Erectile Dysfunction: Pathogenesis Erectile Dysfunction - Persistent or recurrent inability to achieve an erection sufficient to achieve desired sexual performance Psychogenic Erectile Dysfunction Sudden onset, sporadic -> (circumstantial), younger, nocturnal/AM erection present -> Anxiety, depression, strained relationship, lack of sexual arousal, psychological disorder -> Possible mechanisms include an imbalance of central neurotransmitters, over inhibition of spinal center by the brain, and sympathetic overactivity -> Normal Noctumal penile tumescence and rigidity Neurogenic Erectile Dysfunction Neurologic disease, trauma, iatrogenic, diabetes mellitus -> Central (cerebral or spinal cord); peripheral (afferent/sensory neuropathy) or efferent (autonomic neuropathy) -> decreased parasympathetic nerve firing -> decreased NO release -> Abnormal Nocturnal penile tumescence and rigidity Endocrinologic Erectile Dysfunction Hypogonadism, hyperprolactinemia, hyperthyroidism, alcoholism, iatrogenic -> circulating free testosterone Vasculogenic Erectile Dysfunction Hypertension, smoking, hyperlipidemia, diabetes, cardiovascular disease, iatrogenic -> Endothelia cell damage and small vessel disease (penile artery diameter 1-2 mm) #Erectile #Dysfunction #Pathophysiology #Urology #Diagnosis
