madman
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The Madmans hot on your trail Dr. Khera LOL!
39.1 Introduction
Erectile dysfunction (ED) is defined as the inability to attain and/or maintain sufficient penile rigidity for sexual satisfaction. It is a complex, multifactorial condition that is part of the normal aging process, and thus most commonly affects middle-aged and elderly men. However, ED is seen in men of all ages, making it a common chief complaint in both primary care and urologic clinics. ED may result from several mechanisms: difficulty initiating erection (psychogenic, neurogenic,endocrinogenic), difficulty filling (arteriogenic), and/or difficulty maintaining blood flow (veno-occlusive) within the penis. This chapter will discuss medical and surgical management options for ED as well as psychosexual therapy, lifestyle modification, and hormone replacement therapy.
ED may be a manifestation of another condition and may resolve upon treatment of the underlying issue. In special cases including primary or predominantly psychogenic ED, poor overall health, or endocrinologic issues, specific management options are available and recommended.
39.1.1 Psychogenic ED
39.1.2 Organic ED Secondary to Poor Overall Health
39.1.3 Organic ED Secondary to Hypogonadism
ED may present as a symptom of testosterone deficiency. While hormone replacement therapy alone is not an effective treatment for ED in these patients [5], testosterone-deficient receiving combination hormone replacement and a phosphodiesterase type-5 (PDE5) inhibitor report better erectile function scores compared to men receiving either therapy alone [6]. Testosterone therapy in PDE5 inhibitor nonresponsive patients results in improved erectile function[7], although testosterone monotherapy is not recommended in patients with normal testosterone levels. The optimum efficacy of PDE5 inhibitor medication is most likely to be achieved once testosterone levels are normalized [8].
39.2 Medical Management
39.2.1 PDE5 Inhibitors
39.2.1.1 Use in the General ED Population
39.2.1.2 Use in Special Populations
39.2.1.3 Use in Post-RP/RT ED
39.2.1.4 Contraindications
39.2.1.5 Adverse Events
39.2.1.6 Other Concerns
39.2.2 Local Therapies
39.2.2.1 Use of ICI
39.2.2.2 Adverse Events Associated with ICI
39.2.2.3 Intraurethral Alprostadil
39.2.2.4 Alprostadil – Topical
39.2.3 Devices
39.3 Surgical Management
39.3.1 Penile Prosthesis
39.3.1.1 Use of Penile Prostheses
39.3.1.2 Infection
39.3.1.3 Erosions
39.3.1.4 Mechanical Failure
39.3.1.5 Managing Changes in Penile Length
39.3.2 Vascular
39.3.2.1 Arterial
39.3.2.2 Venous
39.4 Future Direction and Experimental Therapy
39.4.1 Extracorporeal Shockwave Therapy
39.4.2 Intracavernosal Stem Cell Therapy
39.4.3 Platelet-Rich Plasma
39.5 Conclusion
ED is a multifactorial and complex condition affecting a wider range of male patients and is a common chief complaint in primary care and urologic clinics. A solid understanding of the many treatment options available will help physicians meet the needs of these patients.
39.1 Introduction
Erectile dysfunction (ED) is defined as the inability to attain and/or maintain sufficient penile rigidity for sexual satisfaction. It is a complex, multifactorial condition that is part of the normal aging process, and thus most commonly affects middle-aged and elderly men. However, ED is seen in men of all ages, making it a common chief complaint in both primary care and urologic clinics. ED may result from several mechanisms: difficulty initiating erection (psychogenic, neurogenic,endocrinogenic), difficulty filling (arteriogenic), and/or difficulty maintaining blood flow (veno-occlusive) within the penis. This chapter will discuss medical and surgical management options for ED as well as psychosexual therapy, lifestyle modification, and hormone replacement therapy.
ED may be a manifestation of another condition and may resolve upon treatment of the underlying issue. In special cases including primary or predominantly psychogenic ED, poor overall health, or endocrinologic issues, specific management options are available and recommended.
39.1.1 Psychogenic ED
39.1.2 Organic ED Secondary to Poor Overall Health
39.1.3 Organic ED Secondary to Hypogonadism
ED may present as a symptom of testosterone deficiency. While hormone replacement therapy alone is not an effective treatment for ED in these patients [5], testosterone-deficient receiving combination hormone replacement and a phosphodiesterase type-5 (PDE5) inhibitor report better erectile function scores compared to men receiving either therapy alone [6]. Testosterone therapy in PDE5 inhibitor nonresponsive patients results in improved erectile function[7], although testosterone monotherapy is not recommended in patients with normal testosterone levels. The optimum efficacy of PDE5 inhibitor medication is most likely to be achieved once testosterone levels are normalized [8].
39.2 Medical Management
39.2.1 PDE5 Inhibitors
39.2.1.1 Use in the General ED Population
39.2.1.2 Use in Special Populations
39.2.1.3 Use in Post-RP/RT ED
39.2.1.4 Contraindications
39.2.1.5 Adverse Events
39.2.1.6 Other Concerns
39.2.2 Local Therapies
39.2.2.1 Use of ICI
39.2.2.2 Adverse Events Associated with ICI
39.2.2.3 Intraurethral Alprostadil
39.2.2.4 Alprostadil – Topical
39.2.3 Devices
39.3 Surgical Management
39.3.1 Penile Prosthesis
39.3.1.1 Use of Penile Prostheses
39.3.1.2 Infection
39.3.1.3 Erosions
39.3.1.4 Mechanical Failure
39.3.1.5 Managing Changes in Penile Length
39.3.2 Vascular
39.3.2.1 Arterial
39.3.2.2 Venous
39.4 Future Direction and Experimental Therapy
39.4.1 Extracorporeal Shockwave Therapy
39.4.2 Intracavernosal Stem Cell Therapy
39.4.3 Platelet-Rich Plasma
39.5 Conclusion
ED is a multifactorial and complex condition affecting a wider range of male patients and is a common chief complaint in primary care and urologic clinics. A solid understanding of the many treatment options available will help physicians meet the needs of these patients.
