evaluation of sexual function after prostatectomy- shim score
TRANSCRIPT
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Hemodynamics of penile erection
• Erection and detumescence are hemodynamic events regulated by relaxation and erection of the corporal smooth muscles
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Flaccid state of penis
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Erect state of penis (veno-occlusive mechanism)
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Innervation of penis
Relations of cavernous nerves to urethra are as follow:
Posterolateral to apex of prostate (5 & 7 o’clock).
Lateral to membranous urethra (3 & 9 o’clock).
Anterior to bulbar urethra (1 & 11 o’clock) where it enter the hilum of penis.
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Arterial supply of penis
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Venous drainage of penis
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Ejaculation
• Efferent signals traveling in hypogastric nerve activate secretions and transport sperm from the distal epididymis, vasa deferentia, seminal vesicles, and prostate to the prostatic urethra.
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Ejaculation
• Coordinated closing of the internal urethral sphincter, relaxation of the external sphincter and rhythmic contractions of the bulbospongiosus muscles direct the semen into the bulbous urethra (emission).
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Sexual dysfunction following TURP
Incidence of sexual dysfunction:
• Retrograde ejaculation is an established compliaction of TURP (upto 83%).
• Effect on other aspects of erectile function is still controversial (range from 5-13%).
(Munteuer et al., 2006)
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Risk factors for ED after TURP
• Risk factors for sexual dysfunction include:
Capsular perforation adjacent to neurovascular bundle at the prostatic apex.
Small adenoma.
D.M.
(Munteuer et al., 2006)
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ED after PKVP (plasma kinetic vaporization of prostate)
• Incidence: 10.6%
• Risk factors for sexual dysfunction include:
Capsular perforation.
D.M.
(Xiao yong et al., 2006)
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Sexual Health Inventory for men (SHIM)
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SHIM score
• Total score ranges from 5 to 25 based on the 5 questions.
• Each point is rated on likert score of:
1= least functional; …….; 5= most functional.
(Prost and Buvat, 2006)
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SHIM score
• The score characterizes ED severity as follows:
22 – 25 = normal EF.
17 – 21 = mild ED.
12 – 16 = mild to moderate ED.
8 – 11 = moderate ED.
< 7 = severe ED.
(Prost and Buvat, 2006)
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