ERECTILE DYSFUNCTION

Question 1

True or False

Normal male erections are a neurovascular event relying on an intact autonomic and somatic nerve supply to the penis, arterial blood flow supplied by the paired cavernosal arteries, and smooth and striated musculature of the corpora cavernosa and pelvic floor

Answer 1

True

Question 2

Erections are caused and maintained by what?

Answer 2

1. increase in arterial blood flow
2. relaxation of smooth muscle within the sinusoids of the corpora cavernosa
3. increase in venous resistance

Question 3

What is the key neurotransmitter that initiates and sustains erections?

Answer 3

Nitric oxide

Question 4

What is the consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance?

Answer 4

ED

Question 5

ED can have organic and what other etiologies that can frequently overlap?

Answer 5

psychogenic

Question 6

Organic erectile dysfunction may be an early sign of what?

Answer 6

cardiovascular disease

Question 7

Loss of libido may be indicative of what?

Answer 7

androgen deficiency

Question 8

The most common cause of ED is a decrease in arterial flow resultant from what?

Answer 8

progressive vascular disease

Question 9

Medications such as what are associated with ED?

Answer 9

1. Antihypertensive
2. Antidepressants
3. Opioids

Question 10

What is a fibrotic disorder of the tunica albuginea of the penis resulting in the varying degrees of penile pain, curvature, or deformity?

Answer 10

Peyroine disease

Question 11

What is the loss of seminal emission?

Answer 11

anejaculation

Question 12

Androgen deficiency by decreasing prostate and seminal vesicle secretions may cause what?

Answer 12

anejaculation

Question 13

Sympathetic denervation as a result of spinal cord injuries, DM, or pelvic or retroperitoneal surgery or radiation may cause what?

Answer 13

anejaculation

Question 14

True or False

Severity, intermittency, and timing is an important part of the patient history for ED

Answer 14

True

Question 15

These are all important lifestyle factors in the patient history of patients with what?

1. sexual orientation
2. relationship quality
3. alcohol
4. tobacco
5. marijuana
6. recreational drugs
7. use of porn to maintain arousal

Answer 15

ED

Question 16

History of these listed below are important portions of the medical history in patients with what?

1. Meds
2. Dyslipidemia
3. HTN
4. Depression
5. Neuro disease
6. Pelvic trauma, surgery, irradiation
7. Prostate cancer
8. Peyronie disease

Answer 16

ED

Question 17

True or False

The ability to attain but not maintain an erection may be the first sign of endothelial dysfunction and further cardiovascular risk stratification should be considered

Answer 17

True

Question 18

What are some labs would you run for an ED patient?

Answer 18

1. Lipid profile
   a. evaluating for dyslipidemia
2. Glucose
   a. evaluating for DM
3. Testosterone
   a. if abnormalities are found
   1. Free testosterone (drawn between 8-10am)
   2. Luteinizing hormone

Question 19

What are good lifestyle modifications that can help with ED and reduce cardiovascular risk factors?

Answer 19

1. smoking cessation
2. reduced alcohol intake
3. diet
4. exercise

Question 20

Men with psychogenic component of ED may benefit from what?

Answer 20

sexual health therapy or counseling

Question 21

Hormonal replacement is managed by who?

Answer 21

Urology

offered to men with hypogonadism

Question 22

What oral agents can be given to patients with ED?

Answer 22

Phosophodiesterase-5 inhibitors

1. Sildenafil (Viagra)
2. Vardenadil (Levitra)
3. Tadalafil (Cialis)
4. Avanafil (Stendra)

Question 23

What are some alternative treatments for ED?

Answer 23

1. Urethral injectable – Prostaglandin E2
2. Vacuum erection device
3. Penile prosthetic
4. Vascular reconstruction

Question 24

Should you MEDEVAC a patient with a prolonged penile erection greater than 4 hours?

Answer 24

YES

can result in an ischemic injury of the corpora cavernosa from venous congestion and cessation of arterial inflow

Question 25

True or False Ischemic priapism is a medical emergency requiring immediate medical or surgical intervention to avoid irreversible penile damage

Answer 25

True

Question 26

Where should patients with ED with the following be reffered? 1. Priapism (MEDEVAC) 2. Initial oral therapy initiation 3. Inadequate response to meds 4. Unable to tolerate side effects 5. Peyronie disease or other penile deformity 6. History of pelvic or perineal trauma, surgery, or radiation

Answer 26

Urology