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40 Cards in this Set
- Front
- Back
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Erectile dysfunction, also called impotence,
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is the inability to achieve or maintain an erect penis.
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They may report
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decreased frequency of erections
inability to achieve a firm erection or rapid detumescence (subsiding of erection) |
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In the US, 30 million men
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experience erectile dysfunction
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More than half of men 40-70
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are unable to attain or maintain an erection sufficient for satisfactory sexual performance
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The physiology of erection and ejaculation is
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complex and involves PARASYMPATHETIC AND SYMPATHETIC components
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Erection involves the
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release of NITROUS OXIDE into the
CORPUS CAVERNOSUM during sexual stimulation ITS RELEASE ACTIVATES: CYCLIC GUANOSINE MONOPHOSPHAGE (cGMP) causing smooth muscle relaxation This allows flow of blood into the CORPUS CAVERNOSUM, resulting in erection |
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Erectile dysfunction has both psychoegenic and organic caues
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Psychogenic causes include:
anxiety fatigue depression pressure to perform negative body image absence of desire privacy, trust, relationship issues Organic causes: cardiovascular disease endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism and hypothyroidism), cirrhosis, chronic renal failure, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin lymphoma, leukemia), nuerologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis) trauma to the genital or pelvic area alcohol, smoking, medications |
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Classes of Medications (Erectile Dysfunction)
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Antiadrenergic and antihypertensive:
Guanethidine (Ismelin) Clonidine (Catapres) Hydralazine (Apresoline) Metoprolol (Lopressor) Anticholinergics and phenothiazines: Prochlorperazine (Compazine) trihexyphenidyl (Artane) Antiseizure: Carbamazepine (Tegretol) Antifungals: Keoconazole (Nizoral) Antihormone (prostate cancer treatment): flutamide (Eulexin) leuprolide (Lupron) Antipsychotics: Haloperidol (Haldol) chlorpromazine (Thorazine) Antispasmodics: oxybutynin (Ditropan) Anxiolytics, sedative-hypnotics, tranquilizers lorazepam (Ativan) triazolam (Halcion) Beta Blockers: nadolol (Corgard) CCB: nifedipine (Adalat, Procardia) Carbonic anyhydrase inhibitors: acetazolamide (Diamox) H2 antagonists: nizatidine (Axid) NSAIDs; naproxen (Naprosyn) Diuretics: hydrochlorothiazide (HydroDIURIL) FUROSEMIDE (Laxis) sprionolactone (Aldactone) Antidepressants: tricyclic antidepressants: amitriptyline (Elavil) desipramine (Norpramin) |
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Antifungals:
Keoconazole (Nizoral) Antihormone (prostate cancer treatment): flutamide (Eulexin) leuprolide (Lupron) Antipsychotics: Haloperidol (Haldol) chlorpromazine (Thorazine) Antispasmodics: oxybutynin (Ditropan) Anxiolytics, sedative-hypnotics, tranquilizers lorazepam (Ativan) triazolam (Halcion) Beta Blockers: nadolol (Corgard) CCB: nifedipine (Adalat, Procardia) Carbonic anyhydrase inhibitors: acetazolamide (Diamox) H2 antagonists: nizatidine (Axid) NSAIDs; naproxen (Naprosyn) Diuretics: hydrochlorothiazide (HydroDIURIL) FUROSEMIDE (Laxis) sprionolactone (Aldactone) Antidepressants: tricyclic antidepressants: amitriptyline (Elavil) desipramine (Norpramin) selective serotonin reuptake inhibitors: fluoxetine (Prozac): Parkinson's Levodopa Antihistamines: Benadryl |
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The diagnosis of erectile dysfunction requires a
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sexual and medical history
analysis of presenting symptoms physical exam neurologic exam detailed assessment all medications alcohol drugs various lab studies |
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Nocturnal penile tumescence tests are conducted
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to monitor changes in penile circumference
Helps to determine if organic or psychological cause |
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In healthy men, noctural penile erections closely parallel
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rapid eye movement (REM) sleep in occurrence and duration
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Organically impotent men show inadequate
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sleep-related erections that correspond to their waking performance.
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Arterial blood flow to the
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penis is measuring using a Doppler probe.
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In addition, nerve conduction tests and
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extensive psychologic eval may be carried out
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Treatment can be
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medical, surgical or both, depending on the cause
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The American urological Association (AUA) guidelines on treatment of erectile dysfunction suggests that
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therapy for associated disorders (alcoholism, diabetes) or
adjustments of medications may be neessary |
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Endocrine therapy instituted to treat
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erectile dysfunction SECONDARY to hypothalamic-pituitary-gonadal dysfunction may REVERSE the condition
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Insufficient penile blood flow may be treated
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with VASCULAR surgery
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Patients with erectile dysfunction from
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psychogenic causes are referred to a health care provider or therapist who specializes in sexual dysfunction
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Patients with erectile dysfunction secondary to ORGANIC may be candidates for
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PENILE IMPLANTS
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Current therapies for erectile dysfunction include pharmacologic
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urethral suppositories
penile implants vacuum constriction devices These options should be considered in a STEPWISE fashion, with increasing invasiveness and risk balanced against the likelihood of efficacy |
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Choice of treatment made jointly
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by physician, patient and partner
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Phosphodiesterase-5 (PDE-5) inhibitors, ORAL MEDS - FIRST LINE THERAPY
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sildenafil (Viagra)
vardenafil (Levitra) tadalafil (Cialis) During sexual stimulation, PDE-5 inhibitors INCREASE BLOOD FLOW TO THE PENIS TAKE ABOUT ONE HOUR BEFORE SEXUAL ACTIVITY ERECTION CAN LAST ONE TO TWO HOURS |
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SIDE EFFECTS PDE-5
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headache
flushing dyspepsia diarrhea nasal congestion lightheadedness CONTRAINDICATED IN MEN WHO TAKE ORGANIC NITRATES (isosorbide (Isordil), Nitro-Dur, nitroglycerin) can cause SEVERE HYPERTENSION |
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PDE-5 must be used with caution in pt's with
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retinopathy
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For pt's with contraindications to PDE-5:
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injecting vasoactive agents
alprostadil papaverine phentolamine directly into the penis COMPLICATIONS: Priapism and development of fibrotic plaques at the injection site FIRM ERECTIONS: 50% INJECTION TWENTY MINUTES BEFORE LASTS ONE HOUR |
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Alprostadil is also formulated in a
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gel pellet that can be inserted into the tip of the urethra using an applicator to create an erection
smooth muscle relaxant, blood flow May be used TWICE a day urethral/genital PAIN, risk of HTN and syncope DO NOT USE WITH PREGNANT WIFE INSERTED 10 MINUTES BEFORE ERECTION ONE HOUR |
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Penile Implants
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Semi-rigid rod
Inflatable Soft silicone Surgically implanted into CORPUS CAVERNOSUM Reliable Requires surgery Healing - THREE WEEKS Subsequent cytoscopic surgery difficult Semirigid rod results in permanent SEMIERECTION Indefinite inflatable prosthesis: Saline returns from penile receptacle to reservoir |
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Two general types of penile implants are availale
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the malleable, noninflatable, nonhydraulic prosthesis (semi-rigid rod)
inflatable, hydraulic prostheses |
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The semi-rigid rod (Small-Carrion prosthesis results in a
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permanent semierection but can be bent into an unnoticeable position when appropriate
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The inflatable prosthesis simulates
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natural erections and natural flaccidity
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Complications after implantation include
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infection
erosion of the prosthesis through the skin (more common with semi-rigid rod |
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Factors to consider in choosing a penile prosthesis are
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the pt's ADLs
social activities expectations of the pt/partner Counseling for adapt purposes |
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Negative-Pressure Devices
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Vacuum devices may also be used to induce an erection
A plastic cylinder is placed over the FLACCID penis and negative pressure is applied. When an erection is attained, a constriction band around the base of the penis to maintain The patient is instructed not to leave the constricting band in place for longer than 1 hour Only devices with a vacuum limiter are recommended Many find satsifactory, others experience premature loss of penile rigidity or PAIN when applying suction or during intercourse |
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When an erection is attained
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a constriction band is placed around the base of the penis to maintain the erection
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The patient is instructed not to leave the constricting band in place
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for longer than 1 hour to avoid penile injury
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Only devices with a
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vacuum limiter are recommended for use
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Many men find this method satisfactory, others report
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premature loss of penile rigidity or pain when applycing suction or during intercourse
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NURSING MANAGEMENT - ERECTILE DYSFUNCTION
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Personal satisfaction and ability to satisfy the partner
Men with illness/disability may need assistance of a sex therapy Support groups Impotenence Anonymous and I-Anon |
