1. Approach to Erectile Dysfunction Dr Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital

4. Pathophysiology of ED ED by Classification Causes of Organic ED Clinical Manual of Sexual Medicine Sexual Dysfunctions in Men. Based on the Reports of the 2nd International Consultation on Sexual Dysfunctions, 2003.

5. How is ED diagnosed?

7. ED as an indicator of other medical conditions

8. Major Risk Factors for ED: Chronic Diseases 1. Martin-Morales A et al. J Urol . 2001;166:569-575. 2. Braun M et al. Int J Impot Res . 2000;12:305-311. 3. Goldstein I. Am J Cardiol . 2000;86(suppl):41F-45F. 4. Feldman HA et al. J Urol . 1994;151:54-61. Chronic Disease Increased ED Risks* Diabetes 1,2  4.1 Prostate disease 1   2.9 Peripheral vascular disease 1  2.6 Cardiac problems 1  1.8 Hyperlipidemia 1  1.6 Hypertension 1,2  1.6 Depression 3,4  1.8 * Age-adjusted odds ratio.  Prostatic symptoms on the International Prostate Symptom Score (IPSS) questionnaire.

9. Certain Diseases are Strongly Associated with ED Note: 64% of men with ED reported at least one or more of these conditions Rosen et al. Curr Med Res Opin 2004;20:607-17 ED n=4,422 No ED n=23,416 19 7 16 4 13 36 17 29 14 0 5 10 15 20 25 30 35 40 HTN CHD/ angina High cholesterol Diabetes Depression/ anxiety Men reporting disease (%) 25 p < 0.0001 There is a higher prevalence of co-morbid diseases in men with ED

10. Current treatment of ED

14. CV Safety Viagra Levitra ® Cialis Myocardial infarction 0.8 % 0.4 % 1.2 % Cardiac death 0.23 % 0.05 % 0.3 % Mittleman et al. Int J Clin Pract 2003;57;597-600; Porst et al. IJIR 2002;14(Suppl 4):S59; Montorsi et al. Eur Urol 2004;45:339-45

22. What if PDE5I is not effective?

23. PDE 5 inhibitors - tablets Vacum device Intra-cavernosal PGE injections Hormone replacement therapy Surgery Others – traditional medicine, supplements

30. Thank you