Download - Disfungsi Ereksi
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Disfungsi Ereksi
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Definisi Disfungsi Ereksi
Ketidakmampuan untuk mencapai
atau mempertahankan ereksi
yang cukup untuk sanggama
yang memuaskan
Keadaan ini dialami sekurang-kurangnya dalam 3 bulan terakhir (Concensus Guideline Panel, Des, 1997)
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Anatomi Penis
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Relaksasi Ereksi Otot polos kavernosa
Kontraksi Detumesensi Otot polos kavernosa
Mekanisme Ereksi
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Mekanisme Ereksi
FLASID EREKSI
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Insidens Alif, 1999 : 13,8 % dari penderita bangsal urologi RSUD Dr. Soetomo (n=1257)
Prevalensi DE menurut umur(data derived from Kinsey et al., 1948)
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Penyebab DE
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Primary stimulus
Membrane bound receptorOr
Cytoplasmic protein
Production of intracellular2nd messenger
Change in intracellularCalcium concentration
Change in smoothMuscle tone
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Sexual Education Obat oral Pompa Vakum
(Vacuum Constriction Device=VCD)
Terapi Lini Pertama
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Obat Oral
Obat oral untuk terapi disfungsi ereksi:
Sildenafil sitrat
Fentolamin
Apomorfin
Fentolamin dan apomorfin belum mendapat persetujuan untuk dipasarkan di Indonesia sebagai obat DE
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Sildenafil sitrat
• Penghambat enzim phosphodiesterase tipe 5 (PDE -5)
• Nama dagang VIAGRA®
• Dosis 25 mg, 50 mg dan 100 mg• Persetujuan POM DepKes RI: Agustus 1999• Persetujuan FDA Amerika: Maret 1998• Banyak beredar Viagra di pasaran gelap
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NANC NOEndothelial cells
Guanylatecyclase
cGMPGMP
RELAX
GTP
PDE5
Ereksi penisSILDENAFIL
Otak
Sumsum Tulang Belakang
Stimulus :• Penglihatan• Penciuman• Pendengaran• Perabaan• Imajinasi
Sistem Saraf Parasimpatis
Mekanisme Kerja Sildenafil
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Pompa Vakum
Efikasi: 70-80% Keluhan:
Sakit (tidak nyaman) Tidak praktis Pasangan terganggu
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Pompa Vakum
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Terapi Lini Kedua
Indikasi: Terapi lini pertama gagal Pilihan penderita
Macam: Injeksi intrakavernosa
PGE1 intrauretra
Note: PGE1 intrauretra belum dipasarkan di Indonesia
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Injeksi Intrakavernosa
Pada bagian samping batang penis, 1/3 proksimal
Hindari vv subkutan dorsal penis ventral penis
Jarum 29-30 G, panjang 1/2 inch
Pijat seluruh batang penis
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PGE1 INTRA URETRA
* Nama Dagang : MUSE (Medicated Urethral System for Erection
* Dosis : 125, 250, 500. 1000 ug
* Cara : - Miksi dulu - Ujung aplikator dimasukkan uretra sampai leher - Ejektor ditekan - Penis digelintir 1-2 menit - Berdiri / berjalan-jalan 10- 15 menit
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Terapi Lini Ketiga• Indikasi:
– Terapi lini pertama dan kedua gagal– Pilihan penderita
• Macam:– Operasi vaskular– Prostesis Penis :
• Semirigid• Self contained inflatable• Fully inflatable:
– Two pieces inflatable– Three pieces inflatable
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Operasi Vaskular
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Operasi Vaskular
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Prostesis Penis
Semirigid Three pieces inflatable
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