Erectile
dysfunction (ED)
Definition: (impotence)
Is defined as consistent or recurrent inability to attain
and\or maintain erection a penile erection sufficientTiation
for
sexual intercourse.
Epidemiology :
In men aged 40-70 years
• mild ED is found in 17%
• moderate ED in 25%
• complete ED in 10 % , incidence increases with age
• 15% of men in their 70
• 30-40 % in their 80
Etiology :
ED is generally divided into psychogenic and organic
causes, although it is multifactorial.
The most important causes of ED :
Impotence
1-Inflamtory: prostatitis
2-Mechanical: Peyronie's disease Firosisin shaft of Pem's
Curvatureof Penis
3-Psychological: depression, anxiety, relationship
difficulties
4-Occulusive vascular factors:
[Link] Et artery
A-arteriogenic; HTN, smoking, hyperlipidemia,
DM, peripheral vascular disease
41 age vein
B-venogenic; impairment of veno-occlusive
mechanism
5-Truama: pelvic fracture, spinal cord injury,
penile trauma . Fontainarearerectionard
ejeculation
6-Extra factor:
Iatrogenic (pelvic surgery, prostatectomy)
Increasing age
CKD
Liver cirrhosis
Priapism
7-Neurogenic: multiple sclerosis, Parkinson disease,
CNS tumor, Spina bifida, nerve damage due to pelvic
surgery or radiation, peripheral neuropathy (DM,
alcohol)
8-Chemical: antihypertensive drugs (B-blocker,
thiazides, ACE inhibitors), anti-arrythmic drugs
(amiodarone), antidepressants (tricyclic, SSRI), anti-
androgens, anticonvulsants (phenytoin,
carbamazepine), anti-Parkinson drugs (levodopa),
statins (atorvastatin) ,alcohol.
9-Endocrine: DM, hypogonadism, hypothyroidism
and hyperthyroidism, hyperprolactinemia
leadto hypogonadism artichedyfon
Investigation:
✓Blood tests:
duet DM
✓fasting glucose, serum (free)
testosterone, LH, FSH, sex-hormone
binding globulin, prolactin, PSA,
thyroid function test, lipid profile
✓Nocturnal penile tumescence and
rigidity testing:
Rigi-Scan device contains 2 rings that
are placed around base and distal
penile shaft to measure number,
duration and rigidity of nocturnal
erections, useful to diagnosing
psychogenic erectile dysfunction
ForVascularity
p
✓ Penile color Doppler USS:
Measures arterial peak systolic and diastolic velocities, pre-
and post intracavernosal injection of PGE1
✓ Cavernosography : imaging and measurement of blood
flow of the penile after intracavernosal injection of
contrast
✓ Penile arteriography:
Reserve for trauma-related ED in younger men to identify
those requiring arterial by-pass surgery
Treatment:
Initially correct any reversible causes
(alter life style, stop smoking and
alcohol, change medication etc.)
Psychosexual therapy:
Aim to understand and address
underlying psychological issues and
provide information and treatment in the
form of sex education, instruction on
improving partner communication skills
Medical treatment:
✓Oral medication:
Phosphodiesterase type-5 (PDE5) inhibitors:
Sildenafil (Viagra), tadalafil (Cialis), vardenafil
(Levitra)
These drugs enhance cavernosal smooth muscle
erection
relaxation and erection relation engorgment WithBlood
Side effect: headache, flushing, visual disturbance,
backache
Paracetal
BE
✓ Intra-urethral therapy:
Alprostadil (caverject): synthetic PGE1 pellet
administered into urethra by special applicator
✓ Intracavernosal injection therapy:
Alprostadil (synthetic PGE1)
Vacuum erection device:
Contain 3 component; vacuum chamber, pump and
constriction band
The penis is placed in the chamber and the vacuum
created by the pump increases blood flow to corpora
cavernosa to induce erection
Androgen replacement therapy:
testosterone replacement is indicated for hypogonadism
Surgical treatment :
Microvascular arteral bypass and venous
ligation surgery:
Consider in vascular disorder, act to increase
arterial blood inflow and decrease venous outflow
Penile prosthesis:
semi-rigid, malleable and inflatable penile prosthesis are
available when other therapies have failed or are
unsuitable
The device is surgically implanted into corpora to
provide penile rigidity
Also useful if there is co-existing penile curvature or
peyronie's disease
Thank U