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Medical and Surgical Management of Erectile Dysfunction
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<blockquote data-quote="madman" data-source="post: 274985" data-attributes="member: 13851"><p>The Madmans hot on your trail Dr. Khera LOL!</p><p></p><p></p><p></p><p></p><p><strong>39.1 Introduction</strong></p><p></p><p><em>Erectile dysfunction (ED) is defined as the inability to attain and/or maintain sufficient penile rigidity for sexual satisfaction.<strong> It is a complex, multifactorial condition that is part of the normal aging process, and thus most commonly affects middle-aged and elderly men.</strong> However, ED is seen in men of all ages, making it a common chief complaint in both primary care and urologic clinics. <strong>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.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>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.</strong></em></p><p></p><p></p><p></p><p></p><p><strong>39.1.1 Psychogenic ED</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>39.1.2 Organic ED Secondary to Poor Overall Health</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>39.1.3 Organic ED Secondary to Hypogonadism</strong></p><p></p><p><em><strong>ED may present as a symptom of testosterone deficiency. <u>While hormone replacement therapy alone is not an effective treatment for ED in these patients</u> [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].</strong> 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].</em></p><p></p><p></p><p></p><p></p><p><strong>39.2 Medical Management</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>39.2.1 PDE5 Inhibitors</strong></p><p><em>39.2.1.1 Use in the General ED Population</em></p><p><em>39.2.1.2 Use in Special Populations</em></p><p><em>39.2.1.3 Use in Post-RP/RT ED</em></p><p><em>39.2.1.4 Contraindications</em></p><p><em>39.2.1.5 Adverse Events</em></p><p><em>39.2.1.6 Other Concerns</em></p><p></p><p></p><p><strong>39.2.2 Local Therapies</strong></p><p><em>39.2.2.1 Use of ICI</em></p><p><em>39.2.2.2 Adverse Events Associated with ICI</em></p><p><em>39.2.2.3 Intraurethral Alprostadil</em></p><p><em>39.2.2.4 Alprostadil – Topical</em></p><p></p><p></p><p><strong>39.2.3 Devices</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>39.3 Surgical Management</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>39.3.1 Penile Prosthesis</strong></p><p><em>39.3.1.1 Use of Penile Prostheses</em></p><p><em>39.3.1.2 Infection</em></p><p><em>39.3.1.3 Erosions</em></p><p><em>39.3.1.4 Mechanical Failure</em></p><p><em>39.3.1.5 Managing Changes in Penile Length</em></p><p></p><p></p><p><strong>39.3.2 Vascular</strong></p><p><em>39.3.2.1 Arterial</em></p><p><em>39.3.2.2 Venous</em></p><p></p><p></p><p></p><p></p><p><strong>39.4 Future Direction and Experimental Therapy</strong></p><p><em>39.4.1 Extracorporeal Shockwave Therapy</em></p><p><em>39.4.2 Intracavernosal Stem Cell Therapy</em></p><p><em>39.4.3 Platelet-Rich Plasma</em></p><p></p><p></p><p></p><p></p><p><strong>39.5 Conclusion</strong></p><p><strong></strong></p><p><strong><em><u>ED is a multifactorial and complex condition</u> 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.</em></strong></p></blockquote><p></p>
[QUOTE="madman, post: 274985, member: 13851"] The Madmans hot on your trail Dr. Khera LOL! [B]39.1 Introduction[/B] [I]Erectile dysfunction (ED) is defined as the inability to attain and/or maintain sufficient penile rigidity for sexual satisfaction.[B] It is a complex, multifactorial condition that is part of the normal aging process, and thus most commonly affects middle-aged and elderly men.[/B] However, ED is seen in men of all ages, making it a common chief complaint in both primary care and urologic clinics. [B]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.[/B][/I] [B]39.1.1 Psychogenic ED 39.1.2 Organic ED Secondary to Poor Overall Health 39.1.3 Organic ED Secondary to Hypogonadism[/B] [I][B]ED may present as a symptom of testosterone deficiency. [U]While hormone replacement therapy alone is not an effective treatment for ED in these patients[/U] [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].[/B] 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].[/I] [B]39.2 Medical Management 39.2.1 PDE5 Inhibitors[/B] [I]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[/I] [B]39.2.2 Local Therapies[/B] [I]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[/I] [B]39.2.3 Devices 39.3 Surgical Management 39.3.1 Penile Prosthesis[/B] [I]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[/I] [B]39.3.2 Vascular[/B] [I]39.3.2.1 Arterial 39.3.2.2 Venous[/I] [B]39.4 Future Direction and Experimental Therapy[/B] [I]39.4.1 Extracorporeal Shockwave Therapy 39.4.2 Intracavernosal Stem Cell Therapy 39.4.3 Platelet-Rich Plasma[/I] [B]39.5 Conclusion [I][U]ED is a multifactorial and complex condition[/U] 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.[/I][/B] [/QUOTE]
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