the relation between endotelium dysfuction as a vascular etiology to penile erectile dysfunction

1. ENDOTHELIAL DYSFUNCTION ( ED ) in ERECTILE DYSFUNCTION( ED ) ED = ED M.Y.ABDEL_MAWLA,MD Zagazig Faculty of Medicine,EGYPT

2. Erectile DysFunction( ED )

7. The Whole Picture

9. (L-NMMA) = N(G)-mono-methyl-L-arginine

10. ( L-NMMA ) = N(G)-mono-methyl-L-arginine (L-NMMA) = N(G)-mono-methyl-L-arginine

12. Causes of Erectile Dysfunction( ED ) Endothelial dysfunction ED Smoking Hypogonadism Endocrine Disorders Hypertension Hyperlipidemia Alcohol abuse Drug abuse Anemia Trauma/surgery to pelvis or spine Peyronie’s disease Vascular surgery Depression

14. The Endothelium

15. LUMEN Tunica adventitia Tunica media Tunica intima

16. Vasoconstriction and dilatation Normal Vasoconstriction Vasodilatation

17. Vasoconstriction Vasodilatation Vasoconstriction and dilatation ↓ Resistance to flow ↑ Resistance to flow

18. Endothelial Apoptosis Normal Apoptosed

19. The Endothelium As an Endocrine Organ

25. NO induces synthesis of cGMP by stimulation of GC leading to relaxation of myosin (muscle protein)

28. Endothelin peptides Endothelin-1, a 21-amino-acid peptide, is the predominant isoform of the endothelin peptide family that includes ET-2, ET-3, and ET-4 Endothelin-1 is produced primarily by endothelial cells but can also be synthesized by vascular smooth muscle cells (VSMCs) and by macrophages The action of ET-1 are mediated by 2 receptor subtypes, ETA and E TB receptors

39. ENOTHELIUM DYSFUNCTION( ED )

41. The Mechanism of the Assocation Between Endothelium&Erectile Dysfunction

43. The roles of two forms of nitric oxide synthase in cavernosal smooth muscle relaxation and the initiation and maintenance of penile erection Watts Permission obtained from National Academy of Sciences © Hurt KJ et al . (2002) Proc Natl Acad Sci USA 99: 4061–4066.

45. Endothelial dysfunction in DM

62. Endothelium in Hypertension

63. Endothelial mechanoreceptors changes in hypertension –induced stress

66. Can We Measure Endothelial Function ??

70. What is the Treatment. for Endothelial Dysfunction ??

75. New Horizons in ED Treatment

89. THANK YOU