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51 Cards in this Set
- Front
- Back
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What precipitates and maintains erection?
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increase in arterial flow, active relaxation of smooth muscle elements of sinusoids with the corporal bodies of the penis and an increase in venous resistance
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What is needed for normal male erection?
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intact autonomic and somatic nerve supply to penis, smooth and striated musculature of the corposa cavernosa and pelvic floor, and arterial inflow supplied by the paired pudendal arteries
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What functions does contraction of the bulbocavernosus and ischiocavernosus muscles serve?
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causes further rigidity of the penis during erection
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Definition of impotence
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consistent inability to maintain an erect penis with sufficient rigidity to allow sexual intercourse
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What percentage of men over 65 are affected by ED?
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25%
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What is the cause of most ED?
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organic cause rather than psychogenic cause
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If a patient has an erection when he wakes up, but cannot get one during the day, what is the more likely cause?
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psychogenic cause of ED
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What are the generalized types of psychogenic ED?
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generalized unresponsiveness AND generalized inhibition
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What are the situational types of psychogenic ED?
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partner related, performance related, psychological distress or adjustment related
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Is there nocturnal erection with organic ED?
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no
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What are the causes of organic ED?
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neurogenic, hormonal, arterial, cavernosal (venogenic), drug induced
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Three general categories of ED
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organic, psychogenic, or combined organic/psychogenic
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What medical conditions put people at risk for ED?
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DM, HDL, HTN, neurologic disease, renal failure, previous prostate cancer tx, psychological conditions, obstructive sleep apnea, hormonal disorders, previous groin trauma
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What percentage of patients with DM will have ED?
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50%
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What age group is at increased risk for ED?
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over 40
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Besides medical conditions, what other lifestyle factors out people at risk for ED?
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drug use, smoking, alcohol abuse, obesity, sedentary lifestyle,
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In the history what type of questions should you ask about the patient's sexual dysfunction?
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loss of libido, loss of emission, anorgasmia, premature ejaculation, delayed ejaculation; and is the ED chronic, occasional, or situational
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What group of people usually will experience premature ejaculation?
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younger patients
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What is the International Index of Erectile Function (IIEF)?
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self administered questionnaire for erectile dysfunction
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What type of meds (prescribed) may contribute to ED?
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antihypertensives (B Blockers, Thiazide diuretics, Spirinolactone, and Clonidine); prostate agents- Cardura and Hytrin; antidepressants, cimetidine, and ketaconazole
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On PE what do you look for with ED?
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secondary sexual characteristics, gynecomastia or galactorrhea?, check peripheral vascular and focused neurosensory, check for penile scarring, plaques; check for testicular size and masses, do prostate exam
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What hormone labs will you do with ED?
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testosterone and prolactin; if abnormal--f/up with serum FSH and LH, and consider endocrine referral
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Labs done with ED
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CBC, urinalysis, fasting lipid panel, and glucose; as well as serum testosterone and prolactin
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What is the use of Nocturnal penile tumescence testing?
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To help differentiate between organic and psychological cause
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What result in the direction injection of vasoactive substances into penis will suggest that no other work up is needed?
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erection (indicates intact vascular system)
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What is injected in the vasoactive substance special test?
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prostaglandin E1 (alprostadil)
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Describe the stamp test.
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Stamps are wrapped around penis and if they break apart while sleeping, they more than likely had an erection
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Treatment of psychogenic ED
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behaviorally oriented sexual therapy
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Treatment of organic ED for those with documented androgen deficiency
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hormonal replacement in form of testosterone patches or testosterone injections (Androderm)
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What should be ruled out before exogenous testosterone tx if started?
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prostate cancer
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What patients should under penile duplex Doppler sonography, arteriography, or cavernosometry/ography?
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patients who do not achieve erection with increases doses on penile injection and who would consider vascular reconstructive surgery in order to correct ED
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What patients can use vacuum pump?
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for pts with venous disorder who cannot get erection with vasoactive substance injection
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How does a vacuum constrictor device cause an erection?
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by creating a partial vacuum around the penis, which draws blood into the corpora cavernosum
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What is the purpose of the penile tourniquet?
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holds blood in penis for up to 30 minutes to maintain erection
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What is the vasoactive therapy for ED?
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alprostadil (Prostaglandin E1)--either injected or inserted as pellet into the urethra
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Where is alprostadil injected into penis and what syringe is used?
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use tuberculin syringe and inject at the base and lateral aspect
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What oral therapies are used for ED?
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PDE-5 Inhibitors--- Viagra, Levitra, and Cialis
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Adverse affects of PDE-5 Inhibitors
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hypotension, temporary color vision disturbances, mild HA, facial flushing, priaprism
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Patients on this med cannot take PDE-5 Inhibitors
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Nitroglycerin
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What is the name of the intraurethral suppository for ED?
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MUSE
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Who gets 1/2 dose of Viagra?
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age over 65 and hepatic/renal impairment
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Max dose of Viagra
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one per day taken 50 mg PO one hour before intercourse
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Dose of Levitra
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max one per day 2 mg PO one hour prior
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Dose of Cialis
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20 mg PO on hr prior, no more than once every 2 days
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How long does Cialis last?
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36 hours---causes prolonged side effects
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Which ED med is ok with food or a drink?
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Cialis
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CI to PDE-5 Inhibitors
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men using nitrates and menusing alpha blcokers for BPH
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Relative CI to PDE-5 Inhibitors
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active coronary ischemia in men not on nitrates, cornoary heart failure, borderline hypotension, multiple hypertensive agents, zoles
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Types of penile implants
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flexible rod, inflatable
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Besides implants, what surgery options are available for ED?
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vascular reconstruction
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Basic lifestyle changes that will aid ED
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regular exercise, healthy diet, smoking cessation, decrease alcohol intake, limit long distance cycling/change seat, optimize mgmt of DM, HDL, and CVD
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