ErectileDysfunction

By

Waleed Dawood

Erectile Dysfunction

Meaning :

“ The inability to achieve and maintain a penile

erection satisfactory for sexual intercourse”

(Does not include ejaculation disorders)

Anatomy of the penis

• Tunica Albuginea• Corpora Cavernosa

-- Sinusoid• Corpus Spongiosum

-- Sinusoid• Glans Penis• Artrial supply• Venous drainage• Nerve

Arterial Supply

• Internal iliac artery• internal pudendal artery

[main]– Dorsal artery– Bulbourethral artery– Cavenous artery

• External iliac, Obturator, vesical and femoral artery. [accessory]

Venous drainage

• Emissary veins, transformed from peripheral sinusoids

• Deep dorsal vein [main]• Bulbourethral vein,

Cavernous vein

[ accessory]

Mechanism of erection :

Dilatation arterioles&arteries

expanding of sinusoids

compression of subtunical venular plexuses

Emissary veins enclosed

increasing of intracavernous pressure to raise the penis

Mechanism of Detumescence

Transient intracorporeal pressure increase

[smooth muscle contraction]

Pressure decrease slowly

[slow reopening of the venous channels]

Pressure decrease fast

[venous outflow capacity is fully restored]

Neuroanatomy of penile erection

• Peripheral pathways

– autonomic [ C. Cavenosa & C. Spongiosum]– somatic [ Glans Penis & C. Spongiosum]

Sympa, - NE releaseParasym, + NO & Ach releaseSomatic, +Ach release

Neuroanatomy of penile erection

• Supraspinal pathways [ hypothalamus, limbic system and cerebral cortex]

dopaminergic & adrenergic recepters promotes sexual

drive

serotonin recepters inhibits sexual

drive

Classification of Erectile Dysfunction

• Psycogenic• Neurogenic• Endocrinologic• Arteriogenic• Cavernosal (Venogenic)• Drug-induced• Erectile dysfunction associated with

aging, systemic disease & others

Cause of Erectile Dysfunction

Alcohol AbuseAnxiety or Depression

Coronary Artery DiseaseDiabetes

Hormonal AbnormalitiesHypertension

Peripheral Vascular DiseaseRenal or Hepatic Failure

Anemia SmokingSurgery(Pelvic or Perineal)

Trauma to pelvic or spineMedication : AntiHT,

Antidepressant, Antiarrhythmic,Antipsychotics

Diuretics, Anticonvulsants, Antiandrogen, Narcotics

Treatments of

Erectile Dysfunction

Treatments of Erectile Dysfunction

Drug Therapy :Orally AdministrationIntracarvernous InjectionMUSE or Intraurethral Suppository

Vacuum DevicesHorrmone Replacement TherapySurgeryOthers

• Drug Therapy : Orally Administration

YohimbinePhentolamineApomorphineSildenafil

Treatments of Erectile Dysfunction

Yohimbine

alpha 2 -antagonist

Side effect : anxiety, tachycardia

Treatments of Erectile Dysfunction Drug Therapy : Orally Administration

Apomorphine (Sublingual)

Stimulate brain dopaminergic mechanism

Side effect : nausea, vomit, yawn

Treatments of Erectile Dysfunction Drug Therapy : Orally Administration

Sildenafil

Phosphodiesterase Inhibitor

Side effect : headache, flushing, dyspepsiavisual disturbance

Contraindication : co-administration with nitrateMI, CHF

Treatments of Erectile Dysfunction Drug Therapy : Orally Administration

Intracavernous Injection

vasoactive agents into corpora cavernosaerection

Vasoactive AgentPapaverinePhentolamineAlprostadil

Treatments of Erectile Dysfunction

Intracavernous Injection

Side effect : priapism, small nodule, subcutaneous

hemorrhage, pain, trauma, scar

Treatments of Erectile Dysfunction

Intraurethral suppositories“MUSE” (Medicated urethral system for erection)

Treatments of Erectile Dysfunction

Vacuum Devices

Treatments of Erectile Dysfunction

Hormone Replacement Therapy :

Testosterone

Treatments of Erectile Dysfunction

Surgery

Treatments of Erectile Dysfunction

The End