Erectile dysfunction evaluation

Yohimbine (4.43) is an antagonist. Yohimbine, an indole alkaloid closely related to reserpine—an a antagonist—has been evaluated as a potential treatment for male erectile dysfunction. Naphazoline (4.46) and other a-agonist imidazoline compounds are nasal decongestants, used by inhalation to decrease swelling of the nasal mucosa. Overdependence on and overuse of these drugs can lead to rebound swelling. 

Male Erectile Dysfunction West Midlands Region Development and Evaluation Committee (DEC)... 

Intracavernosal alprostadil was effective and well tolerated in the treatment of erectile dysfunction, according to the results of a 6-month study (funded by Pharmacia Upjohn) in 848 men (mean age 52 years) with at least a 4-month history of erectile dysfunction (12). This is provided that the individual dose is established by titration and patients receive training in injection techniques and periodic supervision during treatment. An initial dose was established for each patient and the patients then administered the alprostadil themselves at home. Of 727 evaluable patients, 682 (94%) had at least one erectile response after the injection of alprostadil, and 88% of injections lead to a satisfactory sexual response. The most commonly reported adverse event was penile pain, reported by 44% of patients, but only after 8% of injections. In just over half of the patients who had penile pain, the condition was reported as mild. Prolonged erection, penile fibrosis, and priapism occurred in 8,4, and 0.9% of patients respectively. Treatment was withdrawn because of medical events in 4% of patients, and drug-related events accounted for treatment withdrawal in 2% of patients. 

Yohimbine is well tolerated at the oral doses used for erectile dysfunction. The main side effects are nausea, dizziness, and nervousness. Headache and skin flushing have also been reported. Yohimbine has no significant effect on jS-adrenergic receptors, and its effect on blood pressure has not been adequately evaluated. Common side effects after parenteral administration include sweating, nausea, and vomiting. Yohimbine penetrates the blood-brain barrier and can produce a complex pattern of responses (93). The central effects include anti-diuresis, a general picture of central excitation including elevated blood pressure and heart rate, increased motor activity, irritability, and tremor. 

With the availability in the late 1990s of effective medications for erectile dysfunction independent of the etiology, diagnostic evaluation of erectile dysfunction became streamlined. " Key assessments include a description of the severity of the erectile dysfunction, a medical history, a review of concurrent medications, a physical examination, and selected clinical laboratory tests. ... 

A physical examination of the patient should include a check for hypogonadism (i.e., signs of gynecomastia, small testicles, and decreased body hair). The penis should also be evaluated for diseases associated with penile curvature (e.g., Peyronie s disease), which are also associated with erectile dysfunction. Femoral and lower extremity pulses should be assessed to provide an indication of vascular supply to the genitals. Anal sphincter tone and other genital reflexes should be checked to provide an indication of the integrity of the nerve supply to the penis. 

Beckman TJ, Abu-Lebdeh HS, Mynderse LA. Evaluation and medical management of erectile dysfunction. Mayo Clin Proc 2006 81 385-390. 

Gauthaman, K., and A.R Ganesan. 2008. The hormonal effects of Tribulus terrestris and its role in the management of male erectile dysfunction—An evaluation using primates, rabbit and rat. Phytomedicine 15(l-2) 44-54. 

Baseline diagnostic evaluation for erectile dysfunction can identify the underlying pathological conditions and associated risk factors in 80% of patients. Such screening may diagnose reversible causes of erectile dysfunction and also unmasks medical conditions that manifest with erectile dysfunction as the first symptom (Hatzichristou et al. 2002). 

The clinical evaluation of patients with erectile dysfunction should he thorough and systematic, with attention to the appropriate use of sexual symptom questionnaires and symptom scales, detailed medical and sexual history, physical examination, and basic screening laboratory tests. Still open is the question of which specific tests such as tumescence and rigidity measurements, intracavernous administration of vasoactive drugs and color/duplex Doppler sonography are required for adequate clinical assessment. 

Detailed evaluation of the penile vascular supply is mandatory to plan intervention in patients with postraumatic erectile dysfunction who are candidates for penile revascularization surgery. These patients are frequently young, have often suffered traumatic straddle injuries to the pelvis and may be unresponsive to oral and intracaver-nosal therapy (Golijanin et al. 2007a Golijanin et al. 2007b). 

As erectile dysfunction occurs in a considerable percentage of patients with Peyronie s disease (Ralph et al. 1992 Ahmed et al. 1998 Kadioglu et al. 2000), evaluation of the penile vessels with Doppler techniques is useful to distinguish different causes for impotence and is critical for detecting subclinical abnormalities of penile hemodynamics that may have a role in postoperative erectile dysfunction (Montorsi et al. 2000). 

Clinical Evaluation of Erectile Dysfunction in the Era of PDE-5 Inhibitors The Residual Role of Penile Color Doppler US... 

Hakim LS (2002) Peyronie s disease an update. The role of diagnostics. Int J Impot Res 14 321-323 Hatzichristou D, Hatzimouratidis K, Bekas M et al (2002) Diagnostic steps in the evaluation of patients with erectile dysfunction. J Urol 168 615-620 Kadioglu A, Tefekli A, Erol H et al (2000) Color Doppler ultrasound assessment of penile vascular system in men with Peyronie s disease. Int J Impot Res 12 263-267 Lobo JR, Nehra A (2005) Clinical evaluation of erectile dysfunction in the era of PDE-5 inhibitors. Urol Clin North Am 32 447-455, vi... 

Fitzgerald SW, Erickson SJ, Foley WD et al (1991) Color Doppler sonography in the evaluation of erectile dysfunction patterns of temporal response to papaverine. AJR Am J Roentgenol 157 331-336... 

Grey-scale and color-Doppler ultrasonographies are the most widely used, non-invasive and readily available imaging modalities for diagnostic purposes in studying erectile dysfunction (Lehmann et al. 1996). In fact, after clinical examination, it is the first tool in imaging algorithms used for the evaluation of the anatomic and functional status of the penis and of the penile vessels in patients who complain of erectile problems (NIH 1993). 

A simplified and reduced version has been developed (Table 6.2), called the Sexual Health Inventory for Men (SHIM), and is used in clinical practice as a valid method to evaluate the severity of erectile dysfunction (Rosen et al. 2002). The SHIM score also allows the efficacy of treatment to be monitored. 

These two indices give a global evaluation of erectile function, but do not assess other sexual disorders since they do not provide information regarding the causes of erectile dysfunction, which can be organic or psychological or secondary to other health issues... 

Ultrasound evaluation of patients with erectile dysfunction should be performed in the appropriate environment, respecting the privacy of the patient. Good quality equipment and transducers suited to evaluation of superficial structures must be used. 

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