SlideShare uma empresa Scribd logo
1 de 61
 
ERECTILE DYSFUNCTION G . POURMAND MD UROLOGY RESEARCH CENTER TEHRAN UNIVERSITY OF MEDICAL SCIENCES MAY-JUNE 2008
LIFE QUALITY OF LIFE
The sumerians GALEN INTRODUCTION
Natural Impotence Supra Natural Impotence   EGYPTIAN PAPYRI
Scythia Rich ( horse Rider ) Poor Hippocrates
Air Influx Hanged Man  ARISTOLE Leonardo Da vinci
The penis does not obey the order of its master  who tries to erect or shrink it at will. Instead the penis erects freely while its master is asleep , the penis must be said to have its own mind by any stretch of the imagination. The penis does not obey the order of its master  who tries to erect or shrink it at will. Instead the penis erects freely while its master is asleep , the penis must be said to have its own mind by any stretch of the imagination.
[object Object],[object Object],ERECTILE DYSFUNCTION
1) Vascular factors (DM,HTN,HLP) 2) Neurogenic factors (Autonomic dysfunction, peripheral neuropathy)  3) Psychogenic (Depression, Anxiety) 4) Endocrine factors (Test, FSH, LH, PRL , hyperthyroidism) 5) Pharmacologic factors (specially antihypertensives) 6) Other factors( Zn deficiency, hypoxemia) ETIOLOGY
American Women 30-50% Risk Factors same as males  Psychogenic 10% Desire Arousal Orgasm  Kaplan (1979)   Excitement, Plateu, Orgasmic, Resolution. Master and Johnson (1966)   Female Sexual Dysfunction
[object Object],[object Object],[object Object],[object Object],Causes of ED:
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
Erectogenic  Nitric oxide (NO) Serotonin (5HT) Dopamine Vasoactive intestinal polypeptide (VIP) Histamine Oxytocin Pituitary adenylate cyclase  activating peptide (PACAP) Calcitonin gene-related  peptide (CGRP) Substance P Erectolytic  Noradrenaline  Neuropeptide Y Gamma-aminobutyric acid (GABA) Neurotransmitters involved in penile erection
Central Erection Pathway Schematic  Central Stimulation (Stimulatory) Imagery  (Inhibitory) Stress Anxiety Dopamine Receptors  Oxytocin Seretonin Parabentricular  Nucleus  Midbrain  Spinal Cord  Cerebral Cortex ERECTION + -
 Physical examination & history  (a)    Sildenafil citrate    Lab.(Ts,PRL,LH,FSH)  (b)    Radiologic evaluation ( colour doppler ultrasonography,etc) a- Massry b- Chopp R.T ,Mendez R.   EVALUATION & DIAGNOSIS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],A Practical Evaluation of Men with ED
E.D Hx & P/E Depression, Vascul.,Medications NPT Ts & PRL NL ABNL Ts ,Bro,Clom. Succ. Fail
NPT NL ABNL Psychog. Doppler,ICI, PGE1 Psy Rx± Hor.Rx NL Succ. Fail AB NL Medications Fail Succ A.&V. Problem Surg Vacc Prosth
ED Hx & PE Sildenafil Response Cont. Sild. No Response Hb. Corr. Sex Hor. Drugs NPT
NPT ABNL NL ICI Doppler with ICI PGE ABNL NL Cont. ICI Corp. Cav. Bx NO Measurement Prosthesis
 
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],TREATMENT
1- Medical  - Ts Replacement  - PRL reduction  - Zn replacement  - Treatment of anemia - PDE5 inhibitors  TREATMENT
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],New Horizons in ED Treatment
[object Object],[object Object],[object Object],[object Object],New Horizons in ED Treatment
[object Object],[object Object],[object Object],[object Object],[object Object],New Horizons in ED Treatment
2- Gene therapy TREATMENT
NITRIC OXIDE ( NO) Neuronal (n NOS)  Endothelial (e NOS)  Inducible (i NOS) Genes and ED
L- Arginine L-Citrulline NO   synthase NITRIC OXIDE
 
NITRIC OXIDE ,[object Object],[object Object],[object Object]
Penile variant of nNOS (Pn NOS) is a reasonable candidate for gene therapy .
[object Object],[object Object],[object Object],[object Object],New Horizons in ED Treatment
[object Object],[object Object],[object Object],[object Object],[object Object],New Horizons in ED Treatment
 
hMaxi-K hMaxi-K isn't just for getting erections; it may also be effective in other ailments including overactive bladder, asthma, irritable bowel syndrome, benign prostatic hyperplasia, premature labor, and premenstrual syndrome. New Horizons in ED Treatment
3 -I.C.I 4 -Penile prosthesis (risk of infection) 5 - Surgery (poor response) TREATMENT
 
Penile Prosthesis Indications: - Patients who have failed other therapies - Peyronie’s disease - Severe vasculogenic disease
Malleable Prosthesis - Easy for patient and partner to use - Few mechanical parts - Same-day surgery usually possible - Least expensive type of prosthesis
Two-Piece Inflatable Prosthesis - Small inflation pump provides comfort and ease - Fast and easy one-step deflation procedure - Better conceal ability when flaccid than with malleable or  self-contained devices
Three-Piece Inflatable Prosthesis -  Most closely approximates the feel of a natural erection - Cylinders expand in girth - Some cylinders have the potential to expand in length - When inflated, it feels more firm and more full than other prosthetic erections - When deflated, it feels softer and more flaccid with better conceal ability than with other prosthetic devices
 
 
 
 
 
 
 
 
 
 Careful evaluation is needed to point out the underlying cause of the main problem.    The treatment must be based on aetiologic factor(s)     PDE5 inhibitors are safe medications for ED; however, new drugs have shown promising results in the ongoing clinical trials. Conclusions
[object Object],[object Object],Conclusions
 

Mais conteúdo relacionado

Mais procurados

Hypogonadism and testosterone replacement part 2
Hypogonadism and testosterone replacement part 2Hypogonadism and testosterone replacement part 2
Hypogonadism and testosterone replacement part 2
PeninsulaEndocrine
 

Mais procurados (20)

Erectile dysfunction
Erectile dysfunctionErectile dysfunction
Erectile dysfunction
 
Erectile dysfunction and Premature Ejaculation
Erectile dysfunction and Premature Ejaculation Erectile dysfunction and Premature Ejaculation
Erectile dysfunction and Premature Ejaculation
 
Erectile Dysfunction
Erectile Dysfunction Erectile Dysfunction
Erectile Dysfunction
 
Erectile Dysfunction
Erectile DysfunctionErectile Dysfunction
Erectile Dysfunction
 
Nutrition And Erectile Dysfunction Public
Nutrition And Erectile Dysfunction PublicNutrition And Erectile Dysfunction Public
Nutrition And Erectile Dysfunction Public
 
Erectile Dysfunction and Scleroderma: Evaluation and Managament
Erectile Dysfunction and Scleroderma: Evaluation and ManagamentErectile Dysfunction and Scleroderma: Evaluation and Managament
Erectile Dysfunction and Scleroderma: Evaluation and Managament
 
Erectile Dysfunction: New Paradigms in Treatment
Erectile Dysfunction: New Paradigms in Treatment Erectile Dysfunction: New Paradigms in Treatment
Erectile Dysfunction: New Paradigms in Treatment
 
Premature Ejaculation
Premature EjaculationPremature Ejaculation
Premature Ejaculation
 
Role of pelvic floor in male sexual dysfunction
Role of pelvic floor in male sexual dysfunctionRole of pelvic floor in male sexual dysfunction
Role of pelvic floor in male sexual dysfunction
 
Raising Hope for Fading Manhood
Raising Hope for Fading ManhoodRaising Hope for Fading Manhood
Raising Hope for Fading Manhood
 
Postprostatectomy sexual dysfunction is restoring erections enough?
Postprostatectomy sexual dysfunction is restoring erections enough?Postprostatectomy sexual dysfunction is restoring erections enough?
Postprostatectomy sexual dysfunction is restoring erections enough?
 
Male sexual dysfunction
Male sexual dysfunctionMale sexual dysfunction
Male sexual dysfunction
 
Hypogonadism and testosterone replacement part 2
Hypogonadism and testosterone replacement part 2Hypogonadism and testosterone replacement part 2
Hypogonadism and testosterone replacement part 2
 
Erectile Dysfunction:Evaluation and Management by Dr Shahjada Selim
Erectile Dysfunction:Evaluation and Management by Dr Shahjada SelimErectile Dysfunction:Evaluation and Management by Dr Shahjada Selim
Erectile Dysfunction:Evaluation and Management by Dr Shahjada Selim
 
Intralesional treatment in Peyronie's Disease
Intralesional treatment in Peyronie's DiseaseIntralesional treatment in Peyronie's Disease
Intralesional treatment in Peyronie's Disease
 
Sleep in Chronic Illnesses with a Focus on Scleroderma
Sleep in Chronic Illnesses with a Focus on SclerodermaSleep in Chronic Illnesses with a Focus on Scleroderma
Sleep in Chronic Illnesses with a Focus on Scleroderma
 
Postoperative cognitive dysfunction (pocd) in the (1)
Postoperative cognitive dysfunction (pocd) in the (1)Postoperative cognitive dysfunction (pocd) in the (1)
Postoperative cognitive dysfunction (pocd) in the (1)
 
Hypothyroidism:Updates of Management-Dr Shahjada Selim
Hypothyroidism:Updates of Management-Dr Shahjada SelimHypothyroidism:Updates of Management-Dr Shahjada Selim
Hypothyroidism:Updates of Management-Dr Shahjada Selim
 
Sexual rehabilitation
Sexual rehabilitationSexual rehabilitation
Sexual rehabilitation
 
Ejaculation physiology and pathology
Ejaculation  physiology and pathologyEjaculation  physiology and pathology
Ejaculation physiology and pathology
 

Destaque

Erectile Dysfunction And Tadalafil
Erectile Dysfunction And TadalafilErectile Dysfunction And Tadalafil
Erectile Dysfunction And Tadalafil
BALASUBRAMANIAM IYER
 
Testicular Disorders & Erectile Dysfunction
Testicular Disorders & Erectile DysfunctionTesticular Disorders & Erectile Dysfunction
Testicular Disorders & Erectile Dysfunction
Patrick Carter
 
Phosphodiesterase 5 inhibitors
Phosphodiesterase 5 inhibitorsPhosphodiesterase 5 inhibitors
Phosphodiesterase 5 inhibitors
Soumya Nath Maiti
 
Erectile dysfunction in diabetes
Erectile dysfunction in diabetesErectile dysfunction in diabetes
Erectile dysfunction in diabetes
PeninsulaEndocrine
 

Destaque (12)

Erectile Dysfunction [Dr. Edmond Wong]
Erectile Dysfunction [Dr. Edmond Wong]Erectile Dysfunction [Dr. Edmond Wong]
Erectile Dysfunction [Dr. Edmond Wong]
 
Erectile Dysfunction
Erectile DysfunctionErectile Dysfunction
Erectile Dysfunction
 
Erectile Dysfunction Symptoms And Treatment
Erectile Dysfunction Symptoms And TreatmentErectile Dysfunction Symptoms And Treatment
Erectile Dysfunction Symptoms And Treatment
 
Metabolic syndrome and erectile dysfunction
Metabolic syndrome and erectile dysfunctionMetabolic syndrome and erectile dysfunction
Metabolic syndrome and erectile dysfunction
 
Erectile Dysfunction And Tadalafil
Erectile Dysfunction And TadalafilErectile Dysfunction And Tadalafil
Erectile Dysfunction And Tadalafil
 
Testicular Disorders & Erectile Dysfunction
Testicular Disorders & Erectile DysfunctionTesticular Disorders & Erectile Dysfunction
Testicular Disorders & Erectile Dysfunction
 
Endothelial Dysfunction Y O U S R Y Y Yeasured
Endothelial  Dysfunction   Y O U S R Y Y YeasuredEndothelial  Dysfunction   Y O U S R Y Y Yeasured
Endothelial Dysfunction Y O U S R Y Y Yeasured
 
Diabetes mellitus and erectile dysfunction by Dr. Mohand Yaghi PgDip (urol) C...
Diabetes mellitus and erectile dysfunction by Dr. Mohand Yaghi PgDip (urol) C...Diabetes mellitus and erectile dysfunction by Dr. Mohand Yaghi PgDip (urol) C...
Diabetes mellitus and erectile dysfunction by Dr. Mohand Yaghi PgDip (urol) C...
 
Androgens - drdhriti
Androgens - drdhritiAndrogens - drdhriti
Androgens - drdhriti
 
Phosphodiesterase 5 inhibitors
Phosphodiesterase 5 inhibitorsPhosphodiesterase 5 inhibitors
Phosphodiesterase 5 inhibitors
 
Erectile dysfunction in diabetes
Erectile dysfunction in diabetesErectile dysfunction in diabetes
Erectile dysfunction in diabetes
 
9. metabolic syndrome
9. metabolic syndrome9. metabolic syndrome
9. metabolic syndrome
 

Semelhante a Erectile Dysfunction

Erection physics witkov modification
Erection physics witkov modificationErection physics witkov modification
Erection physics witkov modification
Brian Witkov
 
drugsforurologicaldisorders-180401070647 (1).pdf
drugsforurologicaldisorders-180401070647 (1).pdfdrugsforurologicaldisorders-180401070647 (1).pdf
drugsforurologicaldisorders-180401070647 (1).pdf
dattesh5049
 
13236530 Anesthesia Pharmacology
13236530 Anesthesia Pharmacology13236530 Anesthesia Pharmacology
13236530 Anesthesia Pharmacology
Tsega Tilahun
 

Semelhante a Erectile Dysfunction (20)

Erectile dysfunction updates
Erectile dysfunction updatesErectile dysfunction updates
Erectile dysfunction updates
 
Erection physics witkov modification
Erection physics witkov modificationErection physics witkov modification
Erection physics witkov modification
 
Journal presentation on essential tremor
Journal presentation on essential tremorJournal presentation on essential tremor
Journal presentation on essential tremor
 
Erectile Dysfunction: A Man's Nightmare! New Proven Solution!
Erectile Dysfunction: A Man's Nightmare! New Proven Solution!Erectile Dysfunction: A Man's Nightmare! New Proven Solution!
Erectile Dysfunction: A Man's Nightmare! New Proven Solution!
 
Dapoxetin
DapoxetinDapoxetin
Dapoxetin
 
MALE GONADAL FUNCTION AND DYSFUNCTION (MALE HYPOGONADISM)
MALE GONADAL FUNCTION AND DYSFUNCTION (MALE HYPOGONADISM)MALE GONADAL FUNCTION AND DYSFUNCTION (MALE HYPOGONADISM)
MALE GONADAL FUNCTION AND DYSFUNCTION (MALE HYPOGONADISM)
 
Phosphodiesterases and drug inhibitors.pptx
Phosphodiesterases and drug inhibitors.pptxPhosphodiesterases and drug inhibitors.pptx
Phosphodiesterases and drug inhibitors.pptx
 
Advances in management of seizure disorder
Advances in management of seizure disorderAdvances in management of seizure disorder
Advances in management of seizure disorder
 
Erectile dysfunction
Erectile dysfunctionErectile dysfunction
Erectile dysfunction
 
Adrenergic agonists & antagonists
Adrenergic agonists & antagonistsAdrenergic agonists & antagonists
Adrenergic agonists & antagonists
 
Drugs for Erectile Dysfunction
Drugs for Erectile DysfunctionDrugs for Erectile Dysfunction
Drugs for Erectile Dysfunction
 
drugsforurologicaldisorders-180401070647 (1).pdf
drugsforurologicaldisorders-180401070647 (1).pdfdrugsforurologicaldisorders-180401070647 (1).pdf
drugsforurologicaldisorders-180401070647 (1).pdf
 
BRAIN DEATH.pptx
BRAIN DEATH.pptxBRAIN DEATH.pptx
BRAIN DEATH.pptx
 
Premature ejaculation
Premature ejaculation Premature ejaculation
Premature ejaculation
 
13236530 Anesthesia Pharmacology
13236530 Anesthesia Pharmacology13236530 Anesthesia Pharmacology
13236530 Anesthesia Pharmacology
 
1.endocrinology-consideration.ppt
1.endocrinology-consideration.ppt1.endocrinology-consideration.ppt
1.endocrinology-consideration.ppt
 
Class androgens
Class androgensClass androgens
Class androgens
 
疼痛機制 The mechanism of Pain
疼痛機制 The mechanism of Pain疼痛機制 The mechanism of Pain
疼痛機制 The mechanism of Pain
 
Endocrine system
Endocrine systemEndocrine system
Endocrine system
 
Presentation on experimental evaluation of memory enhancers
Presentation on experimental evaluation of memory enhancersPresentation on experimental evaluation of memory enhancers
Presentation on experimental evaluation of memory enhancers
 

Mais de Patricia Khashayar (20)

Natural remedies treat chronic wounds
Natural remedies treat chronic woundsNatural remedies treat chronic wounds
Natural remedies treat chronic wounds
 
Recommended food for Ramadan
Recommended food for RamadanRecommended food for Ramadan
Recommended food for Ramadan
 
sterile water
sterile watersterile water
sterile water
 
plastic surgeon
plastic surgeonplastic surgeon
plastic surgeon
 
Alternative medicine Coconut
Alternative medicine CoconutAlternative medicine Coconut
Alternative medicine Coconut
 
War-related health problems in Iraq
War-related health problems in IraqWar-related health problems in Iraq
War-related health problems in Iraq
 
Alternative medicine Carrot
Alternative medicine CarrotAlternative medicine Carrot
Alternative medicine Carrot
 
Alternative medicine Apple
Alternative medicine AppleAlternative medicine Apple
Alternative medicine Apple
 
infertility2
infertility2infertility2
infertility2
 
Alternative medicine Cinnamon
Alternative medicine CinnamonAlternative medicine Cinnamon
Alternative medicine Cinnamon
 
alternative medicine borage
alternative medicine boragealternative medicine borage
alternative medicine borage
 
Nanotalk last
Nanotalk lastNanotalk last
Nanotalk last
 
Shakibaei takes his final bow
Shakibaei takes his final bowShakibaei takes his final bow
Shakibaei takes his final bow
 
Alternative medicine Pomgrenate
Alternative medicine PomgrenateAlternative medicine Pomgrenate
Alternative medicine Pomgrenate
 
JC
JCJC
JC
 
Kaposi sarcoma
Kaposi sarcomaKaposi sarcoma
Kaposi sarcoma
 
A revolution in Chinese stem cell technology
A revolution in Chinese stem cell technologyA revolution in Chinese stem cell technology
A revolution in Chinese stem cell technology
 
Gabapentine
GabapentineGabapentine
Gabapentine
 
computer
computercomputer
computer
 
Alternative medicine Caraway
Alternative medicine CarawayAlternative medicine Caraway
Alternative medicine Caraway
 

Último

Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
mahaiklolahd
 
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
adilkhan87451
 

Último (20)

Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
 
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
 
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
 
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
 
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
 
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 
8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
 
Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...
Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...
Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...
 
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
 
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
 
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
 
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
 
Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...
Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...
Call Girls Service Jaipur {9521753030} ❤️VVIP RIDDHI Call Girl in Jaipur Raja...
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
 
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
 

Erectile Dysfunction

  • 1.  
  • 2. ERECTILE DYSFUNCTION G . POURMAND MD UROLOGY RESEARCH CENTER TEHRAN UNIVERSITY OF MEDICAL SCIENCES MAY-JUNE 2008
  • 4. The sumerians GALEN INTRODUCTION
  • 5. Natural Impotence Supra Natural Impotence EGYPTIAN PAPYRI
  • 6. Scythia Rich ( horse Rider ) Poor Hippocrates
  • 7. Air Influx Hanged Man ARISTOLE Leonardo Da vinci
  • 8. The penis does not obey the order of its master who tries to erect or shrink it at will. Instead the penis erects freely while its master is asleep , the penis must be said to have its own mind by any stretch of the imagination. The penis does not obey the order of its master who tries to erect or shrink it at will. Instead the penis erects freely while its master is asleep , the penis must be said to have its own mind by any stretch of the imagination.
  • 9.
  • 10. 1) Vascular factors (DM,HTN,HLP) 2) Neurogenic factors (Autonomic dysfunction, peripheral neuropathy) 3) Psychogenic (Depression, Anxiety) 4) Endocrine factors (Test, FSH, LH, PRL , hyperthyroidism) 5) Pharmacologic factors (specially antihypertensives) 6) Other factors( Zn deficiency, hypoxemia) ETIOLOGY
  • 11. American Women 30-50% Risk Factors same as males Psychogenic 10% Desire Arousal Orgasm Kaplan (1979) Excitement, Plateu, Orgasmic, Resolution. Master and Johnson (1966) Female Sexual Dysfunction
  • 12.
  • 13.
  • 14.
  • 15.  
  • 16.  
  • 17.  
  • 18. Erectogenic Nitric oxide (NO) Serotonin (5HT) Dopamine Vasoactive intestinal polypeptide (VIP) Histamine Oxytocin Pituitary adenylate cyclase activating peptide (PACAP) Calcitonin gene-related peptide (CGRP) Substance P Erectolytic Noradrenaline Neuropeptide Y Gamma-aminobutyric acid (GABA) Neurotransmitters involved in penile erection
  • 19. Central Erection Pathway Schematic Central Stimulation (Stimulatory) Imagery (Inhibitory) Stress Anxiety Dopamine Receptors Oxytocin Seretonin Parabentricular Nucleus Midbrain Spinal Cord Cerebral Cortex ERECTION + -
  • 20.  Physical examination & history (a)  Sildenafil citrate  Lab.(Ts,PRL,LH,FSH) (b)  Radiologic evaluation ( colour doppler ultrasonography,etc) a- Massry b- Chopp R.T ,Mendez R. EVALUATION & DIAGNOSIS
  • 21.
  • 22. E.D Hx & P/E Depression, Vascul.,Medications NPT Ts & PRL NL ABNL Ts ,Bro,Clom. Succ. Fail
  • 23. NPT NL ABNL Psychog. Doppler,ICI, PGE1 Psy Rx± Hor.Rx NL Succ. Fail AB NL Medications Fail Succ A.&V. Problem Surg Vacc Prosth
  • 24. ED Hx & PE Sildenafil Response Cont. Sild. No Response Hb. Corr. Sex Hor. Drugs NPT
  • 25. NPT ABNL NL ICI Doppler with ICI PGE ABNL NL Cont. ICI Corp. Cav. Bx NO Measurement Prosthesis
  • 26.  
  • 27.  
  • 28.  
  • 29.
  • 30. 1- Medical - Ts Replacement - PRL reduction - Zn replacement - Treatment of anemia - PDE5 inhibitors TREATMENT
  • 31.
  • 32.
  • 33.
  • 34. 2- Gene therapy TREATMENT
  • 35. NITRIC OXIDE ( NO) Neuronal (n NOS) Endothelial (e NOS) Inducible (i NOS) Genes and ED
  • 36. L- Arginine L-Citrulline NO synthase NITRIC OXIDE
  • 37.  
  • 38.
  • 39. Penile variant of nNOS (Pn NOS) is a reasonable candidate for gene therapy .
  • 40.
  • 41.
  • 42.  
  • 43. hMaxi-K hMaxi-K isn't just for getting erections; it may also be effective in other ailments including overactive bladder, asthma, irritable bowel syndrome, benign prostatic hyperplasia, premature labor, and premenstrual syndrome. New Horizons in ED Treatment
  • 44. 3 -I.C.I 4 -Penile prosthesis (risk of infection) 5 - Surgery (poor response) TREATMENT
  • 45.  
  • 46. Penile Prosthesis Indications: - Patients who have failed other therapies - Peyronie’s disease - Severe vasculogenic disease
  • 47. Malleable Prosthesis - Easy for patient and partner to use - Few mechanical parts - Same-day surgery usually possible - Least expensive type of prosthesis
  • 48. Two-Piece Inflatable Prosthesis - Small inflation pump provides comfort and ease - Fast and easy one-step deflation procedure - Better conceal ability when flaccid than with malleable or self-contained devices
  • 49. Three-Piece Inflatable Prosthesis - Most closely approximates the feel of a natural erection - Cylinders expand in girth - Some cylinders have the potential to expand in length - When inflated, it feels more firm and more full than other prosthetic erections - When deflated, it feels softer and more flaccid with better conceal ability than with other prosthetic devices
  • 50.  
  • 51.  
  • 52.  
  • 53.  
  • 54.  
  • 55.  
  • 56.  
  • 57.  
  • 58.  
  • 59.  Careful evaluation is needed to point out the underlying cause of the main problem.  The treatment must be based on aetiologic factor(s)  PDE5 inhibitors are safe medications for ED; however, new drugs have shown promising results in the ongoing clinical trials. Conclusions
  • 60.
  • 61.