EVALUATION AND TREATMENT OF ERECTILE DYSFUNCTION

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EVALUATION AND TREATMENT OF ERECTILE DYSFUNCTION
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EVALUATION AND TREATMENT OF ERECTILE DYSFUNCTION

• History
• Duration
• Onset rapid or slow
• Is the patient able to attain any erection?
• Is the patient able to ejaculate?
• Is ejaculation premature?
• Change in libido
• Vision changes
• BPH or bladder outlet obstructive symptoms
• History of pelvic trauma
• Mini mental status examination
• Depression evaluation
• Assessment of life stressors
• Previous therapy
• Concomitant medical problems-cardiac disease,
  diabetes
• Previous surgeries with particular attention to
  pelvic, vascular and neurologic surgeries.
• Thorough review of systems paying particular
  attention to cardiac, vascular, endocrine, and
  neurologic complaints.

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EVALUATION AND TREATMENT OF ERECTILE DYSFUNCTION

• Physical exam
• Complete physical examination
• Evaluate for evidence of cardiac disease
• Examine for gynecomastia as in indicator or
  endocrine disease
• Thorough sensory and motor neurologic evaluation.
• Complete vascular examination.
• Full genital examination looking for penile
  abnormalities such as phimosis, plaques, or other
  deformities and examinining testicular size and
  assess for testicular masses.
• Digital rectal examination.

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EVALUATION AND TREATMENT OF ERECTILE DYSFUNCTION

• Laboratory studies
• Complete blood count to identify anemia or
  leukemia.
• Chemistry 7 to assess renal function and blood
  glucose.
• Liver function tests to rule out underlying
  hepatic dysfunction.
• Lipid panel to evaluate for hyperlipidemia.
• Morning (0800) testosterone IF patient complains
  of decreased libido.

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EVALUATION AND TREATMENT OF ERECTILE DYSFUNCTION

• Treatment
• Abnormalities noted on physical and laboratory
  examination should be evaluated and corrected
  prior to administering medical therapy for ED.
• Primary therapy with a phosphodiesterase (PDE)
  inhibitor. Levitra 10 or 20 mg is the recommended
  starting dose.
• PDE inhibitor therapy is contraindicated in
  patients taking nitrates and those with
  cardiovascular events in the previous 3 months.
• PDE inhibitor is contraindicated in patients with
  retinitis pigmentosa.
• Providers should proceed with caution when
  prescribing PDE inhibitors who have had recent
  cardiac events or complex cardiovascular disease.
• Patients should receive counseling as to proper
  administration and use of the medications.
• Patients may require 5-8 attempts before
  achieving success.
• Patient experiencing significant side effects
  with administration such as headache, rhinitis,
  gastrointestinal upset should receive several
  doses prior to discontinuing therapy. Multiple
  uses have been demonstrated to result in
  decreased adverse side effects.
• Patients not achieving erection with one PDE
  inhibitor may be changed to another PDE inhibitor
  in an attempt to achieve efficacy.

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EVALUATION AND TREATMENT OF ERECTILE DYSFUNCTION

• Indications for referral to Neurology
• Focal neurologic deficit or concern for
  underlying neurologic disease.
• Indications for referral to Endocrinology
• Decreased serum testosterone
• Indications for referral to Psychiatry
• Depression or other mental disease outside of the
  Primary Care Providers scope of care
• Indications for further cardiac evaluation
• Recent cardiovascular events
• Evidence of cardiac disease on examination
• Indications for referral to Urology
• Failure to respond to medical therapy.
• Providers may refer patients to the Urology
  Clinic specifically for a Vacuum Erection Device
  (VED). Please place this in your consult.
• Patients deemed not able to take PDE inhibitors
  due to cardiac disease.

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