Diagnostics for Erectile Dysfunction
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Questions and Answers

What is a characteristic of psychogenic erectile dysfunction (ED)?

  • Gradual onset
  • Short duration (correct)
  • Intermittent course (correct)
  • Absence of morning erections
  • Which condition is most commonly associated with organic erectile dysfunction?

  • Performance anxiety
  • Stress
  • Hypertension (correct)
  • Depression
  • What change in morning erections is often observed in organic erectile dysfunction?

  • Present and good quality
  • Intermittent and varying quality
  • Absent or weak (correct)
  • Always strong
  • What role does history taking play in diagnosing erectile dysfunction?

    <p>It differentiates organic from psychogenic ED.</p> Signup and view all the answers

    Which of the following is a focus during the local examination of a patient with erectile dysfunction?

    <p>Evaluation of penile size and conditions</p> Signup and view all the answers

    What is the typical course of organic erectile dysfunction over time?

    <p>Progressive</p> Signup and view all the answers

    Which of the following is NOT a potential cause of erectile dysfunction?

    <p>Regular exercise</p> Signup and view all the answers

    In the context of erectile dysfunction, a history of diabetes would most likely indicate what?

    <p>Organic ED</p> Signup and view all the answers

    What does the intracavernous injection (ICI) test primarily screen for?

    <p>Vasogenic erectile dysfunction</p> Signup and view all the answers

    What is the recommended starting test for evaluating erectile dysfunction?

    <p>Serum testosterone level</p> Signup and view all the answers

    How does nocturnal penile tumescence monitoring help in diagnosing erectile dysfunction?

    <p>It confirms the physical capability of penile erections.</p> Signup and view all the answers

    What factors may be assessed through laboratory investigations in erectile dysfunction patients?

    <p>Fasting blood sugar and serum testosterone</p> Signup and view all the answers

    What happens during the nocturnal erections experienced during REM sleep?

    <p>They are more frequent in adolescents.</p> Signup and view all the answers

    What indicates normal penile hemodynamics during the intracavernous injection test?

    <p>Immediate full rigid erection lasting over 30 minutes</p> Signup and view all the answers

    What kind of tests may be required according to clinical suspicion in erectile dysfunction evaluations?

    <p>Liver and renal function tests</p> Signup and view all the answers

    What is typically the characteristic response in the case of a venous leak during the intracavernous injection test?

    <p>Erection lasts for less than 30 minutes</p> Signup and view all the answers

    What is the primary method used for evaluating penile arteries in cases of penile arteriogenic erectile dysfunction (ED)?

    <p>Duplex Ultrasonography</p> Signup and view all the answers

    Which of the following criteria indicates normal cavernosal arteries during the ICI test?

    <p>Peak systolic velocity more than 25 cm/sec</p> Signup and view all the answers

    What indicates a suspicion of venous leak in the evaluation of erectile dysfunction?

    <p>No or unsustained erection in the ICI test</p> Signup and view all the answers

    What is the normal maintenance rate of saline infusion to achieve and maintain a rigid erection in cavernosometry?

    <p>Less than 15 ml/min</p> Signup and view all the answers

    What characterizes neurogenic erectile dysfunction (ED) in terms of vasoactive agent responses?

    <p>Prolonged erection with minimal agent doses</p> Signup and view all the answers

    What abnormality would suggest a need for selective internal pudendal angiography?

    <p>Delayed erection response in the ICI test</p> Signup and view all the answers

    In patients with erectile dysfunction, increased end diastolic velocity greater than 5 cm/sec in duplex assessment is indicative of what?

    <p>Possible venous leak</p> Signup and view all the answers

    What is the initial criterion for determining arterial health during the ICI test in men with ED?

    <p>Peak systolic velocity greater than 25 cm/sec</p> Signup and view all the answers

    Study Notes

    Reflexes

    • Cremasteric reflex: contraction of the cremaster muscle, elevating the scrotum in response to cold or arousal.
    • Scrotal reflex: regulates the positioning of the scrotum based on temperature.
    • Bulbocavernosus reflex: contraction of bulbocavernosus muscle during penile stimulation, indicating nerve function.

    Diagnostic Procedures for Erectile Dysfunction (ED)

    Laboratory Investigations

    • Essential tests include fasting and post-prandial blood sugar, serum testosterone, and prolactin levels.
    • Additional tests based on clinical suspicion: liver function tests, renal function tests, and thyroid profile (T3, T4, TSH).

    Nocturnal Penile Tumescence (NPT) Monitoring

    • Penile erections typically occur during REM sleep, averaging 4-5 times a night in adolescents.
    • Frequency and duration of erections decrease with age.
    • NPT monitoring differentiates organic from psychogenic ED; the Regiscan is the most precise method for tracking these erections.

    Penile Vascular Studies

    • Intracavernous Injection (ICI) Test:

      • Screens for vasogenic ED using vasodilators (e.g., Prostaglandin E1).
      • Normal response: full rigid erection within 10 minutes lasting over 30 minutes.
      • Delay indicates arterial issues, while unsustained erections suggest venous leaks; in neurogenic ED, prolonged erection occurs with minimal doses.
    • Confirmatory Tests for Penile Arteriogenic ED:

      • Duplex Ultrasonography: evaluates penile arteries; normal shows:
        • Peak systolic velocity >25 cm/sec.
        • Diameter increase >75% post-ICI.
      • Selective Internal Pudendal Angiography: invasive, performed before arterial surgery.
    • Confirmatory Tests for Venogenic ED:

      • Indicated if venous leak is suspected; signs include:
        • No or unsustained erection in ICI test, normal arteries but elevated end diastolic velocity >5 cm/sec.
      • Cavernosometry: assesses intracavernous pressure; normal parameters include:
        • Induction rate <40 ml/min.
        • Maintenance rate <15 ml/min.
        • Pressure drop <40 mm Hg in half a minute post-infusion.

    Causes of ED

    • Systemic disorders: liver, renal, and heart failures.
    • Hyperprolactinemia: associated with various drugs including alcohol and marijuana.
    • Myxedema: affects hormone levels, leading to dysfunction.
    • Medications: estrogen and antiandrogens can contribute to ED.

    Diagnosis of ED

    History Taking

    • Distinguishes between organic and psychogenic ED:
      • Psychogenic: sudden onset, intermittent course, short duration, present morning erections, erections during non-coital occasions.
      • Organic: gradual onset, progressive course, long duration, absent or weak morning erections.

    Physical Examination

    • General: assess blood pressure, pulse, and secondary sexual characteristics.
    • Local:
      • Penis: inspect for Peyronie’s disease, fibrosis, and size.
      • Scrotum: evaluate testis size and consistency; assess prostate and seminal vesicles via rectal examination.

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    Description

    This quiz covers key diagnostic procedures for assessing erectile dysfunction (ED). Focus on understanding the necessary laboratory investigations and reflex tests associated with ED. It is essential for students and professionals in the medical field to familiarize themselves with these critical assessments.

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