Erectile dysfunction and cardiovascular disease

Patients with cardiovascular disease are at increased risk of developing erectile dysfunction (ED). This may be a consequence of atherosclerosis of the penile arteries, a reduced cardiac output, or a side-effect of drugs used to reduce cardiovascular risk factors (particularly beta-blockers, thiazide diuretics and, occasionally, lipid-lowering drugs). ED is a distressing condition, which often diminishes the patient's self-esteem, with the potential for damage to his psychological health and his relationship with his partner and family. When treating ED, the underlying aetiology should be established by careful examination and consideration of medical history and concurrent medication. Until recently, pharmacological treatment options involved intracavernous injections (alprostadil or moxisylyte) or intraurethral alprostadil. These treatments are often inconvenient and not well accepted by the patient. The recent introduction of oral sildenafil promises to revolutionise the treatment of ED. In double-blind, placebo-controlled trials in patients with ED, sildenafil improved erectile function and quality of life and was well tolerated. ED is a clinically important complication of cardiovascular disease and should be asked about and treated accordingly. It is important that effective treatments, including sildenafil, should be available for treating patients with cardiovascular disease and ED.     

Male infertility and erectile dysfunction in spinal cord injury: a review.

OBJECTIVE: To review the pathophysiology, evaluation, and management of erectile dysfunction and infertility in spinal cord injury (SCI). STUDY SELECTIONS: Studies that covered various treatment options and their contraindications, complications, or side effects, including sildenafil (Viagra), intracavernosal injection therapy, topical medications and a urethral delivery system, a vacuum erection device, and penile prostheses. Other studies covered the effects of SCI on reproduction: spermatogenesis and testicular function, and seminal constituents. In addition, assisted reproductive techniques were compared: external vibratory stimulation, electroejaculation, testicular sperm aspiration, and intracytoplasmic sperm injection. CONCLUSION: Goal-directed therapy is the mainstay of treatment of erectile dysfunction in men with or without SCI. The choice of therapy is often defined more by the needs of the patient's sexual relationship than by his erectile dysfunction. The majority of men with SCI are infertile because of a combination of ejaculatory dysfunction, impaired spermatogenesis, and poor semen quality. Although many technological advances have evolved to overcome ejaculatory dysfunction, the sperm density, motility, and function remain poor. Until these parameters are improved, men with SCI will have to pursue more financially and emotionally taxing procedures. Further studies to elucidate the cellular and molecular mechanisms of diminished sperm quality are needed. Addressing the issues of erectile dysfunction and male infertility may help to preserve the relationship between the patient and his partner.     

Teaching a patient to successfully operate a penile prosthesis

Despite the fact that penile prosthesis devices represent the most invasive and least chosen of treatments for erectile function issues, these devices have the highest patient satisfaction rates of all the available treatments. This article will review the process of teaching a patient and his partner how to successfully operate the device.     

Women’s Reactions to Partner’s Ejaculation Problems

Ejaculation problems—too rapid, too slow, or absent—may be as ancient as man himself but less researched than erectile difficulties. This article gives attention at long last to the woman partner who struggles to understand and react to recurrence of the ejaculation dysfunction. Some women may be wrongly blamed while others may berate him for his inability to overcome the symptom. Today, it is essential to gain more knowledge with added understanding of how his partner is impacted if the ejaculation problem persists. There are usually two patients when a sexual problem presents.     

Partners' perspective of erectile dysfunction: literature review

Erectile dysfunction is a problem which men may or may not share with their partners for a variety of reasons. This literature review of 26 articles revealed the partners' perspective of men with erectile dysfunction. Partners fell into four groups: supportive partner/acceptable to patient (the optimum category); supportive partner/unacceptable to patient; non-supportive partner/acceptable to patient; and non-supportive partner/unacceptable to patient. With comprehensive education and counselling by urology nurses, the couples could move into the optimal category. There is increasing recognition that the partner should be involved in the assessment, diagnosis, patient education, counselling and choice of treatment for long-term treatment to be successful, unless the informed patient is unwilling.     

Cardiovascular disease: the effect of erectile dysfunction on adherence to cardiovascular disease medication

Due to their similar aetiologies, cardiovascular disease (CVD) and erectile dysfunction (ED) are closely linked, with the prevalence of ED being approximately 75% for individuals at high risk of CVD. ED can have a detrimental effect on quality of life not only for the individual but also his sexual partner which in turn impacts upon their intimate relationship. Some CVD medications have been found to have a negative effect on erectile function and therefore act as an influential factor for the cessation of important CVD medication. Low adherence to CVD medication has been linked to increased health costs, hospitalizations and importantly, a higher risk of mortality. Research has shown that men find it difficult to seek medical help in relation to ED which is also compounded by the notion that health care providers do not address sexual issues adequately. Patients' beliefs about CVD medication are modifiable and therefore an opportunity exists not only for health care providers to facilitate discussions in relation to ED and medication adherence but also encompass an opportunity to increase adherence to CVD medication through intervention.     

Prostate cancer and sexuality: implications for nursing

In the United States, men aged 65 and older are at particular risk for prostate cancer. Treatments for prostate cancer may result in erectile dysfunction, which can affect the older man's sense of self as well as his relationship with his intimate partner. Research has shown a range of factors associated with sexuality for men who have had prostate cancer and their partners. The PLISSIT model can be applied to nursing assessment and intervention of sexuality and prostate cancer. Nurses must acknowledge the sexuality of older men and their partners and the potential effect that prostate cancer can have on this multifaceted aspect of their lives.     

Erectile dysfunction: etiology, evaluation, and treatment options

The evaluation and treatment of male sexual dysfunction has evolved into a more extensive evaluation. This new evaluation should now include evaluation of hypogonadism, ejaculatory function, lower urinary tract symptoms, and depression. The evaluation may be readily accomplished with the use of questionnaires. The management of these entities is discussed, including the novel phosphodiesterase-5 for male erectile dysfunction. Inclusion of the partner in the evaluation and management scheme will provide added benefit and may produce a better outcome.     

Sildenafil citrate (Viagra) is effective and well tolerated for treating erectile dysfunction of psychogenic or mixed aetiology

Sildenafil citrate (Viagra) has been shown to be an effective treatment for erectile dysfunction (ED) of organic aetiology. This study assessed the efficacy and tolerability of sildenafil for treating ED of psychogenic and mixed psychogenic/organic aetiology. Men with ED of psychogenic and mixed aetiology were randomised in a double-blind, fixed-dose study to placebo (n = 95) or sildenafil 10 mg (n = 90), 25 mg (n = 85), or 50 mg (n = 81) once daily for 28 days. Efficacy was evaluated with two global efficacy questions, a patient log of erectile activity, a sexual function questionnaire and a partner questionnaire. Patients receiving sildenafil had significantly more grade 3 (hard enough for penetration) or grade 4 (fully hard) erections per week than patients receiving placebo, and a greater proportion of patients receiving sildenafil reported that treatment had improved their erections (p < 0.001). Results of the sexual function questionnaire demonstrated significant improvement for patients with ED receiving sildenafil compared with patients receiving placebo for frequency, hardness and duration of erections (p < 0.01), and for enjoyment of sexual intercourse and satisfaction with sex life (p < 0.05). The results of the partner questionnaire were consistent with the results reported by patients and showed that treatment with sildenafil was associated with significant improvement in the partners' own sex lives (p < 0.001). Adverse events were mostly mild to moderate in nature. The commonest adverse events were headache, dyspepsia, flushing, myalgia, arthralgia and flu syndrome. Discontinuations due to treatment-related adverse events were few, ranging from 1.1% to 6.2% for patients receiving different doses of sildenafil and 4.2% for patients receiving placebo. Sildenafil is an effective and well-tolerated treatment for ED of psychogenic or mixed aetiology with once-daily dosing.     

Early relief of erectile dysfunction after laser decompression of herniated lumbar disc

OBJECTIVE: The use of percutaneous laser disc decompression (PLDD) for the treatment of erectile dysfunction caused by herniated disc disease is described. SUMMARY BACKGROUND DATA: Disc herniation is often overlooked as a cause of erectile dysfunction, with few cases reported in the literature. METHODS: Two patients with erectile dysfunction were treated with PLDD as outpatients. RESULTS: In addition to the early return of erectile function in both cases, immediate pain relief was achieved in the second case. Follow-up visits confirmed continued normal sexual function and lack of pain. CONCLUSIONS: The literature now includes 23 cases well-documented cases of erectile dysfunction caused by spinal cord disc herniation. PLDD is a minimally invasive procedure that that can be used to treat herniation of intervertebral discs, which has been found to cause erectile dysfunction.     

HOLISTIC APPROACH TO THE MANAGEMENT OF ERECTILE DISORDERS IN A MALE SEXUAL HEALTH CLINIC

SUMMARY A holistic view is given of the management of erectile disorders in a male sexual health clinic. Responsibility for the choice of treatment programme is shared with the patient, who makes informed consent. Involvement of the patient's partner is encouraged throughout. The increasing importance of good management for erectile dysfunction is indicated by the prevalence of the condition and the fact that, with a growing proportion of the population over the age of 65, it is age-related.     

Suggested community psychiatric nursing interventions with clients suffering from anorexia nervosa and bulimia nervosa

Clients suffering from the fasting and gorging syndromes of anorexia and bulimia nervosa are at significant risk of self-harm even if treated with apparent success in hospital Two major issues (not inevitably co-existing) appear to be at work in these illnesses, distorted perception by the sufferer of his or her own body appearance and stressful interpersonal relationships originating in one of a variety of groups of which the sufferer is a member (Fear of psychosexual maturity, that is, the clients' inability to develop an age-appropriate sexual identity, is treated in this paper as being the product of faulty interactional patterns, it is also a less clear-cut issue in bulimia nervosa than in anorexia) A supervised hospital in-patient treatment regime concentrating upon weight gain, effective discouragement of purgation and vomiting, possible drug treatment and perhaps dual or independent usage of individual or group psychotherapy with focused cognitive–behavioural task-oriented approaches, will not realize effective change unless these issues are resolved Community psychiatric nurses (CPNs) are well-placed to observe and supervise people with eating disorders who are potentially vulnerable to relapse following discharge from hospital Strategies for effective CPN interventions in the community care of anorectic and bulimic clients are suggested in the paper     

Is smoking a cause of erectile dysfunction? A literature review

Erectile dysfunction is common, and its prevalence increases with age owing to age-related diseases of vascular, hormonal, neurogenic and psychogenic factors. A literature review was undertaken to explore the impact of smoking on erectile dysfunction. The literature review of 18 studies revealed the detrimental effect of smoking on erectile function. Smokers were 1.5 times more likely to suffer erectile dysfunction than non-smokers. Men may be unaware of the effect of tobacco on erectile function. This literature review presents strong reasons for stopping smoking, and highlights the need for education within a comprehensive smoking cessation programme. All men should be offered smoking cessation treatment which includes nicotine replacement therapy and continued support. Randomized controlled trials are needed to explore the effect of smoking and smoking cessation on erectile dysfunction.     

纤维支气管镜在急危重症中的临床应用

目的 提高纤维支气管镜在急危重症患者抢救治疗中起着重要的作用认识。方法对108例急危重症患者其中96例经纤支镜引导下经鼻气管插管开放气道,共进行272次床边纤支镜吸痰及肺泡灌洗治疗。结果其中96例行纤支镜引导下鼻气管插管,插管时间均少于30秒,108例急危重症患者纤支镜吸痰及灌洗,术后患者血氧饱和度升高,血气分析氧分压提高,二氧化碳分压下降,氧和指数明显升高,治疗后体温降低,白细胞、中性粒细胞降低至正常,胸片示病灶吸收好转,所有患者气道分泌物均明显减少,呼吸道症状均有所改善。结论纤维支气管镜在急危重症患者抢救治疗中起着重要作用,值得临床重视及广泛应用价值。     

Lymphoedema 1: components and function of the lymphatic system

Lymphoedema is an incurable and debilitating condition which has a negative impact on the quality of life of the sufferer and his/her family. Information with regards to diagnosis and treatment is often scarce and conflicting in nature. The following series of articles should enable nurses to recognize the condition, provide basic information to a patient and instigate treatment though referral. The first article describes the anatomy, physiology and functions of the lymphatic system. The focus is on the parts of the lymphatic system which are specific to the condition of lymphoedema and aims to place subsequent articles in context. The following articles describe the different types of lymphoedema and the four main elements of treatment that are central to the management of the condition.     

Disorders of erectile potency in diabetes mellitus

The incidence of erectile dysfunction in patients with long-term diabetes mellitus can be as high as 50%. Diabetic microangiopathy is regarded as the most important pathogenic factor. In this review of a group of 210 impotent patients evaluated and treated at our centre we report on the examination data (angiopathy, neuropathy, psychogenic factors) in 36 patients with diabetes in comparison with the corresponding findings in 169 non-diabetic patients. In 5 patients erectile dysfunction had actually preceded the clinical manifestations of diabetes mellitus. Autoinjection therapy was started in 62% of all the diabetic patients, since this is effective, minimally invasive and, therefore, applicable to a large group of patients. This form of therapy was accepted by 90% of our patients' partners, which is in accordance to the reports in the literature. However, treatment had to be interrupted in 2 out of the 22 patients, owing to lack of cooperation on the part of the sexual partner. No complications were attributable to autoinjection therapy.     

Nursing considerations in brachytherapy-related erectile dysfunction

Following definitive local treatment for early-stage prostate cancer, preservation of erectile function has been assumed to be most likely following brachytherapy. However, recent studies have demonstrated that brachytherapy-related erectile dysfunction (ED) is more common than initially reported. The exacerbation of brachytherapy-related ED is closely related to several clinical, treatment, and dosimetric parameters including pre-implant erectile function and radiation dose to the proximal penis. The majority of patients with brachytherapy-induced ED respond favorably to oral erectogenic agents.     

Male infertility: a challenge for primary health care providers

Male infertility is a poorly understood problem that often receives awkward management from health care providers. Some abnormalities of the male reproductive system that lead to infertility can be treated successfully, others cannot. Any diagnosis of infertility can create an emotional crisis for the infertile male and his partner, which requires support, understanding and counseling from clinicians. This article examines the process of evaluating reproductive function, determining patient needs, establishing a plan of care and understanding treatment options for the infertile male.     

Attitudes of diabetic men after implantation of a semi-rigid penile prosthesis

Erectile impotence is a common and distressing problem in diabetic men. In order to examine the impact of a penile prosthesis on the quality of life of the recipients, we mailed a questionnaire to all patients (N = 49) who received a semi-rigid (Small-Carrion) prosthesis at the Seattle VAMC from 1976 to 1981. Fourteen patients with diabetes and 23 without diabetes returned the questionnaire. Direct comparisons showed no statistically significant differences between the responses of the two groups. Based on a scale of 1-7 (1 = worst, 4 = no change, 7 = best), the general effect of the operation on the quality of life of the recipients was 5.7 +/- 0.3 (Mean +/- SEM); the quality of intercourse was 5.1 +/- 0.3; the patient's perception of his partner's response to the prosthesis was 5.2 +/- 0.3; and the patient's perception of postoperative changes in his relationship with his partner was 5.6 +/- 0.3. Eighty-three percent of the patients were satisfied with the performance of the prosthesis. Most of the patients (86%) felt that their preoperative expectations had been fulfilled and would elect to have the procedure if they had it to do over again. However, five patients (14%) stated that they would not elect the operation again because their partners did not appreciate the operation (N = 2); the operation produced severe, prolonged pain (N = 1); or the patient's expectations had not been fulfilled (N = 2). Preoperative counseling should be used to foster realistic patient and partner expectations. This operation, which appears to improve the quality of life for most diabetic patients with erectile impotence, should be considered a part of standard care and not as a cosmetic procedure or extraordinary care.