wk 14, lec 2 Flashcards
frequency of types of ED causes
32% vascular
20% psychogenic
12-25% drug induced
3-19% hormonal (thyroid, pituitary, gonadal)
5-24% homronal (diabetes)
cardiovascular facrtors causing ED
atherosclerosis, hypertesnion, diabetes, hyperlipidemia
psychological factors and ED
stress, anxiety, depression, relationship issues
urological factors causing ED
peyronie disease (fibrous scar tissue cause curvature)
prostate cancer (surgery, radiation)
bladder disorders (neurological)
metabolic factors causing ED
obesity
insulin resistnace (reduce nitric oxide)
hormonal imbalance (low testosterone)
causes of ED
ORGANIC:
vasculogenic
neulorgic
anatomic
endocrinologic
psychogenic
-generalized or situational
most common ED
vasculogenic
causes of vasculogenic ED
traumatic vascular injury, pelvic radiation, and cycling
risk factors for vasculogenic ED
hypertension, smoking, dyslipidemia, and diabetes
changes in vasculogenic ED
hypoxia
decrease prostaglandin E1
increase pro fibrotic cytokines
–> collagen and veno-occlusive dysfunction
neuronic ED
nerve signaling deficits from CNS to corpora cavernosa
decrease neuronal nitric oxide
brain centers for sexual drive impactsed by parkinsons and stroke
i.e. diabetic neuropathy, pelvic surgery, disc herniation, MS
endocrinological factors in ED
testosterone: impacts endothelial nitric oxygen production
low T comorbid with diabetes and hyperlipidemia
hyperprolactinemia (inhibit GnRH –> low T)
hyperthyroid (libido) , hypothryoid (high prolactin, low T)
psychogenic ED
stress and anxiety
neurological: hypothalamus, cerebral cortex, limbic system,
excessive sympathetic outflow and circulating catecholamines
high NE
premature ejactulation
drug induced ED
Antihypertensive, SSRIs, opiates, anti androgens, anti fungal, heart failure meds, alcohol
endothelial dysfunction and vascular insufficiency in ED
impaired nitric oxide bioavailability–> reduced vasodilation and inflammation
vascular insufficiency from atherosclerosis, hypertesnion, CVD risk –> inadequate penile blood flow
aging and ED
decrease smooth muscle relaxation and arterial compliance
decline in NO production
comorbid diabetes and HTN
imagine for ED
doppler ultrasound: penile blood flow
penile arteriography: arterial blockage
balanitis
causes
risks
sx
inflamed glans penis (head of penis)
inflammatory trigger: hygiene, infection, chemicals –> immune response
risks: diabetes, uncircumcised, immunosuprress
sx: red, itch, swell, discharge, edema
manage: topical anti fungal or antibiotic
phimosis
causes
factors
exam
foreskin not being able to be fully retract over the glans
tight foreskin –> inflammation or infection –> scar/fibrosis
factors: hygiene, infections, balanitis, scars
exam: high, non-retractable foreskin
tx: stretching exercises, topical corticosteroids, surgery
paraphrimosis vs phimosis
Foreskin becomes trapped behind glans due to retraction of a tight
foreskin
Characterized by foreskin not being able to be fully retract over the glans
paraphimosis
Foreskin becomes trapped behind glans due to retraction of a tight
foreskin
contract glans –> imparired blood flow, swelling, ischmia, necrosis
URGENT or else necrosis and ischemia
epispadias and hypospadias
congenital penile anomalities; abnornal uterhtra opening (embryologic)
epispadias= urethral on dorsal surface of penis
hypospadias= urethra on ventral surface of penis
causes of episadias and hypospadias
Embryological defects are caused by by failure of fusion of urethral folds
(hypospadias) or abnormal positioning of genital tubercle (epispadias)
urtehra on wrong part of penis
epi= dorsal
hypo=ventral
apenia
congenital; absence of penis
urethra open on perineum or inside rectum
dx: karyotyping
megalopenis
rapid enlargement of penis in childhood
increased testosterone
micropenis
small penis from testosterone deficiency in fetal development
tx: androgen replacement therapy
