Erectile Dysfunction

Cause: MC= organic not psychological--> HTN, DM, hyperlipidemia, and cardiovascular disease.  Drugs: B-blockers

Dx:  cbc, urinalysis, lipid profile, thyroid function, testosterone, glucose,a nd prolactin.  Nocturnal penile tumescence differs organic from psychological cause --> if have nocturnal erections = psycho cause. Studis for arterial and venous vasculature.

TX: sex therapy, test replacement, weight loss if BM>30, PDE-5 I = sildenafil, vardenafil, tadalafil (DO NOT use with nitrates).  Vacuum devices, injection of vasoactive sub, and penile prostheses.

Hydrocele

What: mass of fluid filled congenital remnants in tunica vaginalis

S/S:  soft, nontender fullness that transilluminates

DX:  urinalysis neg., US rarely done

TX: elective repair

Varicocele

what: formation of venous vericosity within spermatic vein - usually L bc vein is longer and joins the left renal vein.

S/S: chronic, nontender "bag of worms" that does not transilluminate.  Inc. in size with valsalva

Dx:  doppler sonography 

TX: surgery - vein ligation if painful or causing infertility.