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ERECTILE DYSFUNCTION G . POURMAND MD UROLOGY RESEARCH CENTER TEHRAN UNIVERSITY OF MEDICAL SCIENCES MAY-JUNE 2008
LIFE QUALITY OF LIFE
The sumerians GALEN INTRODUCTION
Natural Impotence Supra Natural Impotence   EGYPTIAN PAPYRI
Scythia Rich ( horse Rider ) Poor Hippocrates
Air Influx Hanged Man  ARISTOLE Leonardo Da vinci
The penis does not obey the order of its master  who tries to erect or shrink it at will. Instead the penis erects freely while its master is asleep , the penis must be said to have its own mind by any stretch of the imagination. The penis does not obey the order of its master  who tries to erect or shrink it at will. Instead the penis erects freely while its master is asleep , the penis must be said to have its own mind by any stretch of the imagination.
[object Object],[object Object],ERECTILE DYSFUNCTION
1) Vascular factors (DM,HTN,HLP) 2) Neurogenic factors (Autonomic dysfunction, peripheral neuropathy)  3) Psychogenic (Depression, Anxiety) 4) Endocrine factors (Test, FSH, LH, PRL , hyperthyroidism) 5) Pharmacologic factors (specially antihypertensives) 6) Other factors( Zn deficiency, hypoxemia) ETIOLOGY
American Women 30-50% Risk Factors same as males  Psychogenic 10% Desire Arousal Orgasm  Kaplan (1979)   Excitement, Plateu, Orgasmic, Resolution. Master and Johnson (1966)   Female Sexual Dysfunction
[object Object],[object Object],[object Object],[object Object],Causes of ED:
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
Erectogenic  Nitric oxide (NO) Serotonin (5HT) Dopamine Vasoactive intestinal polypeptide (VIP) Histamine Oxytocin Pituitary adenylate cyclase  activating peptide (PACAP) Calcitonin gene-related  peptide (CGRP) Substance P Erectolytic  Noradrenaline  Neuropeptide Y Gamma-aminobutyric acid (GABA) Neurotransmitters involved in penile erection
Central Erection Pathway Schematic  Central Stimulation (Stimulatory) Imagery  (Inhibitory) Stress Anxiety Dopamine Receptors  Oxytocin Seretonin Parabentricular  Nucleus  Midbrain  Spinal Cord  Cerebral Cortex ERECTION + -
 Physical examination & history  (a)    Sildenafil citrate    Lab.(Ts,PRL,LH,FSH)  (b)    Radiologic evaluation ( colour doppler ultrasonography,etc) a- Massry b- Chopp R.T ,Mendez R.   EVALUATION & DIAGNOSIS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],A Practical Evaluation of Men with ED
E.D Hx & P/E Depression, Vascul.,Medications NPT Ts & PRL NL ABNL Ts ,Bro,Clom. Succ. Fail
NPT NL ABNL Psychog. Doppler,ICI, PGE1 Psy Rx± Hor.Rx NL Succ. Fail AB NL Medications Fail Succ A.&V. Problem Surg Vacc Prosth
ED Hx & PE Sildenafil Response Cont. Sild. No Response Hb. Corr. Sex Hor. Drugs NPT
NPT ABNL NL ICI Doppler with ICI PGE ABNL NL Cont. ICI Corp. Cav. Bx NO Measurement Prosthesis
 
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],TREATMENT
1- Medical  - Ts Replacement  - PRL reduction  - Zn replacement  - Treatment of anemia - PDE5 inhibitors  TREATMENT
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],New Horizons in ED Treatment
[object Object],[object Object],[object Object],[object Object],New Horizons in ED Treatment
[object Object],[object Object],[object Object],[object Object],[object Object],New Horizons in ED Treatment
2- Gene therapy TREATMENT
NITRIC OXIDE ( NO) Neuronal (n NOS)  Endothelial (e NOS)  Inducible (i NOS) Genes and ED
L- Arginine L-Citrulline NO   synthase NITRIC OXIDE
 
NITRIC OXIDE ,[object Object],[object Object],[object Object]
Penile variant of nNOS (Pn NOS) is a reasonable candidate for gene therapy .
[object Object],[object Object],[object Object],[object Object],New Horizons in ED Treatment
[object Object],[object Object],[object Object],[object Object],[object Object],New Horizons in ED Treatment
 
hMaxi-K hMaxi-K isn't just for getting erections; it may also be effective in other ailments including overactive bladder, asthma, irritable bowel syndrome, benign prostatic hyperplasia, premature labor, and premenstrual syndrome. New Horizons in ED Treatment
3 -I.C.I 4 -Penile prosthesis (risk of infection) 5 - Surgery (poor response) TREATMENT
 
Penile Prosthesis Indications: - Patients who have failed other therapies - Peyronie’s disease - Severe vasculogenic disease
Malleable Prosthesis - Easy for patient and partner to use - Few mechanical parts - Same-day surgery usually possible - Least expensive type of prosthesis
Two-Piece Inflatable Prosthesis - Small inflation pump provides comfort and ease - Fast and easy one-step deflation procedure - Better conceal ability when flaccid than with malleable or  self-contained devices
Three-Piece Inflatable Prosthesis -  Most closely approximates the feel of a natural erection - Cylinders expand in girth - Some cylinders have the potential to expand in length - When inflated, it feels more firm and more full than other prosthetic erections - When deflated, it feels softer and more flaccid with better conceal ability than with other prosthetic devices
 
 
 
 
 
 
 
 
 
 Careful evaluation is needed to point out the underlying cause of the main problem.    The treatment must be based on aetiologic factor(s)     PDE5 inhibitors are safe medications for ED; however, new drugs have shown promising results in the ongoing clinical trials. Conclusions
[object Object],[object Object],Conclusions
 

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Erectile Dysfunction

  • 1.  
  • 2. ERECTILE DYSFUNCTION G . POURMAND MD UROLOGY RESEARCH CENTER TEHRAN UNIVERSITY OF MEDICAL SCIENCES MAY-JUNE 2008
  • 4. The sumerians GALEN INTRODUCTION
  • 5. Natural Impotence Supra Natural Impotence EGYPTIAN PAPYRI
  • 6. Scythia Rich ( horse Rider ) Poor Hippocrates
  • 7. Air Influx Hanged Man ARISTOLE Leonardo Da vinci
  • 8. The penis does not obey the order of its master who tries to erect or shrink it at will. Instead the penis erects freely while its master is asleep , the penis must be said to have its own mind by any stretch of the imagination. The penis does not obey the order of its master who tries to erect or shrink it at will. Instead the penis erects freely while its master is asleep , the penis must be said to have its own mind by any stretch of the imagination.
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  • 10. 1) Vascular factors (DM,HTN,HLP) 2) Neurogenic factors (Autonomic dysfunction, peripheral neuropathy) 3) Psychogenic (Depression, Anxiety) 4) Endocrine factors (Test, FSH, LH, PRL , hyperthyroidism) 5) Pharmacologic factors (specially antihypertensives) 6) Other factors( Zn deficiency, hypoxemia) ETIOLOGY
  • 11. American Women 30-50% Risk Factors same as males Psychogenic 10% Desire Arousal Orgasm Kaplan (1979) Excitement, Plateu, Orgasmic, Resolution. Master and Johnson (1966) Female Sexual Dysfunction
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  • 18. Erectogenic Nitric oxide (NO) Serotonin (5HT) Dopamine Vasoactive intestinal polypeptide (VIP) Histamine Oxytocin Pituitary adenylate cyclase activating peptide (PACAP) Calcitonin gene-related peptide (CGRP) Substance P Erectolytic Noradrenaline Neuropeptide Y Gamma-aminobutyric acid (GABA) Neurotransmitters involved in penile erection
  • 19. Central Erection Pathway Schematic Central Stimulation (Stimulatory) Imagery (Inhibitory) Stress Anxiety Dopamine Receptors Oxytocin Seretonin Parabentricular Nucleus Midbrain Spinal Cord Cerebral Cortex ERECTION + -
  • 20.  Physical examination & history (a)  Sildenafil citrate  Lab.(Ts,PRL,LH,FSH) (b)  Radiologic evaluation ( colour doppler ultrasonography,etc) a- Massry b- Chopp R.T ,Mendez R. EVALUATION & DIAGNOSIS
  • 21.
  • 22. E.D Hx & P/E Depression, Vascul.,Medications NPT Ts & PRL NL ABNL Ts ,Bro,Clom. Succ. Fail
  • 23. NPT NL ABNL Psychog. Doppler,ICI, PGE1 Psy Rx± Hor.Rx NL Succ. Fail AB NL Medications Fail Succ A.&V. Problem Surg Vacc Prosth
  • 24. ED Hx & PE Sildenafil Response Cont. Sild. No Response Hb. Corr. Sex Hor. Drugs NPT
  • 25. NPT ABNL NL ICI Doppler with ICI PGE ABNL NL Cont. ICI Corp. Cav. Bx NO Measurement Prosthesis
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  • 30. 1- Medical - Ts Replacement - PRL reduction - Zn replacement - Treatment of anemia - PDE5 inhibitors TREATMENT
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  • 34. 2- Gene therapy TREATMENT
  • 35. NITRIC OXIDE ( NO) Neuronal (n NOS) Endothelial (e NOS) Inducible (i NOS) Genes and ED
  • 36. L- Arginine L-Citrulline NO synthase NITRIC OXIDE
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  • 39. Penile variant of nNOS (Pn NOS) is a reasonable candidate for gene therapy .
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  • 43. hMaxi-K hMaxi-K isn't just for getting erections; it may also be effective in other ailments including overactive bladder, asthma, irritable bowel syndrome, benign prostatic hyperplasia, premature labor, and premenstrual syndrome. New Horizons in ED Treatment
  • 44. 3 -I.C.I 4 -Penile prosthesis (risk of infection) 5 - Surgery (poor response) TREATMENT
  • 45.  
  • 46. Penile Prosthesis Indications: - Patients who have failed other therapies - Peyronie’s disease - Severe vasculogenic disease
  • 47. Malleable Prosthesis - Easy for patient and partner to use - Few mechanical parts - Same-day surgery usually possible - Least expensive type of prosthesis
  • 48. Two-Piece Inflatable Prosthesis - Small inflation pump provides comfort and ease - Fast and easy one-step deflation procedure - Better conceal ability when flaccid than with malleable or self-contained devices
  • 49. Three-Piece Inflatable Prosthesis - Most closely approximates the feel of a natural erection - Cylinders expand in girth - Some cylinders have the potential to expand in length - When inflated, it feels more firm and more full than other prosthetic erections - When deflated, it feels softer and more flaccid with better conceal ability than with other prosthetic devices
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  • 59.  Careful evaluation is needed to point out the underlying cause of the main problem.  The treatment must be based on aetiologic factor(s)  PDE5 inhibitors are safe medications for ED; however, new drugs have shown promising results in the ongoing clinical trials. Conclusions
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