Flashcards in Genitourinary Deck (378)
What is a total match and total mismatch score?
match = 000
mismatch = 222
What are the types of match and which is most important?
A, B, DR
A is most important, each one has two subtypes
What is erectile dysfunction/impotence?
the inability to achieve and maintain an erection for sexual performance
In who is erectile dysfunction commonly seen?
in elderly due to erectile capacity decreasing with age
What causes erectile dysfunction?
vascular, neurogenic, iatrogenic, anatomical, hormonal, psychogenic
DM, hypertension, MS, nerve damage, hormonal imblances, atherosceloris, heart disease, unhealthy lifestyle, oebese, alcoholic, smoking, drug abuse, medications, antihypertensive, antipsychotics, antidepressant
What psychological factors can cause erectile dysfunction?
stress, fear, gloom, uncertainty, sadness, relationship problems
Lifestyle choices to help erectile dysfunction?
quit smoking, reduce alcohol, dont abuse drugs, exercise regularly, psychotherpay, talk to partner
What is erectile function?
neurovascular phenomenon under hormonal control causing arterial dilation, smooth muscle relaxation and activation of the corporeal veno occlusive mechanism
Anatomy of the penis?
left and right corpora cavenosa covered by and fused together by tunica albuginea, containing spongy vascular erectile tissue with trabeculated smooth muscle lined by endothelial cells
corpus spongiosum has thinner tunica and contains the urethra, glans penis and bulb of penis
Blood supply of the penis?
internal iliac supplies the internal pudendal which supplied the
dorsal penile - glans penis
cavernosal - spongy tissue of corpora
bulbar - bulb, spngiosum, glans
Venous drainage of the penis?
sinusoids to subtunieal plexus to circumflex veins and deep dorsal veins
corpora cavernosa to cavernous veins to crural veins to internal pudendal veins
Nerve supply of the penis?
erection = s2-s4
relax = t11-l2
cavernous never carries both fibres
Physiology behind an erection?
NO release causes cGMP build up
cGMP dependent pKa activates large conductance, K+ channels open, so hyperpolarising and relaxing vascular and trabecular smooth muscle cells allowing engorment
What is the difference between psychogenic and organic erectile dysfunction?
organic is gradual, no erection in any circumstances and morning erections are effected
psychogenic is sudden, situational and unaffected by morning erections
Causes of hypogonadism?
testicular dysfunction (high LH, low testosterone), hypothalamic dysfunction (low LH as cant produce any), pituritary dysfunction, chronic illness, age
Tests for erectile dysfunction?
nocturnal penile tumescence and rigidity, intracavernosal injection test, duplex USS of penile arteries, arteriography, morning testosterone, fasting glucose, lipid profile
Treatment of erectile dysfunction?
lifestyle, psychosexual counselling, PDE5 inhibitors, ampomorphine SL, intracavernous injections, intraurethral aloprostadil, vacuum device, testosterone replacement, monitor for hepatic and prostatic disease, viagra, change BP meds, start satin, penile prosthesis implantation
How do PDE5 inhibitors treat erectile dysfunction?
increase blood flow, vasodialation and erection via action on NO
What are the 3 types of oral pharmacology for erectile dysfunction?
sildenafil (viagra), tadalafil (Cialis) and vardenafil
How does sildenafil (viagra) work?
60 minute wait after administration, effected by food and alcohol, reduced efficacy after fatty meal, increased erections in diabetics, successful intercourse, cheap and can be prescribed
How does tadalafil work in erectile dysfunction?
30 min wait, maintained for 36 hours, 2 a week, last long time
How does varenafil treat erectile dysfunction?
30 min wait, less effective after fatty meal
When is oral pharacology contraindicated in erectile dysfunction?
concurrent use of nitrates, hypertension, degenerative retinal disorders, unstable angina, stroke, MI, bleeding, peptic ulcer, renal/hepatic impairment
Side effects of oral pharmacology in erectile dysfunction?
headache, flushing, dyspepsia, nasal congestion, dizziness, visual disturbance, back pain, myalgia
Side effect of alpha blockers ?
How does sublingual apomorphine treat erectile dysfunction?
centrally acting dopamine agonist, sublingual, no CI with nitrates, lower efficacy than PDE5 inhibitors, limited to mild-moderate ED
How does a vacuum constriction device treat erectile dysfunction?
passive engorgment with constricton ring, 90% efficacy and reduced efficacy over time, keeps the blood in the penis due to pressure, causing penis enlargement, use for 30 mins, it is a cold erection
Side effects of a vacuum constriction device for ED?
painful, inability to ejeculate, petechiae, bruises, numbness, expensive
Contraindications of vacuum constriction device for ED?
bleeding disorder or anticoagulants