Στυτική δυσλειτουργία

Erectile dysfunction

Erectile dysfunction is defined as the inability to achieve an erection capable of penetration. Of the patients who seek medical help, one in four men are under the age of 40, and of these, 50% has severe erectile dysfunction. Unfortunately, it is a taboo subject for most men, who are afraid to come to the Urologist for help. Of note, patients with erectile dysfunction may have underlying vascular disease and require cardiac evaluation. The causes are divided into idiopathic, organic, iatrogenic and psychogenic (especially in young men).

Vascular causes

Smoking
Lack of physical activity
Obesity
Hypertension
Coronary artery disease
Peripheral vasculopathy
Diabetes Mellitus
Hyperlipidemia
Chronic renal failure
Chronic liver failure

Neurological causes

Parkinson's disease
Multiple sclerosis
Spinal trauma
Stroke
Tumors of the nervous system
Polyneuropathy

Anatomical causes

Hypospadias
On duty
Trifle
Gagging
Peyronie's disease
Penile cancer
Prostatic hyperplasia

Hormonal causes

Diabetes Mellitus
Hypogonadism
Hyperprolactinemia
Hyper-, Hypothyroidism

Iatrogenic causes

Urethral surgeries (stenosis, urethroplasty)
Radical prostatectomy
Pelvic radiation
Medication (antihypertensives, antidepressants, antipsychotics, antiandrogens, anabolic substances

Psychological causes

Lack of comfort with the sexual act
Lack of sexual desire
Depression
Stress
Dissatisfaction with the appearance of the genitals
Non-stimulation by sexual partner

Wound

Penile fracture
Pelvic fractures

The diagnosis is based on basic methods that are a main pillar:

History
Clinical examination
Laboratory tests to check diabetes, testosterone, thyroid, etc
Second-line diagnostic methods are:

Estimation of hardness of nocturnal erections (Rigiscan) https://www.androclinica.com/1016-test-de-rigiscan, http://www.imop.gr/diagnwstikes-eksetaseis/katagrafh-nyxterikwn-stysewn

Triplex of iliac arteries

Corpus cavernosum arteriography
Psychiatric assessment
Treatment of erectile dysfunction
Lifestyle change (smoking cessation, weight loss, physical activity)
Treatment of causes that cause erectile dysfunction (Diabetes, hormonal diseases, anatomical causes, etc.)
Pharmaceutical treatment with 5-phosphodiesterase inhibitors (Viagra, Levitra, Cialis, Spedra, etc.).

Endopenial infusion of autologous platelet-rich plasma (PRP) appears to have promising results for mild to moderate erectile dysfunction.