Thank You for Referring This <PATAGEUNITS> Old <PATGENDERFULL> with Erectile

Thank you for referring this <PATAGEUNITS> old <PATGENDERFULL> with erectile dysfunction. His symptoms began [one|two|three|four|five|six|seven] [day(s)|week(s)|month(s)|year(s)] ago. He rates the strength of his erections as out of 10. He states his erections are [sufficient|inadequate] for [sexual intercourse|masturbation]. He has [normal|poor] morning erections. He has [normal|poor] sexual desire. He is currently on [no medications|sildenafil (Viagra)|vardenafil (Levitra)|tadalafil (Cialis) on demand|dailytadalafil (Cialis)|intracavernosal injections] for his symptoms. He has tried [no other medications|sildenafil (Viagra)|vardenafil (Levitra)|tadalafil (Cialis) on demand|dailytadalafil (Cialis)|intracavernosal injections] in the past for his symptoms. [He had no improvement with |He had improvement with][anymedications.|sildenafil (Viagra).|vardenafil (Levitra).|tadalafil (Cialis) on demand.|dailytadalafil (Cialis).|intracavernosal injections.][His IIEF score is indicating ][mildED.|moderateED.|severe ED.] He [denies any|complains of] associated penile curvature. [His most recent testosterone level was on .]

With respect to voiding, the patient [denies any bothersome voiding symptoms|complainsof ][frequency|urgency|nocturia|dysuria|weakstream|incompleteemptying|straining]. There is [no|a] family history of prostate cancer. He [has had|denies any previous] PSA tests. [He states the values have been normal.|He states the values have been elevated.|His last PSA was .|His most recent PSA was on .]

DOS

PHYSICAL EXAMINATION: On examination, the patient is [thin|normalweight|overweight|obese|morbidly obese]. Abdomen is soft. There is [no|RUQ|LUQ|RLQ|LLQ|suprapubic area] tenderness. There are [no|RUQ|RLQ|LUQ|LLQ|lowermidline|uppermidline|midline|peri-umbilical|rightflank|leftflank|suprapubic] surgical scar(s). The penis [is unremarkable|has a palpable plaque]. Scrotum [is unremarkable|contains a][right|left][ epididymal cyst| hydrocele]. Testes are [normal volume|atrophic]. DRE reveals a [mildly|moderately|severely] enlarged, [tender|non-tender] prostate. There is [no|rightleft|left>right] assymmetry. There is [no|rightapex|rightmid-lobe|rightbase|leftapex|leftmid-lobe|left base] nodularity.

In summary, <PATFIRSTNAME> <PATLASTNAME> is a <PATAGEUNITS> old <PATGENDERFULL> with erectile dysfunction. I have ordered [no further investigations at this time|serum a.m. testosterone|PSA|HbA1c|urinalysis and culture|CBC]. We reviewed the patient's risk factors for ED including [his weight|smoking|hypertenstion|diabetes|coronary artery disease|his medications]. We discussed how optimizing his risk factors may improve and prevent worsening of his symptoms. We discussed medical management options including therapy with [PDE5-inhibitors|testosterone replacement|intracavernosal injections]. [I provided him with a prescription for ][sildenafil 50-100 mg as directed|tadalafil 20 mg as directed|tadalafil 5 mg daily|testosterone replacement][. The side effect profile, life-threatening interaction with nitrates and instructions for use were discussed in detail. ][The patient denies the recent use of nitrates.|The patient uses nitrates and therefore I cannot safely prescribe a PDE5-inhibitor at this time.][ Given the patient's cardiac disease, I asked the patient to contact his cardiologist to be cleared for sexual activity prior to any medication use.]

[With repsect to his penile curvature, I explained the natural history of Peyronie's disease and our lack of evidence-based, efficacious treatments. I explained that, in general, surgery is reserved for those with curvature that precludes sexual intercourse or significant pain.]

I have made arrangements to see <PATFIRSTNAME> back in [4-6 weeks|3 months|6months|1 year]. I will keep you updated on his progress.