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Erectile Dysfunction
Medical Treatment
R. Taghavi MD
Professor of Urology
Mashhad University of Medical Sciences
March 2012
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Introduction
Erectile dysfunction (ED , impotence) and
premature ejaculation (PE) are two main
complaints in male sexual medicine.
EAU guidelines for ED or impotence march 2011
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Erectile dysfunction
- Is a common worldwide
- ED is a symptom, not a disease. Some men may
not be properly evaluated or receive treatment
for an underlying disease or condition that may
be causing ED.
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Erectile dysfunction
- Is a common worldwide
- ED is a symptom, not a disease. Some men may not be properly evaluated or receive treatment for an underlying disease or condition that may be causing ED.
ED shares several risk factors with
cardiovascular disease
Lifestyle modification (intensive exercise and
a decrease in BMI) can improve erectile
function
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Treatment of ED
Primary goal
Is to determine the etiology of the disease
and treat it when possible
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Treatment of EDPrimary goal
Is to determine the etiology of the disease and
treat it when possible
Treat the symptom “ED” alone
ED is a symptom, not a disease
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Treatment of ED
As a rule, ED can be treated successfully with
current options, but can not be cured exceptions:
- Psychogenic ED
- Post-traumatic arteriogenic ED in young patients
- Hormonal causes e.g.hypogonadism,hyperprolactinemia
Which can be potentially cured with specific treatment
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Curable causes of EDHormonal causes
Testosterone deficiency:
- Primary testicular failure
- Secondary to pituitary/hypothalamic causes
Testosterone replacement therapy is effective
- IM , oral and transdermal
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Curable causes of EDHormonal causes
Testosterone replacement
Contraindications = Men with:
- History of prostate carcinoma
- Symptoms of prostatism
Caution:
- DRE+PSA before testosterone therapy
Monitor:
- Clinical response
- Development of hepatic or prostatic disease
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Curable causes of ED
Testosterone replacement
Men with coronary artery diseases no
contraindication, however, the hematocrite
level should be monitored and a close
adjustment of testosterone may be
necessary, specially in CHF
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Curable causes of EDPsychosexual counseling therapy
For patients with a significant psychological
problem
Psychosexual therapy alone or with another
therapeutic approach
Takes time and has had variable results
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Treatment of EDUnknown cases of ED
Three lines
First-line therapy
Second-line therapy
Third-line therapy (penile prostheses)
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Treatment of ED
First-line therapy
Oral pharmacotherapy
Topical pharmacotherapy
Vacuum constriction devices “VCD”
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Treatment of ED
Second-line therapy
Patients not responding to oral drug with
high success rate of 85%
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Treatment of EDSecond-line therapy
1. Intracavernous injections
- Monotherapy “Alprostadil PGE1”
- Combination therapy:
* Papaverine + Phentolamine
* Papaverine + Phentolamine + PGE1
2. Intraurethral alprostadil “PGE1”
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Treatment of EDOral pharmacotherapy
Mechanism action
The PDE5 enzyme hydrolyses cyclic
guanosine monophosphate (cGmp) in the
cavernosum tissue of the penis.
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