Download - Taking the measure of a man
Taking the measure of a Taking the measure of a manman
Dr. Simon TreissmanDr. Simon TreissmanOctober 10, 2007October 10, 2007
Taking the measure of a Taking the measure of a manman• Erectile dysfunctionErectile dysfunction
– Failure to Failure to attain attain an erection adequate an erection adequate for intromission.for intromission.
– Failure to Failure to maintainmaintain an erection for a an erection for a length of time adequate for satisfactory length of time adequate for satisfactory sexual relations.sexual relations.
Taking the measure of a Taking the measure of a manman
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30's 40's 50's 60's 70's
SevereModerateMild
Age associated incidence of ED1. J Urol Vol 161(1) Jan 1999 pp 5 - 11
Taking the measure of a Taking the measure of a manman• How can you tell?How can you tell?
– International Index of Erectile function International Index of Erectile function (IIEF)(IIEF)
– 15 item questionaire15 item questionaire22 each with five each with five domains.domains.
– ““Test demonstrates sensitivity and Test demonstrates sensitivity and specificity for detecting treatment-specificity for detecting treatment-related changes in patients over time”.related changes in patients over time”.2. Urology 1997 Jun; 49(6): 822-30
Taking the measure if a Taking the measure if a manman• IIEF developed by RC Rosen in 1997IIEF developed by RC Rosen in 1997
– Evolved into Evolved into IIEF – 5IIEF – 5– Evolved into Evolved into Sexual Health Inventory for Sexual Health Inventory for
Men (SHIM)Men (SHIM)– Evolved into Evolved into SHIM-2 SHIM-2 33
3. Int J Impot Res 2005;17(4): 307 - 319
Taking the measure of a Taking the measure of a manman• Shim or IIEF – 5 handyShim or IIEF – 5 handy• Organic EDOrganic ED strongly associated with strongly associated with
certain diseasescertain diseases44::– Diabetes mellitusDiabetes mellitus– HypertensionHypertension– History of smokingHistory of smoking
4. J Diabetes Complications 2005 Jan – Feb; 19(1): 35 - 41
Taking the measure of a Taking the measure of a manman• Organic EDOrganic ED strongly associated with strongly associated with
certain drugs:certain drugs:– HydrochlorthiazideHydrochlorthiazide– Beta blockersBeta blockers– CimetidineCimetidine– SpironolactoneSpironolactone– Selective serotonin re-uptake inhibitors (SSRI’s)Selective serotonin re-uptake inhibitors (SSRI’s)– KetoconazoleKetoconazole
Taking the measure of a Taking the measure of a manman• Other Other common causescommon causes of ED: of ED:
– Prostate disordersProstate disorders•PSA, urinanalysisPSA, urinanalysis
– HyperprolactinemiaHyperprolactinemia•s. prolactins. prolactin
– HypogonadismHypogonadism•AM free testosteroneAM free testosterone•Bioavailable testosteroneBioavailable testosterone
Taking the measure of a Taking the measure of a manman
• RecapRecap::– Careful historyCareful history– Physical examPhysical exam– Lab assessmentLab assessment
Taking the measure of a Taking the measure of a manman• Treatment:Treatment:
– PDE 5’sPDE 5’s– Intra-cavernosal agentsIntra-cavernosal agents– Vacuum constriction deviceVacuum constriction device– Penile prosthesisPenile prosthesis
Taking the measure of a Taking the measure of a manman• Phosphodiesterase type 5 inhibitorsPhosphodiesterase type 5 inhibitors
– Original 5 phosphodiesterasesOriginal 5 phosphodiesterases identified identified in 1972 within rat brainin 1972 within rat brain55
– Now known to be Now known to be 11+ types / subtypes11+ types / subtypes– Sildenifil citrate Sildenifil citrate incidentally discovered incidentally discovered
in 1996 in 1996 66
5. Uznov and Brown6.6. Int J Impot Res Int J Impot Res 19961996 8 8 (2): 47 - 52(2): 47 - 52
Taking the measure of a Taking the measure of a manman
Sildenafil citrateSildenafil citrate TadalafilTadalafil LevitraLevitraRR
Titrate doseTitrate dose25, 50, 100 25, 50, 100 mgmg1 hour to 1 hour to onsetonset
Standard Standard dosedose20 mg20 mg½ hour½ hour
Standard Standard dosedose20 mg20 mg½ hour½ hour
Avoid food Avoid food and / or and / or alcoholalcohol
N / AN / A N / AN / A
Avoid a-Avoid a-blockers blockers NitratesNitrates
Just nitratesJust nitrates Just nitratesJust nitrates
Taking the measure of a Taking the measure of a manmanSildenafil citrateSildenafil citrate
½ life 3 – 4 ½ life 3 – 4 hourshours
TadalafilTadalafil
½ life 17.5 ½ life 17.5 hourshours
LevitraLevitraRR
½ life 4 – 5 hours½ life 4 – 5 hours
In VitroIn Vitro potencypotency
intermediateintermediateweakestweakest strongeststrongest