The importance of Erectile dysfunction 17/11/10

Aims:
Understanding the pathophysiology of ED and how it effects patients in the widest sense.
Be able to do a ED consultation effectively
Have a knowledge of the usual history and examination findings for common scrotal lumps.
Objectives:
Know that ED can have a physical or a psychological cause
Know the commonest causes of ED needing investigation are: IHD, Diabetes, BP, Smoking.
Know the drugs which can cause ED as a side effect.
Know that ED is a potent risk factor for Cardiovascular disease
Be confident in asking appropriate ED related questions
Know the three Drugs commonly used in ED and their serious side effects.
Awareness of who can be referred on
Be able to recognise orchitis, inguinal hernia, spermatocele, hydrocele, varicocole and testicular cancer from the history
Be able to recognise common scrotal examinations using examination.
Try and think of ED consultations as being a challenge to diagnose a cause. This is physical in nature in 75% of cases. The most important causes to screen for are
  • Smoking
  • Diabetes
  • Hypertension
  • Ischaemic heart disease
Having ED is a potent indicator of IHD – better than cholesterol!
It is a medical problem and should be investigated and treated medically.
Incidence increases and symptoms become more severe with age. It affects 40% of people over 40 and 70% of 70 year olds. / Psychological factors are huge as it affects confidence, relationships, work and illness behaviour. Treatment is as efficacious as hip replacement!
A surgical sieve can increase the number of causes of ED you can think of.
An ED consultation gives the most powerful lever to help persuade patients of lifestyle change – never forget conservative treatments!
  • Weight loss
  • Taking exercise
  • Stopping smoking
Medicines causing ED:
Beta blockers
Bendroflumethiazide– permanent so should be advised of this to start!
Antidepressants
Cimetidine
Oral meds usually start with Viagra
Consider increasing dose from 25mg to 100mg
It takes 30mins to work
It last for up to 4 hrs
SEXUAL stimulation required.
Cialis
Window 24 -36 hrs
Good duration of erection
Improves lipid profile!
Reduces Systolic and Diastolic BP by 5mmHg each
Can be taken daily or PRN
10 – 20mg dose
Side effects:
Priapism
Rarely blindness in retinal disease
Flushing
Low BP
Deaths linked to ‘situation’ not drug
Contraindictions:
MI 3/12
CVA 6/12
? Nitrates – if using advise to ‘stop activity’ I gets angina and don’t take GTN. Call 999 if rest does not work. / Approx costs:
Viagra £5 dose
Levitra £5 dose
Cialis £60 month daily
Consultation Questions
Onset
Duration
Psychological impact
Relationship impact
Smoking
Background disease?
Drugs causing?
Always a problem?
Early morning erections normal quality?
Priapism Advice
Consider injections if full dose 2 different drugs has no effect.
Initial investigations:
Fasting glucose
Lipid profile in last year
BP
Rarely testosterone levels, U+E , LFT
Consider injections if full dose 2 different drugs has no effect.
Psychological Treatments:
Johnson Masters Technique?
Abstaining from sex, then gradually getting closer over several weeks.
Psychosexual counselling available from relate.
All +- Viagra!
Physical Treatments from a urologist:
Penile implants
Treatment resistant cases
Post cancer ED.
Scrotal Swellings:
Hydrocele
Varicocele
Inguinoscrotal hernia
Testicular cancer
Cysts
Spermatolcele
Fournier’s Gangrene