Erectile dysfunction

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Erectile dysfunction

  1. 1. ErectileDysfunction By Waleed Dawood
  2. 2. Erectile Dysfunction Meaning : The inability to achieve and maintain a penile erection satisfactory for sexual intercourse (Does not include ejaculation disorders)
  3. 3. Anatomy of the penis • Tunica Albuginea • Corpora Cavernosa -- Sinusoid • Corpus Spongiosum -- Sinusoid • Glans Penis • Artrial supply • Venous drainage • Nerve
  4. 4. Arterial Supply • Internal iliac artery • internal pudendal artery [main] – Dorsal artery – Bulbourethral artery – Cavenous artery • External iliac, Obturator, vesical and femoral artery. [accessory]
  5. 5. Venous drainage • Emissary veins, transformed from peripheral sinusoids • Deep dorsal vein [main] • Bulbourethral vein, Cavernous vein [ accessory]
  6. 6. Mechanism of erection : Dilatation arterioles&arteries expanding of sinusoids compression of subtunical venular plexuses Emissary veins enclosed increasing of intracavernous pressure to raise the penis
  7. 7. Mechanism of Detumescence Transient intracorporeal pressure increase [smooth muscle contraction] Pressure decrease slowly [slow reopening of the venous channels] Pressure decrease fast [venous outflow capacity is fully restored]
  8. 8. Neuroanatomy of penile erection • Peripheral pathways – autonomic [ C. Cavenosa & C. Spongiosum] – somatic [ Glans Penis & C. Spongiosum] Sympa, - NE release Parasym, + NO & Ach release Somatic, +Ach release
  9. 9. Neuroanatomy of penile erection • Supraspinal pathways [ hypothalamus, limbic system and cerebral cortex] dopaminergic & adrenergic recepters promotes sexual drive serotonin recepters inhibits sexual drive
  10. 10. Classification of Erectile Dysfunction • Psycogenic • Neurogenic • Endocrinologic • Arteriogenic • Cavernosal (Venogenic) • Drug-induced • Erectile dysfunction associated with aging, systemic disease & others
  11. 11. Cause of Erectile Dysfunction Alcohol Abuse Anxiety or Depression Coronary Artery Disease Diabetes Hormonal Abnormalities Hypertension Peripheral Vascular Disease Renal or Hepatic Failure Anemia Smoking Surgery(Pelvic or Perineal) Trauma to pelvic or spine Medication : AntiHT, Antidepressant,
  12. 12. Treatments of Erectile Dysfunction
  13. 13. Treatments of Erectile Dysfunction Drug Therapy : Orally Administration Intracarvernous Injection MUSE or Intraurethral Suppository Vacuum Devices Horrmone Replacement Therapy Surgery Others
  14. 14. • Drug Therapy : Orally Administration Yohimbine Phentolamine Apomorphine Sildenafil Treatments of Erectile Dysfunction
  15. 15. Yohimbine alpha 2 -antagonist Side effect : anxiety, tachycardia Treatments of Erectile Dysfunction Drug Therapy : Orally Administration
  16. 16. Apomorphine (Sublingual) Stimulate brain dopaminergic mechanism Side effect : nausea, vomit, yawn Treatments of Erectile Dysfunction Drug Therapy : Orally Administration
  17. 17. Sildenafil Phosphodiesterase Inhibitor Side effect : headache, flushing, dyspepsia visual disturbance Contraindication : co-administration with nitrate MI, CHF Treatments of Erectile Dysfunction Drug Therapy : Orally Administration
  18. 18. Intracavernous Injection vasoactive agents into corpora cavernosa erection Vasoactive Agent Papaverine Phentolamine Alprostadil Treatments of Erectile Dysfunction
  19. 19. Intracavernous Injection Side effect : priapism, small nodule, subcutaneous hemorrhage, pain, trauma, scar Treatments of Erectile Dysfunction
  20. 20. Intraurethral suppositories “MUSE” (Medicated urethral system for erection) Treatments of Erectile Dysfunction
  21. 21. Vacuum Devices Treatments of Erectile Dysfunction
  22. 22. Hormone Replacement Therapy : Testosterone Treatments of Erectile Dysfunction
  23. 23. Surgery Treatments of Erectile Dysfunction
  24. 24. The End

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