Erectile Dysfunction

Question 1

What should initially be done if someone presents with erectile dysfunction?

Answer 1

• Bloods
  
  • Lipids
  • Fasting glucose
  • Free testosterone
• Calculate 10 year cardiovascular risk.

Question 2

If free testosterone is low or borderline, what should be done?

Answer 2

• Repeat testosterone again.
• FSH
• LH
• Prolactin levels.

And if these are abnormal then refer to endocrinology for further assessment.

Question 3

When should testosterone be measured?

Answer 3

In the morning between 9 and 11am.

Question 4

What can you use to screen for and assess the severity of ED?

Answer 4

The IIEF-5

Question 5

If serum testosterone levels are consistently below 12nmol/L, what can you do?

Answer 5

Trial of testosterone

Question 6

If you gave a trial of testosterone, how long after would you want to follow up with the patient?

Answer 6

6 months

Question 7

If there was an unsatisfactory response to the tesosterone therapy in the case of hypogonadism , what coud you give with it?

Answer 7

PDE-5 Inhibitor

(Sildenafil)

Question 8

Describe your management strategy for treating erectile dysfunction?

Answer 8

• 1st Line
  
  • PDE5 inhibitors - Sildenafil or Taldalafil
  • Vaccum pumps
• 2nd Line
  
  • Intracavernous or intraurethral Aprostadil.
  • Alprostadil cream injected into meatus.
• 3rd Line - Refer for surgical prosthesis.

Question 9

What advise should you give to all patients and why?

Answer 9

Lifestyle advice

It i thought that ED is an early manifestation of CVD.

Question 10

How do you explain to a patient how they should Aprostadil cream?

Answer 10

• Inject into the meatus.
• Starts to work in 5 to 30 minutes
• Lasts for 1 to 2 hours.

Question 11

What are some S/E of Alprostadil cream?

Answer 11

• Rash
• Tingling
• Pain
• Vaginal Irritation