งานนำเสนอกำลังจะดาวน์โหลด โปรดรอ

งานนำเสนอกำลังจะดาวน์โหลด โปรดรอ

Group 3 ธนวัต จางคกูล 43076140 กนกพร ตั้งจิตติพร 43076173 เฉลิมพล ธวัชรา ภรณ์ 43076199.

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งานนำเสนอเรื่อง: "Group 3 ธนวัต จางคกูล 43076140 กนกพร ตั้งจิตติพร 43076173 เฉลิมพล ธวัชรา ภรณ์ 43076199."— ใบสำเนางานนำเสนอ:

1 Group 3 ธนวัต จางคกูล กนกพร ตั้งจิตติพร เฉลิมพล ธวัชรา ภรณ์

2 Erectile Dysfunction Meaning : “ The inability to achieve and maintain a penile erection satisfactory for sexual intercourse ” (Does not include ejaculation disorders)

3 History •The first description of erectile dysfunction, about 2000 B.C., was set down on Egyptian. •Hippocrates concluded that too much horseback riding was the cause of disease. •Aristotle, air influx into penis.

4 Anatomy of the penis •Tunica Albuginea •Corpora Cavernosa -- Sinusoid •Corpus Spongios u m -- Sinusoid •Glans Penis •Artrial supply •Venous drainage •Nerve

5 Arterial Supply •Internal iliac artery •internal pudendal artery [main] –Dorsal artery –Bulbourethral artery –Cavenous artery •External iliac, Obturator, vesical and femoral artery. [accessory]

6 Venous drainage •Emissary veins, transformed from peripheral sinusoids •Deep dorsal vein [main] •Bulbourethral vein, Cavernous vein [ accessory ]

7 Mechanism of erection : Dilatation arterioles&arteries expanding of sinusoids compression of subtunical venular plexuses Emissary veins enclosed increasing of intracavernous pressure to raise the penis

8 Mechanism of Detumescence Transient intracorporeal pressure increase [smooth muscle contraction] Pressure decrease slowly [slow reopening of the venous channels] Pressure decrease fast [venous outflow capacity is fully restored]

9 Neuroanatomy of penile erection •Peripheral pathways –autonomic [ C. Cavenosa & C. Spongiosum] –somatic [ Glans Penis & C. Spongiosum] Sympa, - NE release Parasym, + NO & Ach release Somatic, +Ach release

10 Neuroanatomy of penile erection •Supraspinal pathways [ hypothalamus, limbic system and cerebral cortex] dopaminergic & adrenergic recepters promotes sexual drive serotonin recepters inhibits sexual drive

11 Classification of Erectile Dysfunction •Psycogenic •Neurogenic •Endocrinologic •Arteriogenic •Cavernosal (Venogenic) •Drug-induced •Erectile dysfunction associated with aging, systemic disease & others

12 Cause of Erectile Dysfunction Alcohol AbuseAnxiety or Depression Coronary Artery DiseaseDiabetes Hormonal Abnormalities Hypertension Peripheral Vascular Disease Renal or Hepatic Failure AnemiaSmoking Surgery(Pelvic or Perineal) Trauma to pelvic or spine Medication : AntiHT, Antidepressant, Antiarrhythmic,Antipsychotics Diuretics, Anticonvulsants, Antiandrogen, Narcotics

13

14 Treatments of Erectile Dysfunction

15 Treatments of Erectile Dysfunction Drug Therapy : Orally Administration Intracarvernous Injection MUSE or Intraurethral Suppository Vacuum Devices Horrmone Replacement Therapy Surgery Others

16 •Drug Therapy : Orally Administration Yohimbine Phentolamine Apomorphine Sildenafil Treatments of Erectile Dysfunction

17 Yohimbine alpha 2 -antagonist Side effect : anxiety, ปัสสาวะบ่อย, tachycardia, เพิ่ม arterial pressure Treatments of Erectile Dysfunction Drug Therapy : Orally Administration

18 Phentolamine vasoactive Drug Side effect : orthostatic hypotension, tachycardia Treatments of Erectile Dysfunction Drug Therapy : Orally Administration

19 Apomorphine (Sublingual) Stimulate brain dopaminergic mechanism Side effect : nausea, vomit, yawn Treatments of Erectile Dysfunction Drug Therapy : Orally Administration

20 Sildenafil Phosphodiesterase Inhibitor Side effect : headache, flushing, dyspepsia visual disturbance Contraindication : co-administration with nitrate MI, CHF Treatments of Erectile Dysfunction Drug Therapy : Orally Administration

21 Intracavernous Injection ใช้ vasoactive agents ในการฉีดเข้า corpora cavernosa ทำให้เส้นเลือดขยายตัว เกิดการคั่งของเลือดที่ penis ทำให้เกิด erection Vasoactive Agent Papaverine Phentolamine Alprostadil Treatments of Erectile Dysfunction

22 Intracavernous Injection Side effect : priapism, small nodule, subcutaneous hemorrhage, pain, trauma, scar *combination therapy จะให้ ผลการรักษาที่ดีกว่า monotherapy * การเพิ่ม oral alpha-blocker (Doxazosin) จะเสริมฤทธิ์ในการ ขยายหลอดเลือด Treatments of Erectile Dysfunction

23 Intraurethral suppositories “MUSE” (Medicated urethral system for erection) มีหลอดบรรจุ alprostadil สำหรับสอด เข้าทาง urethra โดยจะออก ฤทธิ์ภายใน 8-10 นาที อาการไม่พึงประสงค์ : ปวด อาการบวม แดง อาจมีเลือดออกในท่อ ปัสสาวะ Treatments of Erectile Dysfunction

24

25 Vacuum Devices Pump จะดูดอากาศออก จาก cylinder ทำให้เกิด สูญญากาศเกิดแรงดึง เลือดเข้า penis และ elastic band จะป้องกัน ไม่ให้เลือดไหลย้อนกลับ Treatments of Erectile Dysfunction

26 Hormone Replacement Therapy : Testosterone เพิ่ม sexual function มีทั้งในรูปแบบการฉีด การ รับประทาน และการทา Treatments of Erectile Dysfunction

27 Surgery - ผ่าตัดใส่ Paired rod เข้าใน corpora cavernosa - ผ่าตัด repair arteries จะช่วยได้ใน กรณี obstruction Treatments of Erectile Dysfunction

28 Others : Alprostadil gel ทาที่ glans penis จะทำให้เพิ่ม penile rigidity Treatments of Erectile Dysfunction

29 Comparision of Treatments Oral Medica tion Intracar venous Injectio n Vacuu m Device HR T Surg ery MUSE Use :AUA guildline : 1st Line(Now) effective in definable & undefinabl e cause Injecti on alterna tives Oldest Treatm ent Androp ause Last choice or Arterial revascul arize and venous ligament in younger pt. Or prostheti c penile implanta tion AUA guildline : 1st Line(Old) effective in definable & undefinabl e cause

30 Comparision of Treatments Oral Medica tion Intracar venous Injectio n Vacuu m Device HR T Surg ery MUSE Agen ts : Sildenafil Yohimbine Phentolam ine Apomorphi ne Alprost adil -Testost erone -Alprostadil Papaverin e Phentolam ine Effect ive : Silden % Others is lower Monotherap y 70-74% Combined 90 % % 90 % up 61 % -

31 Comparision of Treatments Oral Medica tion Intracar venous Injectio n Vacuu m Device HR T Surg ery MUSE Advan tage Comfortab le, Non invasive Less Invasiv e than inj. and no death eviden ce Maintai n BMD Improv e sex fn.,moo d & emotio n Increas e muscle strengt h High effective, no death evidence High effectiv e

32 Comparision of Treatments Oral Medica tion Intracar venous Injectio n Vacuu m Device HR T Surg ery MUSE Dis Advan tage Have Death evidence data lower effective in some case as DM Penile pain urethra l bleedin g More expens ive than injectio n Use only in androp ause long term : Anemia, increas e bl. Viscosit y CI in Prostat e CA 50 % reject the long term treatment cause : decrease in response less interest in sex problem of self inj. Penile pain(11%) priapism (0.5-5%) Patient s and Partner’ s satisfati on less than inj. Expensi ve, uncomf ort.

33 Comparision of Drug Therapy Sildena fil Alprosta dil Papave rine Phentol amine Apo morp hine MUSEAge nts Phosphodie sterase inhibitors : increase NO : increase cGMP Like Alprost adil Phosphod ies- terase inhibitors : Inhibit smooth muscle contracti on Alpha 1,2- adrener gic recepto r blockin g :Dilate arterial vessel :inh. Symp. Stimulat e Brain dopamin ergic mechani sm that effect erection Syn. PG. E alpha- adrenagic blocking agent :Carvenous smooth muscle relax :Arterioles smooth muscle relax Mecha nism % avg. 75 % Monotherap y 70-74% Combined 90 % % % 65 % Effecti ve %

34 Comparision of Drug Therapy Sildena fil Alprosta dil Papave rine Phentol amine Apo morp hine MUSEAge nts oralIntraur ethral suppos itory by applica tor intracarv enous injection oral or Intracar venous injectio n subling ual intracarv enous injection Admin. route mg 5-20 mcg mcg Single 10-60mg Combine 3-5mg (Papa+P hento or Papa+Alp ro) - usual dose mg

35 Comparision of Drug Therapy Sildena fil Alprosta dil Papave rine Phentol amine Apo morp hine MUSEAge nts Definable and undefinabl e such as DM, Olderly with HT spinal cord injury depression Alprost adil injectio n alterna tive like alprostad il like alprosta dil Psycho genic Type Definable and undefina ble such as DM, Olderly with HT spinal cord injury depressio n Use in case - pt. Use nitrate, Heart Disease, Renal&H epatic Impairme nts Predispositio n to priapism eg anemia,leuke mia Anatomical deformation of penis Ab. Penile Anatom y Urethriti s risk of priapism Heart Disease Contra indicati on NA.d ata

36 Comparision of Drug Therapy Sildena fil Alprosta dil Papave rine Phentol amine Apo morp hine MUSEAge nts 16% Headache 10% Flushing 7% Dyspepsia 3% Visual Disturb Papa + Phentolamine 0.4 % Penile Pain 8 % Priapism and fibrosis Nausea Vomit Yawn 35 % Penile Pain 2% Priasism or Fibrosis ADR Have Death evidenc es only Alprostadil has approved in USA Phentolamine has carcinogenic potential effect in rat Dis Advant age 30 % Penile Pain 5% Urethral bleeding 6% Drowsines s sweating, Hypot.

37 The End


ดาวน์โหลด ppt Group 3 ธนวัต จางคกูล 43076140 กนกพร ตั้งจิตติพร 43076173 เฉลิมพล ธวัชรา ภรณ์ 43076199.

งานนำเสนอที่คล้ายกัน


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