Erectile Disfuction and Treatment - · PDF fileMost often, ED is secondary (ie, a man who...
Transcript of Erectile Disfuction and Treatment - · PDF fileMost often, ED is secondary (ie, a man who...
ERECTILE
DYSFUNCTION
Urology Subdepartement dr. Mintohardjo Naval Hospital
dr. Isdiyanto Septiadi, Sp.U
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The persistent
inability to
achieve or
maintain a
penile erection
sufficient for
sexual
intercourse.
So what is impotence or erectile
dysfunction..?
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Most often, ED is secondary (ie, a man who
previously could attain and sustain erections no
longer can). Over 80% = have an organic disease,
ED leads to secondary psychologic difficulties.
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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.
WHAT IS THE AETIOLOGY OF ED..??
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HOW NORMAL ERECTION WORK..???
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PENILE ANATOMY
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NORMAL ERECTILE FUNCTION
Signal from the brain to penis via
cavernosal nerves
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Arterioles dilate (increased inflow) and
venules are compressed (decreased outflow)
Tunica albuginea is a non elastic fascial layer
surronding the cavernosal bodies.
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SO, FOR NATURAL ERECTIONS YOU NEED…
Intact nerves (somebody to start the air flow)
Good blood flow to the penis (working
compressor tubing)
Intact/healthy cavernosal tissue ( a good tire –
sort of)
The ability to block venous output from the
penis (no leak in the tire)
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ERECTIONS
Nerves to start
Arteries to bring blood
Tissue to hold the blood
Ability to block veins
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CAUSES OF ED
Heart Disease (vascular disease)
Diabetes
Smoking
Peyronie’s Disease
Medications
Prostate Cancer treatment
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HEART DISEASE AND ED
Heart disease is actually vascular (i.e. blood
vessel) disease
Vascular disease that works on the heart
usually is in all the blood vessels in tke body
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HEART DISEASE AND ED
Often we see the bood vessel disease first in
the as ED
Nerves to start
Arteries to bring blood
Tissue to hold the blood
Ability to block veins
20 – 50 % of men ED (aged 39-74) had
coronary artery disease
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DIABETES
Diabetes slowly damages small blood vessels all over the body
This decreases blood flow everywhere
It really hurts nerves
Nerves to start
Arteries to bring blood
Tissue to hold the blood
Ability to block veins
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SMOKING
Smoking causes blood vessels to contract and
also damages the lining of blood vessels
Also directly acts on the nerves and decreases
the ability of nerves to cause erections
Nerves to start
Arteries to bring blood
Tissue to hold the blood
Ability to block veins
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PEYRONIE’S DISEASE
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PEYRONIE’S DISEASE
Scarring of the Tunica Albuginea
Causes curvature
Also can decrease the ability of the penis to block blood flow out of the penis
Nerves to start
Arteries to bring blood
Tissue to hold the blood
Ability to block veins
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LOW TESTOSTERONE
Low testosterone clearly associated with
decreased sex drive and morning erections
Thought to support cavernosal tissue
Nerves to start
Arteries to bring blood
Tissue to hold the blood
Ability to block veins
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MEDICATION
Blood Pressure medications
Antidepressants
Narcotics
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PROSTATE CANCER TREATMENT
Surgery (open or robotic)
Radiation
Cryotherapy
Hormonal Therapy
Watchful Waiting
Active Surveillance
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ED PREVELENCE WITH PROSTATE CANCER
TREATMENT
24 – 87 % after radical retropubic
prostatectomy
13 – 70% after radiation therapy
(brachytherapy or external beam radiation)
53 – 95% after cryotherapy
45 – 92% in patients undergoing hormonal
androgen ablation
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RADICAL PROSTATECTOMY
The nerves run near the prostate, are
microscopic, and can be injured during the
case
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ERECTILE DYSFUNCTION AFTER SURGERY
Cavernosal nerves may be cut, cauterized or have excessive traction during surgery
Inflammation and healing occur in the prostate bed immediately adjacent to the cavernosal nerves
Both of these will cause permanent, or a period of neurapraxia (stunned nerves)
(NOBODY TO PUMP AIR INTO THE TIRE)
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ED AND PENILE SHORTENING
There is no difference in penile shortening from
ED caused by prostatectomy, radiation to the
prostate, and ED from other causes (except
Peyronie’s)
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TREATMENTS FOR ERECTILE DYSFUNCTION
Tier 1 : Pills (Phosphodiesterase-5 Inhibitor)
- Viagra (sildenafil), Levitra (Vardenafil), Cialis
(tadalafil)
Tier 2 : VED, Injections, MUSE
Tier 3 : Implant
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PENILE IMPLANT
Psychological barrier
Very high satification rating (72-96%)
Irreversible ED treatment – perfomed when
consevative treatments not effevtive/desired by
patient
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QUESTIONS / DISCUSSION
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