Presentation on theme: "Erectile Dysfunction Steven Lun The Townsville Hospital JCU"— Presentation transcript:
1 Erectile Dysfunction Steven Lun The Townsville Hospital JCU Mater Pimlico / Womens & ChildrensFerring Australia Honary Board Member
2 Learning ObjectivesOn completion of this educational activity , participants should be better able toEvaluate specific needs of patients & their expectations of ED treatmentBe able to take a sexual historyImplement ED treatment strategies
3 Erectile Dysfunction Common Problem Inability to maintain an erection firm enough to have sexual intercourse10 % Male population30 million American men
4 Erectile Dysfunction Significantly associated with Increased ageDiabetesCardivascular DiseaseHypertensionDepressionSmokingMedicationsMultifactorial etiology with physical and psychological factors
6 The Past 1960 ‘s 1970 ‘s 1980 ‘s - Understanding early surgery Pumps implants1980 ‘s - UnderstandingInjections 1983 Brindley
7 Role of NO & cGMP NO is released cGMP formed FlaccidityGuanylate CyclaseErectionNitric OxideNO is released cGMP formedLower intracellular calciumPenile smooth muscle relaxationAnd increased blood flow leads toErectionPDE5 terminates NO/cGMP signalingleading to flaccidityGTP5’-GMPPDE5cGMP
8 NO Receptor Diseases with abnormal NO Production Hypertension Obesity DyslipidemiasDiabetes I and IIHeart FailureAtherosclerosisAgingCigarette smoking
9 1980-90’s Andrology IIEF International Index Erectile function Sep Shim EHS Sear Pairs Edits QEQ Sex QNTP testsDynamic cavernosographyHormonal Testing
14 Vacuum DeviceExternally applied device mechanically effects penile blood engorgementCylinder/pump placed over penis creates closed chamber; pump creates vacuum, drawing blood into corpora cavernosaConstrictive elastic ring then placed at base of penis to restrict flow of suctioned blood
15 Vacuum Device Some Advantages Some Disadvantages Non-invasive Drug freeCost effectiveSome DisadvantagesCumbersomeUnnatural erectionErection is not warm to the touchBruising/burst blood vesselsPenile pain/discomfortNumbnessDelayed ejaculation
16 Intracorporeal Injection Therapy A small needle is used to inject medication directly into the penis. The medication allows blood to flow into the penis creating an erection.Some AdvantagesEffective erectionOn-set of erection within 5 to 20 minutes
17 Intracorporeal Injection Therapy Some DisadvantagesRisk of erection lasting 4 hours or more (priapism)Fear of sticking needle in penisPossible bleeding at injection siteRequires trainingPossible pain at injection siteCavernosal fibrosisPoor long-term tolerability
18 Penile ImplantsAn Option For men who have tried other option without success40 year historyHigh patient and partner satisfaction
19 Satisfaction RatesOverall Patient Satisfaction with ED Treatment
21 Three Piece Prosthesis Some AdvantagesTotally concealed in bodyDevice is inflated to provide rigidity and deflated for concealmentErection longevity is controllableWhen deflated, the cylinders are soft and flaccidExpands in girth (all AMS 700® cylinders) and length (AMS 700 LGX ® and Ultrex ® cylinders)
22 Possible RisksWill make latent natural or spontaneous erections as well as other interventional treatment options impossibleIf an infection occurs, the prosthesis may have to be removedMay cause the penis to become shorter, curved or scarredThere may be mechanical failures of the prosthesisUrogenital pain (typically associated with healing process )
25 Physician trends Prescriptions for ED Constant 2007-10 Primary Care Physicians prescribe majority Medicines followed by UrologistsUrologists Start twice as many new prescriptions
26 What Are Patients Looking For PDE5 I – 50 % dissatisfiedCostProduct performanceSpontaneity
27 What Are Patients Looking For Preferences depend onAgeDuration EDPrior Rx ExperienceSexual Dynamics vsDynamics and frequency sexual relationshipsSide effectsDuration of ActionConsistency of responsePartner satisfaction
29 Has Your Doctor Asked Whether You Have Sexual Difficulties?
30 Barriers to Discussing ED PhysicianDiscomfortLack of KnowledgePersonal BiasTime constraintsPatientEmbarrassmentShameIgnorance re normalCultural beliefsReligious beliefs
31 Impact Of Physician Questioning On Patient Report Of Sexual Complaints Spontaneous reporting ~ 14%Reporting after Direct Questioning ~ 55%
32 Why Take A Sexual History Sexual problems may be the harbinger of underlying diseaseSexual health is an Unalienable right of every patientHas the potential to improve patient – physician relationshipSexual problems are eminently treatableImportant part of setting realistic expectations
33 Principles for Sexual History Taking Patients prefer clinician to InitiateAdjust language to the individual patientAssure confidentialityEmpathetic & normalizing statementsDemonstrate lack of embarrassmentCultural SensitivityAvoid judgement statements & assumptionsAvoid ageismAsk the partner if present
34 Sexual Problem Assessment Phases Affected – Tumescence Ejaculation OrgasmLifelong vs acquired ( timeline )Generalized vs situationalSudden vs gradualDistress = BotherPartner based vs self stimulationRigiditySustaining capabilityNocturnal erections
35 Screening for Sexual Dysfunction Open ended Style questions“Men with diabetes often suffer from ED”“Are you having any problems with ? ““Tell me more ““What do you mean by that “
36 Take Home Messages Sexual history taking is important Sexual history is not an innate skillTraining in this area needs improvementBasic Principles are worth followingPractice and comfort development are essentialAppropriately taken history can impact uponPatient diagnosisPatient decision makingPatient satisfaction
37 Case 1 52 Yr old male executive Enquiring re Vasectomy Complains of ED BMI 26Medications Atenolol NexiumWhat Questions would you ask and would you investigate?
38 Case 2 48 Yr Aircraft maintenance Fitter Complains Impotence 5 years F Reseal Deseal exposureComplains Impotence 5 yearsUnable to initiate TumesenceHas Tried Viagra – no benefitParathesia of feetWhat questions and investigations would you ask for
39 Case 3 62 Yr old male 75 kg Ex Medical Rep wishing for Cure of his ED 40 year smokerPSA 8 CaP Gleason 7 – Radical Prostatectomy 2 yr previousNo MedicationsCialis of no benefitWhat Questions would you askAny Investigations you would do ?
40 Case 4 48 Yr Salesman c/o Impotence 5 Years Can initiate Tumesence but soft and premature detumescenceHas tried viagra ,Mens Clinic to no availWife accusing him of playing around threatening to leaveNo medicationsWhat Questions and Investigations would you ask ?