Erectile Dysfunction and its Clinical Diagnostics by Urologist
Erectile dysfunction (ED) is the inability to achieve or maintain an erection of the penis, sufficient for a sexual intercourse, which occurs for three months or more.
The main task of diagnosing erectile dysfunction is to identify its cause, because it will allow you to choose the method of treatment. Another task of the diagnosis is to obtain additional information necessary to provide an effective therapeutic approach.
Which information will be necessary for urologist to diagnose ED?
Assessment of sexual function includes:
- Assessment of erectile insufficiency: when the first manifestations are noted; how quickly it progresses; degree of expression at the moment; presence of nocturnal / morning erections; the presence of an erectile response to self-stimulation and visual erotic images.
- Violation of sexual desire;
- Assessment of ejaculation, orgasm;
- Information about the sexual function of the partner.
The evaluation of the patient’s psychological state is of great importance for the diagnosis of erectile dysfunction. It is necessary to find out the specifics of the relationship with the sexual partner and the reaction to the existing violations. At the same time, the presence of sexual dysfunction in a regular sexual partner is an aggravating factor and requires a complex of therapeutic and diagnostic measures.
How does the examination take place?
Each patient with erectile dysfunction should undergo a physical examination with an emphasis on evaluation of the genitourinary, endocrine, cardiovascular and nervous systems.
- General examination – the physique and severity of secondary sexual characteristics are evaluated, also it is worth paying attention to signs of thyroid dysfunction: changes in heart rate, hair loss, skin changes, eye symptoms.
- Examination of the external genitalia – allows to detect the presence of deformations of the penis (Peyronie’s disease, congenital deformity), the condition of the scrotum organs. Rectal examination reveals soreness, enlargement of the prostate, and suspected cancer.
Examination in the laboratory
The purpose of the laboratory examination is based on the patient’s complaints and the presence of risk factors in the anamnesis. With erectile dysfunction, the following indicators are recommended:
- Identification of violations of the hypothalamic-gonadal-pituitary system – is performed if hypogonadism or age-related androgen deficiency is suspected.
- Determination of testosterone levels should be done in the morning hours (from 8 to 11-00). The most reliable indicator is the level of free testosterone.
- Determination of glucose and lipid levels – the analysis is necessary for the detection of diabetes mellitus and hyperlipidemia.
Complex ultrasound of the penis
Ultrasound of the penis is a widespread technique that attracts with its simplicity, high informativeness, safety, accessibility and speed (the whole procedure will take no more than 30 minutes). At the initial stage, a complex ultrasound of the penis is used in the rest phase. This allows to exclude the most frequent organic component of erectile dysfunction: volumetric formations, cicatricial changes, various inflammations, congenital anomalies. This study is completely painless and does not require any preliminary preparation of the patient.
If necessary, the doctor may prescribe an additional ultrasound using erectile inducers. In this case, to create an induced erection in the cavernous body of the penis, a vasoactive drug is introduced.
Complex ultrasound examination of the vascular bed of the penis with a pharmacological test allows you to:
- evaluate the parameters of blood flow in all phases of erection,
- reveal the pathology of the vessels,
- determine the mechanism of the occurrence of erectile dysfunction,
- develop an optimal method of treatment.
Instrumental methods of diagnostics
Since both instrumental survey methods are often invasive, indications for their conduct must be clearly defined. The patient should be fully informed about the appropriateness of instrumental methods and their possible consequences.
- Intracavernous test and echodopplerography of the vessels of the penis allows you to evaluate the vascular apparatus of the penis. The test is considered positive when an erection occurs 10 minutes after the intracavernous injection of the vasoactive drug. Sometimes, visual-erotic stimulation is additionally used.
- Selective penile arteriography – currently applied only before reconstructive vascular surgery.
- Cavernosography – used to visualize pathological venous outflow. This method of research is used before the operative treatment of venous insufficiency of the penis.