what are the causes of ED?
- vascular - risk factors as per IHD
- neurological e.g diabetes, CVA, spinal injury, parkinsons
- Hormonal e.g low testosterone
- medication e.g anti depressants, beta blockers
- psychological
what is ED important?
- sensitive marker of early vascular disease
- very important to asses CVS risk
- can potentially mitigate risk of MI, CVA etc.
how can you differentiate between organic and psychological E.D?
speed of onset
- gradual = organic
- sudden = psychological
also, presence of early morning erections absent in organic.
what investigations can be done for ED?
- asses vascular risk factors e.g BP, lipids, glucose, smoking
- early morning testosterone
- prolactin, LH, FSH, PSA is debatable
how can ED be managed?
- psychosexual counselling if psychological
- PDE5 inhibitors
- treat low testosterone if present
- intracavernosal prostaglandin injections
- vacuums tumescence device
- inflatable penile prosthesis
what is phimosis and how does it differ from paraphimosis?
inability to retract the foreskin - can be physiological e.g in a child (if persists into adulthood offer circumcision)| or scarred.
unlike paraphimosis where foreskin is retracted and can’t be rolled back up
what is priapism?
sustained painful erection that persists without sexual stimulation
- common cause is drugs or over use of PD5 inhibitors
- can be caused by venous occlusion
- aspirate to treat or get them to exercise to move blood away from penis
if its high flow, treat with painless angioembolisation of the fistula.
what are some of the risk factors for forniers gangrene aka necrotising fascilata?
- older age
- diabetes
- obesity
- cardiovascular disorders
- alcoholism
- long-term corticosteroid treatment
- malignancy
- HIV
- trauma
how can you get fourniers gangrene?
In general, organisms from the urinary tract spread along the fascial planes to involve the penis and scrotum.
how can fourniers gangrene be treated?
get surgical debribement to treat
what is pirones disease?
fibrosis in the corpus cavenosa = bend in penis. associated with drupypetens contracture
what is a penile fracture?
rupture of the tunica albigenea - blood contained by bucks fascia = get aubergine deformation.
SURGICAL EMERGENCY.
