Chap 82 ED Flashcards Preview

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Flashcards in Chap 82 ED Deck (11):
1

Describe the mechanism of an erection.

parasympathetic division of the ANS causes NO levels to rise in the trabecular arteries and smooth muscle of penis

vasodilation causes corpora cavernosa to fill

simultaneously the ischiocavernosus and bulbospongiosus muscles compress vein of corpora cavernosus preventing egress of blood.

2

Describe the blood supply to the penis.
Which artery affects tumescence?

IIA
branch internal pudendal
becomes common penile after
subdivides into coral, cavernosal and bulbourethral

accessory pudendals from EIA, obturator, vesicle, and femoral arteries

cavernosal

3

What nerve supply is interrupted in AAA surgery?

parasympathetic and visceral afferent nerve fibers

they supply the erectile tissue

4

How many men suffer from ED post AAA repair?
What are the specific erectile issues?

20-30%
retrograde ejaculate
difficult achieving or maintaining erection

5

What are the different causes of ED?

psychogenic
neurogenic
endocrinologic
vasculogenic
drug induced

6

What are risk factors for vasculogenic ED?

HNT
DM
DLP
obesity
smoking

7

What are different diagnostic techniques for ED?

nocturnal penile tumescence monitoring (can distinguish psychogenic from vascular)

penile brachial pressure (high inter-observer reliability)

office injection test (seldom performed)

Duplex
induce erection
PSV, EDV, RI of penile artery

pudendal and penile angiography

8

What are duplex findings suggestive of vascular ED?

PSV 10cm/sec asymmetry

9

Name different pharmacological tx for ED.

PDE5 inhibitor
sildenafil
vardenafil
tadalafil
avanafil

intracavernosal injection
PGE1
phentolamin
papaverine

intraurethral PGE1 suppository

10

How to PDE5 inhibitors work?

inhibit PDE5 enzyme which degrade cGMP

cGMP in the downstream effector of NO

prolonged cGMP decrease intracellular ca and maintains SM relaxation

11

What are mechanical and sx tx of ED?

vacuum constriction devices
penile implant surgery
penile revasclarization
(inf epigastric to dorsal artery bypass)
ligation of crural vein for veno-occlusive dz