Erectile dysfunction (Treatment)
Treatment of Erectile Dysfunction:
- Correct reversible causes
- Alter lifestyle
- Stop smoking
- Change medications
- Psychosexual therapy
- Sex education
- Psychosexual counselling
- Instruction on improving partner communication skills
- Cognitive therapy
- Behavioural therapy
- Pharmacotherapy
- Drug therapy
- PDE5 Inhibitors
- sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra)
- Enhance cavernosal smooth muscle relaxation
- Block the breakdown of cGMP by phosphodiesterase
- Success 80%
- Early use after RP is recommneded
- Contraindications:
- Nitrates
- Recent myocardial infarction
- Recent stroke
- Hypotension
- Unstable angina
- NAION (Non arteritic anterior ischaemia optic nerve neuropathy)
- Cautions
- Intermediate/high risk cardiovascular disease (needs cardiac review)
- Alpha blockers use
- Groups with predisposition to priapism
- Dopamine receptor agonist
- Apomorphine: sublingually, acts centrally on dopaminergic receptors in the paraventricular nucleus of the hypothalamus to enhance and coordinate the effect of sexual sitmuli.
- Intraurethral therapy http://www.muserx.com/hcp/local-vasodilation-therapy-for-ed/mechanism-of-action.aspx
- Synthetic prostaglandin E1 (PGE1) pellet (Alprostadil) intra urethrally
- PGE1 increases cAMP within the corporal smooth muscle, resulting in muscle relaxation.
- SEs: Penile and urethral pain, priapism, local reactions.
- Intracavernosal injection therapy
- Alprostadil (Caverjet ™)
- papaverine (PDE inhibitor)
- In combination with phentolamine (alpha antagonist) or PGE1
- Contraindications:
- Sickle cell disease
- High risk candidates for priapism
- Vaccuum erection device
- When pharmacotherapies have failed.
- Three components:
- Vaccum chamber
- Pump
- Constriction band
- Penis is placed in chamber,
- Vaccum created increases blood flow to corpora cavernosa,
- Constriction band is placed on the base of the penis to maintain rigidity.
- Contraindication:
- Side effects
- Microvascular arterial bypass and venous ligation srugery
- Increase arterial inflow and decrease venous outflow
- Penile prosthesis
- Semi rigid or Malleable
- Inflatable (2 chamber, 3 chamber)
- Indications
- Other therapies failed
- Peyronie’s disease
- Trauma
- penile fibrosis (i.e. secondary to priapism)
- High satisfaction rates (90%)
- SEs:
- Infection
- Erosion
- Mechanical failure
- Penile shortening
- Glans may not fully engorge
- Testosterone replacement therapy
- Indications
- Oral
- Buccal
- Intramuscular
- Pellet
- Transdermal patch
- Gel forms
- PSA, Hb, LFT, before and after starting treatment
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