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Impotence

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Topic updated on 09/26/16 3:23pm

Snapshot
  • A 65-year-old man with a history of alcoholism, tabacco, and hypertension presents to the urology clinic with complaints of erectile dysfunction
Introduction
  • Common
    • 30 million americans
    • 40% of males at 40
    • 70% of males at 70
  • Primary erectile dysfunction = never been able to sustain erection. Caused by
    • psychological (fear of intimacy, depression, anxiety, guilt)
    • decreased testosterone due to hypothalamic-pituitary disorders
    • hyper and hypothyroidism
    • Cushing's syndrome
  • Secondary erectile dysfunction
    • vascular disease
    • drugs (alcohol, diuretics, clonidine, CNS depressants, antidepressants)
    • neurologic (stroke, temporal lobe seizures)

Presentation
  • History
Evaluation
  • Diagnosis is clinical
  • Nocturnal penile tumescence
Treatment
  • Viagra (cGMP phosphodiesterase inhibitor)
  • Vacuum constrictive devices
  • Intracavernosal prostaglandin injection
  • Testosterone therapy for hypogonadism
  • Behavior therapy
  • Alcohol cessation
  • Surgery
    • penile prostheses implantation


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