Erectile Dysfunction

Question 1

What structure is damged in a penile fracture?

Answer 1

Tunica Albuginea of the corpus cavernosum

Question 2

What are the 3 necessary processes in an Erection?

Answer 2

1) Neuro mediated increase in penile arterial flow
2) Relaxation of cavernous smooth muscle
3) Restriction of venous outflow

Question 3

What is the process of gaining an erection?

Answer 3

1) Stimulus
2) NO released
3) cGMP formation
4) vascular SM relaxation
5) Influx of blood into sinusoids

Question 4

What causes the release of an erection?

Answer 4

Signals from the SNS

Question 5

What are the risk factors of Erectile Dysfunction?

Answer 5

Atherosclerosis and associated Risk factors: HTN, DM, Dyslipid, Smoking, Obesity, Sedentary Lifestyle
Other: Venous leak, vasc surgery, pelvic or perineal trauma

Question 6

What meds can cause ED?

Answer 6

CV Drugs: Antihypertensives***
Antihyperlipidemics
Digoxin
***SSRI, Hormonal agents 
Rec Drugs
Cytotoxic agents 
H2 receptor Antagonists
PIs (protease inhibitors)

Question 7

What is the Mechanism of PDE5 Inhibitors?

Answer 7

Inhibits degradation of cGMP
Cavernous SM relaxation
still requires sexual stim

Question 8

What are the SE of PDE5?

Answer 8

Headache, Flushing, Rhinitis, Dyspepsia, Visual Changes, back pain

Question 9

What are the contraindications of PDE5 meds?

Answer 9

Taking Nitrites, active ischemia
Heart attack, stroke, or life threatening arrhythmia in last 6 months
Hypo/hypertension
Retinitis Pigmentosa

Question 10

What is the intraurethral suppository or intracavernosal injection of PGE1?

Answer 10

Increases intracellular cAMP to directly induce SM relaxation and vasodilation
Oral Tx doesn’t work
Instant predictable erection