Question-Erectile dysfunction

[Soul]

A 50 yrs old man reports inability to achieve penile erection. He is a chronic smoker, H/O diabetes type 2, had one episode of MI. What might be the cause for his erectile dysfunction?

1. Loss of sexual interest due to old age
2. Prostratic hypertrophy
3. Atheromatous occlusion of the distal abdominal aorta
4. Oral hypoglycemic agents

[Soul]

It seems no one is interested replying the answer.

[Status Epilepticus]

The most probable answer is

ALL OF THE ABOVE

[Oak]

I would go for 3. because

1. Old age is not related to loss of sexual interest at least at that age.
2. Prostatic hypertrophy has nothing to do with it unless surgery has been done as surgery might damage the neurovascular damage
3. yes, it does as there is vascular copromise
4. OHA do no cause erectile dysfunction instead beta blockers, thiazides, cimetidines does.


its my residual knowledge i haven't gone through the text books or literatures so whats the answer Soul?

[demon_dissector]

i'm saying no.3.

being a smoker, a diabetic and that too a type II means he's over weight, and has previous history of MI...all these put him in a high risk category for heart disease as he must have profound atherosclerotic changes in his vessels. The vessels affected are also the penile arteries which seems like the probable cause for erectile dysfunction.

As for old age and lack of interest...we're talking about a man here...!!

[Psychic]

I'll go for 4...... 'coz oral hypoglycemic agents supresses the testosterone level i guess.
Soul,let us know whats the correct ans

[Soul]

The correct answer is 3.
You guys have done well. The diagnosis made by Oak and demon-dissector is correct and their explanation are superb.
Now let me explain more.
This man came with the complain of erectile dysfunction. He is chronic smoker, diabetic and had a h/o MI. Lab analysis also showed that his LDL and TG were very high and HDL was low. Contrast-enhanced abdominal CT scan
showed complete occlusion of the infrarenal aorta by thrombus that extended into both common iliac arteries. Can you recall pathology??
Yes, this is a typical case of "Leriche Syndrome". Leriche syndrome is caused by atheromatous occlusion of the distal abdominal aorta at the bifurcation into the common iliac arteries and patient complains of erectile dysfunction.
There is a triad of this syndrome: Erectile dysfunction, Claudication in the legs or buttocks, and Absent or diminished femoral pulses. But the later two are not very significant due to development of collaterals. Risk factors include:Cigarette smoking, Hypercholesterolemia, Diabetes. CT and MRI are helpful in Dx. Treatment is aortoiliac bypass.
Cheers !!!

[JNUS]

Thanks a lot..