Medical Information and treatment on Erectile Dysfunction and men's sexual health. A list of some of the available treatment solutions available to men who are suffering from blood flow issues and erectile dysfunction
Invited lecture delivered by Dr Sujoy Dasgupta in a Webinar organized by Sexual medicine Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in February, 2022
Different Treatments and Cures for Erectile Dysfunction or ImpotenceVinay Ghosh
This book has been written for the people who are looking for any type of cure for their erectile dysfunction. Remember that erectile dysfunction is a condition and you can cure it by using some natural cures. However, there are many surgeries and treatments also available for erectile dysfunction. This book has detailed information about all treatments for erectile dysfunction.
ED is the inability to get or keep an
erection firm enough for sexual intercourse. ED can be a total inability to
achieve an erection, an inconsistent ability to do so, or a tendency to sustain
only brief erections.
ED is sometimes called impotence, but that
word is being used less often so that it will not be confused with other,
nonmedical meanings of the term.
The National Institutes of Health estimates
that ED affects as many as 30 million men in the United States. Incidence
increases with age: About 4 percent of men in their 50s and nearly 17 percent
of men in their 60s experience a total inability to achieve an erection. The
incidence jumps to 47 percent for men older than 75. But ED is not an
inevitable part of aging. ED is treatable at any age.
Erectile Dysfunction: New Paradigms in Treatment Ranjith Ramasamy
1. Discuss diagnosis of erectile dysfunction
2. Treatments of ED using Viagra, Cialis, Trimix (intracavernosal injections)
3. Evaluate penile prosthesis and implant as ED surgical therapy options
Invited lecture delivered by Dr Sujoy Dasgupta in a Webinar organized by Sexual medicine Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in February, 2022
Different Treatments and Cures for Erectile Dysfunction or ImpotenceVinay Ghosh
This book has been written for the people who are looking for any type of cure for their erectile dysfunction. Remember that erectile dysfunction is a condition and you can cure it by using some natural cures. However, there are many surgeries and treatments also available for erectile dysfunction. This book has detailed information about all treatments for erectile dysfunction.
ED is the inability to get or keep an
erection firm enough for sexual intercourse. ED can be a total inability to
achieve an erection, an inconsistent ability to do so, or a tendency to sustain
only brief erections.
ED is sometimes called impotence, but that
word is being used less often so that it will not be confused with other,
nonmedical meanings of the term.
The National Institutes of Health estimates
that ED affects as many as 30 million men in the United States. Incidence
increases with age: About 4 percent of men in their 50s and nearly 17 percent
of men in their 60s experience a total inability to achieve an erection. The
incidence jumps to 47 percent for men older than 75. But ED is not an
inevitable part of aging. ED is treatable at any age.
Erectile Dysfunction: New Paradigms in Treatment Ranjith Ramasamy
1. Discuss diagnosis of erectile dysfunction
2. Treatments of ED using Viagra, Cialis, Trimix (intracavernosal injections)
3. Evaluate penile prosthesis and implant as ED surgical therapy options
Erectile Dysfunction Symptoms And TreatmentManas Das
This presentation describes Symptoms And Treatment of Erectile Dysfunction which is a very common diseases in men.Erectile Dysfunction can be cure easily if proper treatment will be taken.To identify Erectile Dysfunction some symptoms are there which can help you.
Erectile Dysfunction Symptoms And TreatmentManas Das
This presentation describes Symptoms And Treatment of Erectile Dysfunction which is a very common diseases in men.Erectile Dysfunction can be cure easily if proper treatment will be taken.To identify Erectile Dysfunction some symptoms are there which can help you.
By: Ayman Rashed,MD
ejaculatory disorders are always bothering. premature, delayed ejaculation, or anejaculation are all challenging both in diagnosis or treatment
Sex is not just going backs and force, we need to understand its physiology and neural concepts, here is a detailed presentation about the physiology of sexual human response and the intercourse, in addition to the benefits and some clinical aspects
Electrical stimulation for erectile dysfunctionaditya romadhon
this lecture presentation for physiotherapy student and practitions to improve their references about electrical stimulation effect on erectile dysfunction
OSA is an entity that is increasingly being managed by otolaryngologists...Hope this presentation helps to clear any doubts regarding its diagnosis and management!
Similar to Erectile Dysfunction Treatment Information by Premier Men's Medical Center (20)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
3. BLOOD SUPPLY OF THE PENIS
Is from the internal pudendal artery, which
enters the perineum through Alcock’s canal and
gives rise to 4 terminal branches
1. Dorsal art.
supplies penile skin and glans and contributes little to
erectile function
2. Cavernosal art.
within the corpora, branches into helicine arterioles
3. Bulbar art.
4. Scrotal art.
4.
5. BLOOD SUPPLY OF THE PENIS
Intracavernosal drainage:
helicine arterioles drain into
vascular lacunar spaces of
corp. cavernosum which
empty into subtunical v.
emissary v., pierce tunica
albuginea deep dorsal v.
• Venous drainage is both intra + extra cavernosal
6. BLOOD SUPPLY OF THE PENIS
Extracavernosal drainage: is via 3 routes
1. Deep dorsal v. – drains distal corpora
into santorini’s vesicoprostatic venous
plexus
2. Cavernosal and crural v. – drains prox.
corpora into santorini’s plexus and int.
pudendal v.
3. Superficial dorsal v. – drains blood from
penile skin, glans and communicates
with deep dorsal v.
7. NERVE SUPPLY OF THE PENIS
Autonomic
Paraympathetic nerves from S2-4 nerve roots
primarily control erectile function while the
sympathetic nerves from T11-L2 control
detumescence and also contribute to ejaculation and
emission.
These autonomic nerve fibers form the pelvic plexus
of nerves and enter the penis within the cavernosal
nerves that course lateral and inferior to the
prostate.
N.B. It is these nerves that are preserved during nerve
sparing radical prostatectomy.
8. NERVE SUPPLY OF THE PENIS
Somatic
Peripheral nerves (dorsal penile and pudendal n.) form
sensory and motor elements through a reflex arc in the sacral
spinal cord at Onuf's nucleus (S2-4).
Peripheral nerves containing sensory elements are also
responsible for erectile function, as they innervate the ischio
and bulbo cavernosus muscles of the penis
9. NERVE SUPPLY OF THE PENIS
Central
Ultimate central nervous system control is likely
initiated in the hypothalamus in the medial pre-optic
area that integrates psychological and tactile stimuli.
10.
11. TYPES OF ERECTION
Reflexogenic erection:
A genital stimulation leads to a
reflexogenic erection. Afferent signal pass
via the pudendal nerve to the sacral
erection center, this sends the efferent
signal via the inferior hypogastric plexus.
The reflexogenic erection is largely
independent of cortical influences, as this
kind of erection can remain intact after
cervical or thoracic spinal cord injuries.
12. Psychogenic erection:
The cortical processing of sensory, visual,
auditory stimuli or fantasies are triggers for an
erection.
The cortical centers influence the sacral erection
centers, which cause the erection via activation of
the inferior hypogastric plexus.
13. Nocturnal erection:
Occurs during the REM sleeping phase and can
be measured during sleeping studies (Nocturnal
penile tumescence = NPT).
Typical for the psychogenic impotence is the
existence of NPT, in contrast to serious
vascular erectile dysfunction.
Sympathetic centers mediate nocturnal erections,
the existence of NPT still cannot rule out damage
to the sacral parasympathetic erection center.
14. REVIEW MECHANISM OF ERECTION:
What happens to the penis during arousal?
Audiovisual or tactile stimuli activate
nuclei of spinal erection center T11-L2 and
S2-4
• Signals relayed via
cavernosal n. to erectile
tissue of corpora cavernosa
activating the veno-occlusive
mechanism
15. • This triggers increased arterial blood flow
into sinusoidal spaces, relaxation of
cavernosal smooth muscle, and opening of
vascular spaces
16. The result: Blood expands the sinusoidal spaces which
compresses the subtunical venous plexuses against the
tunica albuginea decreasing the venous outflow, and
further compressing the emissary veins
18. Excitatory stimuli from the CNS produce erections
through a variety of neurotransmitters.
Many neurotransmitters including acetylcholine (ACh)
and vasoactive intestinal polypeptide (VIP) contribute
to erectile function.
The most important neurotransmitter in the corpora
cavernosa is nitric oxide (NO).
19. Following sexual stimulation, acetyl choline triggers
the release of nitric oxide from endothelial cells,
and diffuses into the corporal smooth muscle.
Nitric oxide (NO) is a gas that acts as a vasodilating
agent, inducing smooth ms relaxation via (guanylate
cyclase) the cGMP system.
Therefore, NO arteries dilate fills the corpora
spongiosum and cavernosa with blood = erection
20. cGMP is broken down by phosphodiesterase type 5 (PDE5).
When this occurs the Ca2+ increases in concentration in the
cell, resulting in contraction of the smooth muscle cells and
detumescence.
N.B. Sildenafil ('Viagra') is a PDE5 inhibitor, and allows for
erections to be maintained in response to stimuli, but does not
initiate erection.
21. ERECTION VS. DETUMESCENCE
Stimulation of the pelvic plexus and the
cavernous nerves (Parasympathetic fibers )
through tactile sensory stimuli to the penis,
releases acetylcholine, which enhances penile
blood flow and smooth muscle relaxation, thus
inducing erection
Sympathetic (adrenergic) fibers and
norepinephrine neurotransmission help to
maintain the penis in its flaccid state.
norepinephrine, activates alpha-adrenergic
receptors that produce vasoconstriction of the penile
vasculature and decompression of penile venules,
which result in detumescence.
22. PHASES OF ERECTION
Phase Term Description
0 Flaccid phase Cavernosal smooth ms contracted; sinusoids
empty; minimal arterial flow
1 Latent (filling)
phase
Increased pudendal artery flow; penile
elongation
2 Tumescent phase Rising intracavernosal pressure; erection
forming
3 Full erection
phase
Increased cavernosal pressure (100 mmHg)
causes penis to become full erect
4 Rigid erection
phase
Further increases in pressure (to several
hundred mmHg) + ischiocavernosal muscle
contraction
5 Detumescence
phase
Following ejaculation, sympathetic discharge
resumes; there is smooth muscle contraction
and vasonstriction; reduced arterial flow; blood
is expelled from sinusoidal spaces
23. SO WHAT IS IMPOTENCE OR ERECTILE
DYSFUNCTION?
The persistent inability to achieve or maintain a penile
erection sufficient for sexual intercourse
24. ED affects about 10% of men aged 40-70 years,
and prevalence increases with age
Primary ED (ie, the man has never been able to
attain or sustain erections) is rare and is almost
always due to psychologic factors (guilt, fear of
intimacy, depression, severe anxiety) or
clinically obvious anatomic abnormalities.
Most often, ED is secondary (ie, a man who
previously could attain and sustain erections no
longer can). Over 80% = have an organic
etiology. However, in many men with organic
disease, ED leads to secondary psychologic
difficulties that compound the problem.
What is the aetiology of ED?
25. I.M.P.O.T.E.N.C.E
Inflammatory Prostatitis, urethritis
Mechanical Peyronie’s Disease, chordee
Psychological Depression, performance anxiety, stress, relationship
difficulties
Occlusive vascular Art: Hypertension, smoking, hyperlipidemia, DM.,
peripheral vascular disease
Ven: venous occlusion due to anatomical or
degenerative changes
Trauma Pelvic fracture, SC inj, penile trauma
Endocrine Hypogonadism, hyperprolactinemia, hypo +
hyperthyroidism
Neurologic Parkinsons, multiple sclerosis, spina bifida, pelvic
surgery, peripheral neuropathy
Chemical Anti-HTN, anti-arrhythmics, antidepressants,
anxiolytics, anti-androgens, anticonvulsants, alcohol,
marijuana, anti-parkonson drugs, LHRH analogues
Extra factors Prostatectomy, old age, CRF, cirrhosis
For details see: Siroky,
Mike B. Handbook of
Urology 2003
26. ED is more prevalent among patients with
atherosclerotic peripheral vascular disease,
hypertension, diabetes mellitus (75% of diabetic pts),
hypercholesterolemia, and heart disease and among
men who smoke cigarettes.
In the majority of impotent men, erectile impairment
has both a psychological and an organic basis.
ED caused exclusively by
emotional stress or psychiatric
disease = 10% - 50% of all
cases
Psychogenic ED
Caused exclusively by
vascular, neurologic,
endocrine, or other physical
disease = 50% - 80%
Organic ED
27. How to diagnose & evaluate ED?
History
Examination
Investigation
28. HISTORY
Sexual
Some symptoms suggest psychogenic ED, and others suggest
organic disease.
A psychogenic cause is suggested by the sudden onset of ED
or the presence of ED under some circumstances but complete
erection at other times.
In contrast, gradual deterioration of erectile quality over
months or years with preservation of libido suggests organic
disease.
Psychological Evaluation
29. HISTORY
Medical
Inquiries should be made about: DM, HTN, smoking,
hypercholesterolemia, and hyperlipidemia as well as
about liver, renal, vascular, neurologic, psychiatric,
and endocrine disease.
Surgical History
Abdominal, pelvic, perineal
Drug History
Androgenic substances are associated with decreased
serum testosterone levels and decreased libido.
30. EXAMINATION
Full Physical
Body habitus, 2ndry sexual characteristics
CVS, abdomen, neurological (bulbocavernosus reflex
is used to assess integrity of S2-4)
External Genitalia
Penis: Phimosis, penile lesions
Testis: size, consistency
DRE
32. INVESTIGATION
Specialized Evaluations:
Indicated for failure of ttt, peyronie’s disease, 1ry ED,
history of surgery/trauma, complicated endocrine or
neuropsychiatric disorder
A. Vascular Evaluation
B. Neurologic Evaluation
C. Psychologic Evaluation
D. Hormonal Evaluation
33. 1st line vascular evaluation: Intracavernosal
injection
Allows bypass of neurologic and hormonal influences,
directly evaluates penile blood flow
Alprostadil (10 – 20 μg) alone, or a combination of
papaverine + phentolamine (ie Bimix), or all three (ie
Trimix).
Compress needle site manually to prevent hematoma
34. 2nd line vascular evaluation:
Duplex U/S: measures penile blood flow; most
reliable and least invasive assessment of ED
Color Doppler U/S: measures arterial peak systolic
velocity value (N:>35 cm/s) and end diastolic velocity
(N:<5 cm/s)
Cavernosography: measures penile blood flow
following intracavernosal inj of contrast and
induction of artificial erection. Can identify venous
leakage.
35. Venous leak (veno-occlusive
insufficiency).
Bilateral (a and b) Doppler
waveforms of the cavernosal
arteries at 25 min post-injection of
prostaglandin E demonstrate a
high peak systolic velocity (>40
cm/s), which excludes arterial
insufficiency as a cause of erectile
dysfunction in this patient.
However, a persistent diastolic flow
velocity of more than 5 cm/s is
suggestive of venous leak.
36. 2nd line vascular evaluation:
Selective Penile Arteriography: to specifically assess a
defective/ruptured branch of cavernous art.
A. Arterial phase of right pudendal arteriography demonstrating obvious
extravasation (arrow) at right penile artery.
B. Venous phase image of right pudendal arteriography demonstrating
expansion of extravasation (arrow) and opacified penile veins.
37. TREATMENT
Psychosexual therapy
Aims to understand and address the underlying
psychological issues following proper evaluation
Instructs the pt on information regarding sex
education, partner communication and sexual
behavioral therapy
38. TREATMENT
Oral Medication
PDE5 (phosphodiesterase type-5) inhibitors (ex.
Sildenafil = viagra, tadalafil = cialis, vardenafil =
levitra)
Blocks the breakdown of cGMP, thus maintaining
erection
Sexual stimulation is still needed to initiate erection
Adverse Effects: headache, visual disturbance
Contraindication: pts on nitrates, recent MI, recent
stroke, unstable angina
39. TREATMENT
Androgen Replacement Therapy: indicated for
hypogonadism. Available in oral, IM, patch & gel
forms. In older men, PSA must be checked before
and during ttt.
Intraurethral pellet therapy: using a synthetic
PGE-1 pellet administered into the urethra.
Unavailable in Egypt.
Intracavernosal therapy: Alprostadil/Caverjet
(synthetic PGE1) enhances cavernosal smooth
muscle relaxation. The needle is inserted at right
angles into the corpus cavernosum on the lateral
aspect of the penile shaft. A/E = priapism, pain,
hematoma
40. TREATMENT
Alternative therapy
Vacuum erection device: uses vacuum chamber, pump and
constriction device to increase blood flow into the penis and
maintain rigidity via constriction band
41. TREATMENT
Alternative therapy
Penile prosthesis: may be semi-rigid, malleable or
inflatable.
Inserted surgically into the corpora to provide sufficient
size & rigidity for sexual intercourse. A/E = erosion,
infection, mechanical failure