Property of Doctor Abdellatif Zayed, Department of Urology, Faculty of Medicine, University of Zagazig, Egypt

1. Dr. Abdellatif ZayedDr. Abdellatif Zayed
Amzayed_1919@yahoo.comAmzayed_1919@yahoo.com
ErectileErectile
DysfunctionsDysfunctions

2. Persistent inability to attain and
maintain an erection sufficient to
permit satisfactory sexual
performance

3. EpidemiologyEpidemiology: 5-10%: 5-10%
Risk factors:Risk factors:
1.1.Lack of exercise,Lack of exercise,
2.2.Obesity and Smoking,Obesity and Smoking,
3.3.HypercholesterolemiaHypercholesterolemia

6.  The muscleThe muscle tonetone maintainsmaintains
contraction of the cavernous smoothcontraction of the cavernous smooth
muscle during flaccid.muscle during flaccid.
 When these musclesWhen these muscles relaxrelax,, the bloodthe blood
flow increases and trapped, leading toflow increases and trapped, leading to
erection.erection.
MechanismMechanism ofof erectionerection

7. Flaccid Erection

8. •Pass posterolateral to the
prostate
•They may be damaged
during radical
prostatectomy or
cystoprostatectomy
SympatheticSympathetic &
parasympatheticparasympathetic nervesnerves

9.  Psychogenic:Psychogenic:
 Sudden onsetSudden onset
 SelectiveSelective
 +ve morning erection+ve morning erection
 Organic:Organic:
1.1. VasculogenicVasculogenic
2.2. NeurogenicNeurogenic
3.3. EndocrinalEndocrinal
CausesCauses of EDED

11. Laboratory tests:Laboratory tests:
1.1. Fasting Blood sugarFasting Blood sugar
2.2. Lipid profileLipid profile
3.3. TestosteroneTestosterone
Basic work up

12.  Nocturnal Penile TumescenceNocturnal Penile Tumescence
 Intracavernosal injection (ICI test)Intracavernosal injection (ICI test)
 Duplex ultrasound of cavernosalDuplex ultrasound of cavernosal
arteriesarteries
Specific tests

13. TreatmentTreatment

14. PhosphodiestrasePhosphodiestrase
inhibitorsinhibitors::
1.1. Sildenafil (Viagra)Sildenafil (Viagra)
1.1. Tadalafil (Cialis, Snafi)Tadalafil (Cialis, Snafi)
1.1. Vardenafil (Levitra)Vardenafil (Levitra)
First line
.. ‫اااااا‬
.. ‫ااااا‬
‫اااااا‬
‫........ااااا‬
‫اااا‬

15. ICIICI
 Prostaglandin E1Prostaglandin E1
 Tri-mix:Tri-mix:
(alprostadil-(alprostadil-
papaverine-papaverine-
phentolamine)phentolamine)
Second line

16. Penile ProsthesisPenile Prosthesis
Third line
Three pieces inflatable process

17. Semi rigid processes

21. Male InfertilityMale Infertility
 Inability of a sexually active, nonInability of a sexually active, non
contracepting couple to achievecontracepting couple to achieve
pregnancy in one year.pregnancy in one year.
 AboutAbout 775% of couples achieve pregnancy5% of couples achieve pregnancy
within 1 year.within 1 year.
 15% seek medical advice for infertility15% seek medical advice for infertility
and <5% remain childless against theirand <5% remain childless against their
well.well.

22. Causes of male infertilityCauses of male infertility
1.1. Pretesticular causesPretesticular causes
2.2. Testicular CausesTesticular Causes
3.3. Post testicular causesPost testicular causes
4.4. Sperm antibodiesSperm antibodies
5.5. Varicocele and sexual problemsVaricocele and sexual problems
6.6. IdiopathicIdiopathic

23. Pretesticular causesPretesticular causes
– Kallmann’s syndrome: IsolatedKallmann’s syndrome: Isolated
gonadotropin deficiency due togonadotropin deficiency due to
absence of GHRH (Anosmia,absence of GHRH (Anosmia,
Deafness, and mental retardation)Deafness, and mental retardation)
– Pituitary gland disordersPituitary gland disorders

24. TesticularTesticular CausesCauses
– Cryptorchidism, Orchitis, or testicularCryptorchidism, Orchitis, or testicular
torsiontorsion
– Bilateral anorchia (Vanishing testesBilateral anorchia (Vanishing testes
syndrome)syndrome)
– Chemotherapy or RadiotherapyChemotherapy or Radiotherapy
– Genetic causes:Genetic causes: Klinfelter’s syndromeKlinfelter’s syndrome
(small firm testes, gynecomastia and(small firm testes, gynecomastia and
hypergonadotropins hypogonadismhypergonadotropins hypogonadism).).
Karyotype: 47,XXYKaryotype: 47,XXY

25. PostPost testiculartesticular causescauses::
– Absence of Vas Deferens/epididymisAbsence of Vas Deferens/epididymis
– Epididymal obstructions (congenital orEpididymal obstructions (congenital or
due to infection)due to infection)

27. SemenSemen AnalysisAnalysis
 Abstinence of 2-3 days, and should beAbstinence of 2-3 days, and should be
examined within 15min of collectionexamined within 15min of collection
 Volume:≥ 1.5mlVolume:≥ 1.5ml
 Count:≥15 million/ml and total no. ≥Count:≥15 million/ml and total no. ≥
39million/ejaculate39million/ejaculate
 Motility:≥32% progressive motility within 1hMotility:≥32% progressive motility within 1h
after ejaculateafter ejaculate
 Morphology:≥4% normal shape and formMorphology:≥4% normal shape and form
 Leucocytes:<1million/mlLeucocytes:<1million/ml

28.  If values are normal , one test is sufficient.If values are normal , one test is sufficient.
But if the results are abnormal, at least twoBut if the results are abnormal, at least two
semen analysis tests are necessarysemen analysis tests are necessary
 Azoospermia : No spermAzoospermia : No sperm
 Oligozospermia: < 15 million/ mlOligozospermia: < 15 million/ ml
 Asthenospermia: <32% motile spermAsthenospermia: <32% motile sperm
 Teratozospermia : <4 % normal formsTeratozospermia : <4 % normal forms
 Oligo-astheno-teratospermia syndromeOligo-astheno-teratospermia syndrome

29. FromFrom previousprevious examsexams
 Clinically, how can you differentiateClinically, how can you differentiate
organic from psychic erectileorganic from psychic erectile
dysfunctiondysfunction
 In semen analysis, normal spermIn semen analysis, normal sperm
count is………………count is………………
 Investigations in case of EDInvestigations in case of ED

30. Thank you
Amzayed_1919@yahoo.com
 0020101953318