Medical Management (PDF)

10/18/23, 4:53 AM Realizeit for Student Medical Management Treatment can be medical, surgical, or both, depending on the cause. Treatment of erectile dysfunction includes therapy for associated disorders (e.g., alcoholism, diabetes) or adjustment of medications (McMahon, 2019). Endocrine therapy i...

10/18/23, 4:53 AM Realizeit for Student Medical Management Treatment can be medical, surgical, or both, depending on the cause. Treatment of erectile dysfunction includes therapy for associated disorders (e.g., alcoholism, diabetes) or adjustment of medications (McMahon, 2019). Endocrine therapy instituted to treat erectile dysfunction secondary to hypothalamic–pituitary–gonadal dysfunction may reverse the condition. Insufficient penile blood flow may be treated with vascular surgery. Patients with erectile dysfunction from psychogenic causes are referred to a health care provider or therapist who specializes in sexual dysfunction. Patients with erectile dysfunction secondary to organic causes may be candidates for penile implants. Currently available therapies for the treatment of erectile dysfunction include pharmacologic therapy (including urethral suppositories), penile implants, and vacuum constriction devices (see Table 53-2). These options should be considered in a stepwise fashion, with increasing invasiveness and risk balanced against the likelihood of efficacy. The patient and, if possible, his partner, should be informed of the relevant treatment options and their associated risks and benefits. The choice of treatment is made jointly by the primary provider, patient, and partner, taking into consideration patient preferences and expectations. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXpO%2fe0zb8VXpgr8WpGa5yIKHGedfP1dqOEseKVJL%2… 1/5 10/18/23, 4:53 AM Realizeit for Student https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXpO%2fe0zb8VXpgr8WpGa5yIKHGedfP1dqOEseKVJL%2… 2/5 10/18/23, 4:53 AM Realizeit for Student Penile Implants https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXpO%2fe0zb8VXpgr8WpGa5yIKHGedfP1dqOEseKVJL%2… 3/5 10/18/23, 4:53 AM Realizeit for Student Two general types of penile implants are available: the malleable, noninflatable, nonhydraulic prosthesis (also called the semirigid rod) and the inflatable, hydraulic prostheses (Lindsey, Lue, & Shindel, 2020). The semirigid rod (e.g., the Small–Carrion prosthesis) results in a permanent semierection but can be bent into an unnoticeable position when appropriate. The inflatable prosthesis simulates natural erections and natural flaccidity. Complications after implantation include infection, erosion of the prosthesis through the skin (more common with the semirigid rod than with the inflatable prosthesis), and persistent pain, which may require removal of the implant. Subsequent cystoscopic surgery is more difficult with a semirigid rod than with the inflatable prosthesis. Factors to consider in choosing a penile prosthesis are the patient’s activities of daily living, social activities, and the expectations of the patient and his partner. Ongoing counseling for the patient and his partner is usually necessary to help them adapt to the prosthesis. Penis Transplants In the United States, a few medical centers have protocols for penis transplants. Candidates for transplantation include military veterans and other men who have suffered traumatic penile injuries. It is believed that men undergoing this surgery will have their ability to urinate and their sexual functioning restored (Ngaage, Elegbede, Sugarman, et al., 2020). Negative-Pressure Devices Negative-pressure (vacuum) devices may also be used to induce an erection. A plastic cylinder is placed over the flaccid penis, and negative pressure is applied. When an erection is attained, a constriction band is placed around the base of the penis to maintain the erection. To avoid penile injury, the patient is instructed not to leave the constricting band in place for longer than 1 hour. Only devices with a vacuum limiter are recommended for use (Sikka & Hellstrom, 2017). Although many men find this method satisfactory, others experience premature loss of penile rigidity or pain when applying suction or during sexual activity. Nursing Management Personal satisfaction and the ability to sexually satisfy a partner are common concerns of patients. Men with illnesses and disability may need the assistance of a sex therapist to identify, implement, and integrate their sexual beliefs and behaviors into a healthy and satisfying lifestyle. The nurse can inform patients about support groups for men with erectile dysfunction and their partners. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXpO%2fe0zb8VXpgr8WpGa5yIKHGedfP1dqOEseKVJL%2… 4/5 10/18/23, 4:53 AM Realizeit for Student https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXpO%2fe0zb8VXpgr8WpGa5yIKHGedfP1dqOEseKVJL%2… 5/5