11/3/2022 0 Comments Roman swipes loginNocturnal penile tumescence testing can be useful to document an intact neurovascular axis, and the absence of nocturnal erectile activity may imply a neurogenic etiology. Intracavernosal injection, penile duplex Doppler ultrasonography, dynamic infusion cavernosometry and cavernosography, and internal pudendal arteriography all may be used to identify vasculogenic ED. Pharmacological, radiological, and psycho-physiological tests are used in efforts to determine the cause of ED. Self-administered questionnaires are useful adjuncts to the case history, but they are not sufficient to diagnose ED correctly or treat it safely. The diagnosis of ED requires a detailed sexual and medical history, physical examination, and laboratory tests. Objective physiologic testing may be used to support the diagnosis of ED, but it cannot substitute for the patient’s self-report in establishing the diagnosis. The definition of ED provided by the National Institutes of Health does not include the duration of dysfunction subsequent recommendations by the World Health Organization specify a three-month minimum duration of symptoms to establish that diagnosis except in cases of trauma or surgically induced ED. Symptom-based definitions are rapidly replacing the routine use of physiologic measures of erectile function such as penile tumescence. Comprehensive questionnaires have been developed (e.g., the International Index of Erectile Function (IIEF)) to define ED presence, severity, and response to treatment. As the public has become more aware of ED, the reported prevalence and severity of this condition have increased. SymptomsĮD is defined as the persistent “inability to achieve or maintain an erection sufficient for satisfactory sexual performance.” The experience of ED may vary based on patients’ and partners’ perceptions and expectations about erectile function and sexual performance. With men increasingly seeking to preserve sexual function and quality of life as they age, the treatment of ED will take on even greater importance in the years to come. Patterns of care may shift away from surgical and device therapies provided by urologists and toward pharmacologic treatments and/or multidisciplinary approaches. While ED is not life threatening, the condition may result in withdrawal from sexual intimacy, reduced quality of life, decreased working productivity, and increased healthcare utilization. The emergence of effective, convenient, and generally well-tolerated new treatment options (along with educational campaigns initiated by the pharmaceutical industry) has contributed to increased public awareness and a greater acceptability of and attention to the health and socioeconomic impacts of male sexual health. The available data likely underestimate current treatment utilization given that in the 22 months after the first PDE-I, sildenafil (Viagra™), was launched, nearly 18 million prescriptions were filled at an approximate cost of $90 per 10-tablet prescription. Patient interest in and treatment for ED surged with the introduction of oral phosphodiesterase-5 inhibitors (PDE-I) in 1998, and expenditures for office visits and other outpatient treatments increased during that time. It is estimated that erectile dysfunction (ED) affects as many as 30 million men in the United States.
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