Genitourinary (Men)

Erectile dysfunction (ED):

Decrease blood flow to penis

Treatment:
A. Non-pharmacological:
§ Lifestyle (decrease weight, stop smoking & alcohol)
§ Manage the underline causes (HTN, Atherosclerosis)
B. Pharmacological:
§ Phosphodiesterase – 5 inhibitors (PED-5): (1st line)
{Sildenafil, Tadalafil, Vardenafil, Avanafil}. # Tadalafil if the ONLY approved for BPH
# MOA: local release of nitric oxide which will inhibit Phosphodiesterase enzyme à increase cGMP à smooth
muscle relaxes à increase blood flow à erection
# SE: Hypotension, Nasal congestion, headache, dizziness, abnormal vision (STOP once this happen)
# CI: nitrate (will cause sever hypotension)

Benning Prostate Hyperplasia (BPH):

Pathophysiology: Prostate depend on testosterone for development and maintained the

size and function

Testosterone 5 -a reductase > Dihydrotestosterone (DHT) # responsible for normal & hyper growth
# too many conversion it will lead to enlargement of the prostate
# So 5-a reductases inhibitors will ONLY be used in case of prostate enlargement > 40 g

BPH worse by: Anticholinergic (atropine, benztropine, ..etc.)

BPH induce by: Chloramphenicol

Treatment:
1. a1- receptor antagonist: {Prazosin, Terazosin, Tamsulosin}
# SE: orthostatic hypotension, nasal congestion, headache, floppy iris syndrome (with tamsulosin)
2. 5 - a - reductase inhibitors: {Finasteride, Dutasteride}
# used ONLY in prostate enlargement > 40 g
3. Combination therapy: {tamsulosin + Finasteride or Dutasteride}
# Symptoms of BPH with enlargement prostate > 40 g
4. Phosphodiesterase – 5 inhibitors (PED-5): {ONLY tadalafil approved for BPH}
5. Antimuscarinic: {Oxybutynin}

Plant used in BP: Saw palmetto

Urinary incontinence (UI):

Treatment:
§ Anticholinergic: {Oxybutynin, Tolterodine, Darifenacin}. # most common used
§ Anti-diuretic (ADH): desmopressin
# Desmopressin also used in: Diabetic insipidus, nocturnal enuresis, UI

NOTE:

ED: PDE-5 (Sildenafil)

BPH: a1- receptor antagonist (Tamsulosin, Prazosin)

BPH with prostate enlargement score > 40: Combination therapy {tamsulosin + Finasteride
or Dutasteride}

BPH + ED: ONLY Tadalafil

Prostate cancer: Flutamide, Androcur

Prostatitis: Finasteride
# Inflammation of prostate gland

Premature ejaculation: duloxetine

# Terazosin treatment of BPH by relaxation of bladder neck

Treatment of Urine incontinence (urgency and frequency): darifenacin

Treatment of Urine retention: Neostigmine, Carbachol, Pilocarpine

Med. induce impotence: Thiazide, Cimetidine, Propranolol, Azoles