Editing Evaluation and Management of Erectile Dysfunction (section)

== Answers ==

# What are the mandatory investigations in a patient with erectile dysfunction as per the AUA/CUA?
#* AUA: history, physical, diabetes screen (fasting glucose or HbA1c), serum testosterone
#* CUA: history, physical
# What are the recommended investigations in a patient with erectile dysfunction as per the AUA/CUA?
#* AUA and CUA: questionnaire
#* CUA: diabetes screening in select patients, serum testosterone in selected patients
# As per the 2021 CUA Guidelines on Erectile Dysfunction, what are the indications to measure serum testosterone?
## Symptoms of hypogonadism
## Failure of PDE5 inhibitor treatment
# What are the 5 domains of the International Index of Erectile Function (IIEF)?
## Sexual desire
## Erectile function
## Intercourse satisfaction
## Ejaculatory/orgasmic function
## Overall sexual satisfaction
# List potential specialized testing options in the evaluation of erectile dysfunction
## Nocturnal Penile Tumescence and Rigidity testing
## Intracavernosal injection
## Penile duplex ultrasound
## Biothesiometry
## Cavernosometry and cavernosograophy
## Arteriography
# List the FDA-approved PDE5 inhibitors for the treatment of ED
## Sildenafil
## Tadalafil
## Verdenafil
## Avanafil
# What are the contraindications to PDE5 inhibitors?
#* Absolute:
## Hypersensitivity
## Concomitant use of nitrates
#* Relative:
## Severe liver disease
## Concomitant use of alpha-blocker
## Severe cardiac disease
## Concomitant use of antiarrhythmics
## Known hereditary degenerative retinal disorders
# Which PDE5 inhibitor is not recommended in patients who take type 1A antiarrhythmics (e.g., quinidine or procainamide) or type 3 antiarrhythmics (e.g., sotalol or amiodarone) or in patients with congenital prolonged QT syndrome?
#* Vardenafil
# What are potential adverse events related to the use of a PDE5i?
## Headache
## Dyspepsia
## Flushing
## Myalgia
## Nasal congestion
## Visual disturbances
## NAION
# Which PDE5 inhibitors have higher rates of visual disturbances? Myalgia?
#* Sildenafil and vardenafil
#* Tadalafil
# What is the onset of action, T1/2, and effect of food intake on the different PDE5 inhibitors?
#* Sildenafil: 30-60 mins, 4 hours, high-fat meal decreases efficacy
#* Verdenafil: 30-60 mins, 4 hours, high-fat meal decreases efficacy
#* Tadalafil: 60-120 mins, 17.5 hours, no effect
#* Avanafil: 15-30 mins, 5 hours, no effect
# What are the non-surgical treatment options for erectile dysfunction?
## Oral PDE5 inhibitors
## Vacuum erection device
## Intraurethral alprostadil
## Intracavernosal injections
# What are the contraindications to intraurethral alprostadil?
## Patients with known hypersensitivity to alprostadil
## Abnormal penile anatomy
## Conditions that increase the risk of priapism
# What are the typical medications in intracavernosal injection?
#* Papaverine (PDE5 inhibitor)
#* Alprostadil (prostaglandin)
#* Phentolamine (alpha-blocker)
#* Atropine (anticholinergnic)
# What are the contraindications to intracavernosal injections?
## Concomitant use of monoamine oxidase inhibitors
## Reduced manual dexterity
## Psychological instability
## Severe coagulopathy and/or unstable cardiovascular disease
## History or risk of priapism
# What are potential complications of penile prosthesis surgery?
#* Intra-operative: corpus injury, urethral injury, crura injury, bleeding
#* Early post-operative: infection, urinary retention
#* Late post-operative: erosion, change in appearance of penis, device malfunction