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Assessment of patients with erectile dysfunction

Created: 5/10/2005

 

ASSESSMENT OF THE PATIENT WITH ERECTILE DYSFUNCTION

Appropriate evaluation is important to:

  • Confirm the diagnosis
  • Assess severity of ED
  • Identify associated conditions
  • Identify specific causes of ED which require specific treatment

History

  • Important for diagnosis
  • Important to distinguish psychogenic from other causes of ED
    • NB Characteristics of psychogenic - Acute onset, presence and rigidity of morning erections
  • Important for severity assessment
    • Traditionally mild associated with problems maintaining erection, worsening ED associated with initiation and eventually absence of erection
    • NB These points probably do not correlate with actual severity, but more likely patient’s perception of severity

Questionnaires

Important in assessing severity and response to treatment

International Index of Erectile Dysfunction (IEFF)

  • Developed by Rosen in 1997 [1]
  • 15 item questionnaire divided into 5 sections erectile function, orgasmic dysfunction, sexual drive, intercourse satisfaction and overall satisfaction
  • More recent 5 item version developed as a screening test with 5 levels of severity – 5-7 severe, 8-11 moderate, 12-16 mild to moderate, 17-21 mild, 22-25 no ED [2]

Examination

Important in identification of aetiological risk factors

  • External genitalia
  • Endocrine: gynaecomastia, body hair and fat distribution
  • Cardiovascular: BP, heart rate, peripheral pulses and peripheral oedema
  • Neurological: Vibration sensation, bulbocavernosus reflex, lower limb power/co-ordination [3, 4]

Laboratory investigations

Important in identification of aetiological risk factors

  • Diabetes mellitus (DM) – ED can be presenting symptom
    • Most appropriate screening test – fasting blood sugar with a cut-off at 7mmol/l ( WHO )
    • Others include urinalysis, HbA1c, oral glucose tolerance test

  • Dyslipidaemia
    • Fasting lipid screen

  • Endocrine disorders eg hypogonadism, hyperprolactinaemia, thyroid disease
    • Routine testosterone should be performed
    • Measured in the morning
    • If abnormal should be repeated with prolactin, luteinising hormone and follicle stimulating hormone
    • Testosterone exists in 3 forms in plasma – free, bound to sex-hormone binding globulin and bound to albumin
    • Free testosterone is most important biologically
    • Total testosterone cheapest and most widely used [3, 4]

Vascular assessment

Arterial

  • Reserved for patients whose ED may be amenable to surgery
    • Eg Damage to penile arteries following pelvic/perineal trauma in young men
  • Duplex USS of penile arteries
    • Peak systolic flow velocity (PSV) and end diastolic velocity (EDV) measured
    • NB PSV < 25cm/sec indicates vascular disease
  • Arteriography of internal pudendal arteries
    • Reserved for young men who are candidates for reconstructive vascular surgery with abnormal Duplex findings

Venous

  • Duplex USS
    • EDV > 3cm/sec indicates abnormal veno-occlusive mechanism
  • Cavernosography/cavernosometry
    • Gold standard
    • Used for patients considered for surgery with a site-specific leak eg congenital venous leak, leak secondary to Peyronie’s/trauma
    • Flow required to maintain erection measured
    • 3ml/sec indicate abnormal venous leakage

References:

1. Rosen, R., et al., The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology, 1997. 49: p. 822-820.

2. Rosen, R., et al., Development of evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF) as a diagnostic tool for erectile dysfunction. Int J Imp Res, 1999. 11: p. 319-326.

3. Jardin, A., et al. Erectile Dysfunction. in The 1st International International Consultation on Erectile Dysfunction. 2000: Plymbridge.

4. Lue, T., et al. The 2nd International Consultation on Sexual Dysfunctions. in The 2nd International Consultation on Sexual Dysfunctions. 2004: Plymbridge.


ArticleDate:20051005
SiteSection: Article
 
   
    
                                            



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