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
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