Erectile dysfunction organic

Box 36.1 Erectile dysfunction organic, psychological or mixed aetiology ... 

Differentiate between organic and psychogenic erectile dysfunction (ED) and describe the etiology and pathophysiology of each. 

Patients who are using certain drugs for erectile dysfunction (eg, sildenafil citrate), because these drugs have been shown to potentiate the hypotensive effects of organic nitrates (sublingual tablets, lingual spray, transdermal). 

Erectile dysfunction, that is, the inability to maintain penile erection for the successful performance of sexual activity, has both organic and psychogenic causes, including as a sequelae to prostatic surgery. Erectile dysfunction is estimated to affect up to 30 million men in the United States. Previous therapies have included penile implants, and intrape-nile injections of alprostadil (see p. 420). Sildenafil [sil DEN a HI], the first oral drug approved for the treatment of erectile dysfunction in males, was introduced in early 1998. 

The combination of organic nitrates and sildenafil citrate (Viagra) can precipitate life-threatening hypotension in patients with angina (112). Sildenafil is a selective inhibitor of cyclic GMP-specific phosphodiesterase type 5, which causes smooth muscle relaxation and vasodilatation, and is an effective treatment for male erectile dysfunction. More than 3.6 million prescriptions have been issued as of August 1998, and so far there have been 69 deaths, 12 of which were attributable to the interaction with nitrates, as reported to the FDA. 

The American Urological Association Erectile Dysfunction Clinical Guidelines Panel, The Treatment of Organic Erectile Dysfunction, 1996, available online at http //shop.auanet. org/timssnet/products/clinical guidelines/ed. pdf, accessed on September 18,2001. 

Erectile dysfunction can result from any single abnormality or combination of abnormalities of the four systems necessary for a normal penile erection. Vascular, neurologic, or hormonal etiologies of erectile dysfunction are collectively referred to as organic erectile dysfunction. About 80% of patients with erectile dysfunction have the organic type. Patients who fail to respond to psychogenic stimuli have psychogenic erectile dysfunction. 

Finally, patients must be in the proper mental frame of mind to be receptive to sexual stimuli. Patients who suffer from malaise, have reactive depression or performance anxiety, are sedated, have Alzheimer s disease, have hypothyroidism, or have mental disorders, commonly complain of erectile dysfunction. In most studies, patients with psychogenic erectile dysfunction generally exhibit a higher response rate to various interventions than do patients with organic erectile dysfunction, as their disease is often less severe. 

A medical history should be obtained to identify concurrent medical illnesses that are risk factors for organic or psychogenic erectile dysfunction. If these underlying diseases are not optimally responding to treatment, this should be addressed before specific treatment for erectile dysfunction is initiated. Also, if the patient smokes cigarettes, drinks excessive amounts of ethanol, or uses recreational drugs, these social habits should be discontinued before specific treatment for erectile dysfunction is started. 

Montague DK, Barada JH, Belker AM, et al. Clinical guidelines panel on erectile dysfunction Summary report on the treatment of organic erectile dysfunction. J Urol 1996 156 2007-2011. 

Teloken C, Rhoden EL, Sogari R et al. Therapeutic effects of high-dose yohimbine hydrochloride on organic erectile dysfunction. J Urol 1998 159 122-124. 

Organic erectile dysfunction—Term used to refer to erectile dysfunction that is due to vascular, neurologic, and/or hormonal causes. 

Erectile dysfunction is a frequently encountered problem whose risk factors parallel those of coronary artery disease. Thus, many men desiring therapy for erectile dysfunction already may be receiving (or may require, especially if they increase physical activity) antianginal therapy. The combination of sildenafil and other phosphodiesterase 5 (PDE5) inhibitors with organic nitrate vasodilators can cause extreme hypotension. 

As indicated earlier, the selective PDE5 inhibitors developed for the treatment of male erectile dysfunction resulting from organic or mixed organic-psychogenic origin have been the most successful PDE inhibitors. The three marketed drugs are sildenafil, vardenafil, and tadalafil (Fig. 17.2). In addition to the treatment of erectile dysfunction, sildenafil has been indicated for the treatment of pulmonary hypertension and female sexual dysfunction. These latter uses are unlabeled uses. 

The interaction between phosphodiesterase type-5 inhibitors and nitrates is established, clinically important, potentially serious and even possibly fatal. Sildenafil and organic nitrates of any form are contraindicated both for erectile dysfunction (within 24 hours of each other ) and for pulmonary hypertension because of the risk of precipitating serious hypotension, or even myocardial infarction. The ACC/AHA Expert consensus document provides a useful list of many of the organic nitrates available, whieh inelude glyeeryl trinitrate (nitroglycerin), isosorbide mononitrate, isosorbide dinitrate and illicit substances such as amyl nitrite. ... 

Urology studies the structure and function of these related organs. Urologists are physicians who are consulted for the treatment of urinary tract infections, kidney stones, prostate enlargement, and urological cancers the correction of urogenital birth defects and the management of stress incontinence (involuntary urination), male infertility, and erectile dysfunction. 

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