Cialis (Tadalafil) 5-10mg (max 20-24h) 1-2h before sex, lasts longest (up to 36h) and can be used daily at 2.5-5mg OD

Question 7

A healthy 54-year-old female with bothersome stress urinary incontinence (SUI) while attempting to exercise, in which she requires the use of incontinence pads. No prior SUI surgery, BMI <40, no pelvic floor radiation, no pelvic organ prolapse, not frail.

What do you recommend? Investigations and Management

Answer 7

Weight loss, smoking cessating, delay surgery i considering bariatric surgery

PFMT (pelvic floor muscle therapy), pessaries

Periurethral bulking agents

Mid-urethral sling (vaginal or obturator)

Shared decision on conservative vs surgical, discuss sexual function may be affected after SUI surgery, risk of retention/worsening voidign

NOT ROUTINE :
* Cystoscopy if LUTS, previous pelvic radiation or procedures, suspected structural causes, recurrent UTI
* Urdodynamic studies (UDS) if elevated PVR, hx pelvix surgery/radiation, suspected void dysfunction, neurological LUT conditions, mixed incontinence, discrepancy of history and physical
* vaginal estrogen if SUI is the ONLY sx