Contemporary Treatment of Erectile Dysfunction (eBook)

Contemporary Treatment of Erectile Dysfunction 3
Preface 5
Contents 7
Contributors 9
Chapter 1: Animal Models for the Study of Erectile Function and Dysfunction 13
Introduction 13
Models Used in the Study of Penile Erection 14
Electrical Stimulation of Peripheral Nerves 14
Pressure Recording in the Corpus Cavernosum 14
Vascular Smooth Muscle Cells In Vitro as a Model System in Erectile Research 15
Reflex Erection Elicited by Peripheral Sensory Stimulation 15
Urethrogenital Reflex 16
Penile Erection in Conscious Animals 16
Ex Copula Erections 16
Noncontact Erections 16
Erection Induced by Electrical and Chemical Stimulation of CNS Structures 16
Models of Erectile Dysfunction 17
Hypertension 18
Aging 18
Diabetes 18
Hypercholesterolemia 18
Cavernous Nerve Injury 19
Hypogonadism 19
Conclusions 19
References 20
Chapter 2: Normal Erectile Physiology 23
Anatomical Review 23
Gross Structure 23
Corpora 24
Glans 24
Arterial Supply 24
Veins 25
Peripheral Innervation 25
Hemodynamics of Erection 27
Flaccid State 27
Tumescence and Erection 27
Detumescence 27
Local Mechanisms of Erection 28
Spinal Control of Erection 28
Supraspinal Control of Erection 29
Paraventricular Nucleus 29
Medial Preoptic Area 30
Other Supraspinal Centers 30
Central Neurotransmission 30
Oxytocin 30
Dopamine 30
Serotonin 31
Nitric Oxide 31
ACTH and a-MSH 31
Other Neurotransmitters 31
References 31
Chapter 3: Psychological Aspects of Erectile Dysfunction 35
Introduction 35
The Brain–Penis Connection 35
The Assessment of Psychological Factors in ED 36
Organic Versus Psychogenic ED 36
The Assessment Process 37
Talking to Patients about Sexual Problems 37
Assessment by History 39
Immediate Factors 41
Individual 41
Interpersonal 42
Underlying Factors 42
Individual 42
Interpersonal 43
Comorbid Mental Health Problems in ED 43
The Development of ED 44
Outcome of Psychological Treatments for ED 45
Integration of Medical and Psychological Interventions for ED 47
Key Points 48
References 48
Chapter 4: Epidemiology of Erectile Dysfunction and Key Risk Factors 50
Background and Overview 50
ED Progression and Remission 53
ED Findings From the Boston Area Community Health Survey 53
Discussion 56
References 57
Chapter 5: Etiology and Risk Factors of Erectile Dysfunction 61
Introduction 61
Epidemiology and Risk Factors 61
Erectile Physiology 62
Cardiogenic and Vascular Correlates with ED 62
Atherosclerosis 63
Cholesterol 63
Hypertension 63
Coronary Artery Disease 64
Obesity 64
Cardiac Risk Association with Severity of ED 65
Diabetes 65
Treatment of ED in Diabetics 66
Metabolic Syndrome 66
Respiratory Disease and Erectile Dysfunction 67
Chronic Obstructive Pulmonary Disease 67
Obstructive Sleep Apnea 67
Neurogenic Factors 67
Parkinson’s Disease and Alzheimer’s Disease 67
Multiple Sclerosis 68
Epilepsy 68
Spinal Cord Injury 68
Cerebrovascular Accidents 68
Peripheral Nerve Injury 68
Psychogenic Risk 69
Depression 69
Endocrine Risk Factors 69
Testicular Failure 69
Androgen Deficiency 69
Hypogonadism 70
Hyperprolactinemia 70
Thyroid Disease 70
Drug-Induced ED 71
Selective Serotonin Reuptake Inhibitors 71
Antihypertensive Agents 71
Statins 71
Antipsychotics 71
Antiandrogens 71
Illicit Substances and Nicotine 72
Ethanol 72
Age and Chronic Illness 72
Benign Prostatic Hypertrophy and Lower Urinary Tract Symptoms 72
Key Points 73
References 73
Chapter 6: Making the Diagnosis of Erectile Dysfunction 78
Introduction 78
Diagnosis of ED: Basic Diagnostic Tools 79
Medical and Sexual History 79
Physical Examination 80
Laboratory Tests 80
Establishing Cardiovascular Risk 81
Scales (Self-Administered Questionnaires) 82
What Do We Get from the First Consultation for ED? 82
Additional Diagnostic Tools 82
Nocturnal Penile Tumescence and Rigidity Test 83
Pharmacological Erection Test 84
Duplex/Doppler Penile Ultrasound 84
Dynamic Infusion Cavernosometry and Cavernosography 85
Phalloarteriography 85
Neurological Evaluation 86
Working Toward a Diagnostic Algorithm 86
References 88
Chapter 7: Drugs that Affect Sexual Function 90
Control of Erection and Male Sexual Function 90
Drug-Induced Sexual Dysfunction and its Mechanisms 92
Antihypertensive Agents 92
Psychotropic Medications 94
Hormonal Agents 95
Lipid Lowering Medication 96
Miscellaneous 97
Toxins and Recreational Drugs 97
Management of Drug-Induced Sexual Dysfunction 98
References 99
Chapter 8: Oral Therapy for Erectile Dysfunction 101
Introduction 101
Definition 101
Historical Perspective 102
First Line Therapy 102
Mechanism of Erection 102
Neurologic 102
Vascular 102
Oral Phosphodiesterase Inhibitors 103
Viagra® 104
Levitra® 105
Cialis® 105
Cardiovascular Assessment 106
Comparison of PDE-5 Inhibitors 106
Other Oral Therapy 108
Combination Therapy 109
Future of Oral Therapy 111
Conclusion 111
References 111
Chapter 9: Self-Injection, Transurethral and Topical Therapy in Erectile Dysfunction 115
Introduction 115
PGE1 (Alprostadil) 116
Administration 117
Side Effects 118
Alprostadil Summary Points 119
Papaverine 119
Administration 120
Side Effects 120
Papaverine Summary Points 120
Phentolamine 120
Side Effects 120
Intracavernous Injection Combinations 120
Bimix (Papaverine, Phentolamine) 121
Trimix (PGE1, Papaverine, Phentolamine) 121
Quadmix (PGE1, Papaverine, Phentolamine, Atropine) 122
ICI Combination Summary Points 122
Selection of Injectable Agents 122
Notes on the Clinic Visit 123
Contraindications to Ici 123
Management of Side Effects 123
Contraindications and Side Effects Summary Points 125
Muse™ 125
Efficacy 125
Administration 126
Side Effects 126
MUSE™ Summary Points 126
Topicals 127
Efficacy 127
Topical Agent Summary 127
Treatment of Erectile Dysfunction After Radical Prostatectomy 127
Post-prostatectomy Penile Rehabilitation Summary Points 128
Conclusion 129
References 131
Chapter 10: Quantification of Erectile Dysfunction After Prostate Cancer Treatment 134
Introduction 134
ED Quantification, Biological Variability, and Study Validity 134
Internal Validity in ED Quantification 143
ED Definition 143
ED Measurement 144
Time Frame Utilized 149
Pt Versus MD Reported 150
Attrition Bias 150
Chance 150
External Validity in ED Quantification 150
ED Comorbidities 151
Patient Interest and Partner Availability 151
Age 151
Baseline Sexual Function 152
Surgeon Factors 152
Number of Nerves Spared 153
Conclusion 153
References 154
Chapter 11: Vacuum Constriction Device: A New Paradigm for Treatment of Erectile Dysfunction 158
Introduction 158
History 159
Mechanism of Action 159
Indications and Contraindications 160
Erectile Dysfunction 161
Penile Rehabilitation 161
Penile Length Preservation 161
Contraindications 161
Evidence 162
Data From Nih Seer Program 163
Complications 165
The Future of VCD Therapy 166
References 166
Chapter 12: Hormonal Evaluation and Therapy in Erectile Dysfunction 168
Introduction 168
Androgens and Erectile Dysfunction 169
General Concepts 169
Androgens in Physiology and Pathophysiology of Erectile Dysfunction 169
Testosterone in the Brain 169
Testosterone in Peripheral Nerves 170
Testosterone and the Vasculature 171
Testosterone in the Penis 171
Vascular Endothelium 172
Trabecular Smooth Muscle 172
Connective Tissue 172
Tunica Albuginea 172
Evaluation of Androgen Status in Men with Erectile Dysfunction 173
Medical History 173
Physical Examination 174
Laboratory Study of Hypogonadism 174
Total Testosterone 174
Free Testosterone 174
Additional Blood Tests 175
Treatment of the Hypogonadal Man with Erectile Dysfunction 175
Patient and Partner Education 175
Modifying Reversible Causes 175
Hormonal Treatment 176
Forms of Testosterone Therapy 176
Topical Gels 176
Transdermal Patches 177
Testosterone Injections 177
Implantable Pellets 177
Buccal Pellets 177
Oral Forms of Testosterone 177
Anti-estrogenic Oral Agents 177
Human Chorionic Gonadotropin 177
Monitoring Patients in Testosterone Replacement Therapy 178
Risks of Testosterone Therapy 178
Other Hormones and Erectile Dysfunction 178
Prolactin 178
Estradiol 179
Thyroid Hormone 179
Cortisol 179
Growth Hormone 179
Conclusions 180
References 180
Chapter 13: Cardiovascular Issues in the Treatment of Erectile Dysfunction 185
Introduction 185
Cardiovascular Response to Sexual Activities 186
Sexual Activity as a Cardiac Risk Factor 188
Key Points 188
Treating ED in Patients with CVD 188
Introduction 188
Lifestyle Factors 189
Androgens 191
Phosphodiesterase Inhibitors 191
Other Therapies 192
Non-arteritic Anterior Ischemic Optic Neuropathy 192
Key Points 192
ED as a Predictor of Occult CAD 192
Key Points 195
Cardiovascular Risk Reduction in Patients with ED 195
Exercise Electrocardiography or Cardiac Computed Tomography? 196
Key Points 197
Conclusion 197
References 197
Chapter 14: The Penile Prosthesis Option for Erectile Dysfunction 200
Introduction 200
Preoperative Period 201
Operative Procedure 203
Complications 205
Patient and Partner’s Satisfaction 208
Summary 209
References 209
Chapter 15: The Effect of Radical Prostatectomy on Erectile Dysfunction 212
Introduction 212
The Pathophysiology of Erectile Dysfunction after Radical Prospect 213
Cavernosal Oxygenation 214
Venous Leak 215
Animal Data Supporting the Concept of Penile Rehabilitation 217
Human Data Supporting the Concept of Penile Rehabilitation 218
The Role of Penile Rehabilitation 221
Structure of a Rehabilitation Program 222
References 223
Chapter 16: Peyronie’s Disease: Natural History, Diagnosis, and Medical Therapy 226
Introduction 226
Epidemiology 226
Natural History 227
Etiology of Peyronie’s Disease 227
Clinical Manifestations 228
Patient Evaluation 229
History 229
Physical Exam 230
Measurement of Erectile Function and Degree of Curvature 231
Imaging and Vascular Studies 231
Medical and Nonsurgical Therapy 231
Intralesional Therapy 231
Verapamil 231
Collagenase 234
Interferon a-2b 234
Iontophoresis and Topical Therapy 234
Iontophoresis 234
Superoxide Dismutase (Orgotein, Lipoxysan®) 234
Verapamil 235
Topical Verapamil 235
Oral Therapy 235
l-Carnitine 235
Potaba™ 235
Pentoxifylline 235
Vitamin E 236
Tamoxifen 236
Colchicine 236
Other Nonsurgical Treatments 236
Penile Traction 236
Shock Wave Therapy 237
Summary of Nonsurgical Treatment Options 237
Key Points 237
References 237
Chapter 17: Peyronie’s Disease: Surgical Therapy 242
Overview and Historical Perspective 242
Penile Anatomy and Pathophysiology 243
Summary Points 244
Patient Presentation and Evaluation 245
Summary Points 245
Surgical Management 245
Summary Points 246
Nesbit Procedure 246
Summary Points 247
Plication Procedures 247
Summary Points 247
Plaque Excision/Incision With Tissue Grafting 249
Summary Points 249
Penile Prosthesis 250
Summary Points 251
Conclusion 251
References 252
Chapter 18: Priapism: Medical and Surgical Therapy 254
Introduction 254
Epidemiology 255
Etiology 255
Hematological Dyscrasias 255
Erectogenic Pharmacotherapy 256
Non-erectogenic Pharmacotherapy 256
Neurological Disorders 257
Trauma 257
Sold Organ Malignancies 257
Idiopathic 257
Pathophysiology 257
Molecular Pathology 258
Pathology 259
Classification 259
Ischemic Priapism 259
Non-ischemic Priapism 260
Stuttering Priapism 260
Neurogenic Priapism 260
Refractory Priapism 260
Idiopathic Priapism 260
Drug-Induced Priapism 261
Natural History 261
Diagnosis 261
History 261
Clinical Examination 262
Laboratory Evaluation 262
Radiological Evaluation 262
Treatment 262
Ischemic Priapism 263
Aspiration With/Without Irrigation 263
Intracorporal Sympathomimetic Administration 264
Penile Shunts – Distal and Proximal Corporoglanular (Cavernoglanular) 264
Penile Prosthesis Insertion 264
Non-ischemic Priapism 265
Observation 265
Arterial Embolization 265
Surgical Ligation 266
Treatment of Systemic Diseases, e.g. Sickle-Cell Disease 266
Prophylactic Treatment 266
Miscellaneous Therapies 267
Risk Management 267
Summary 267
Key Points 267
References 268
Chapter 19: Ejaculatory Disorders 272
Introduction 272
The Physiology of Ejaculation 272
Emission Phase 273
Expulsion Phase 273
Premature Ejaculation 274
Etiology 274
Diagnosis 274
Treatment 276
Behavioral Techniques 276
Pharmacological Therapies 276
Topical Therapies 276
Oral Therapies 276
Miscellaneous Approaches 279
Inhibited Ejaculation (Delayed Ejaculation and Anejaculation) 279
Etiology 279
Diagnosis 280
Treatment 280
Painful Ejaculation 281
Etiology 281
Diagnosis 281
Treatment 282
Conclusions 282
References 282
Index 285