The case of the month

Section Editor:
Stéphane Droupy, MD, PhD, Urologist
Urology Department CHU de Bicêtre - Le Kremlin Bicêtre - France
Experimental Surgery Laboratory - UPRES EA 1602 - Paris South University School of Medicine.
e-mail: Sdroupy@aol.com

A clinical case will be presented followed by multiple choice questions. Visitors will answer the questions and after a month the author of the case will offer step-by-step description of the management he offered to the patient, making also comments on the results of the voting as they will appear graphically in the website.

December 2007 case of the month

A 23-year old man visits his primary case physician complaining of erectile dysfunction. He has tried 6-7 times in his life to have intercourse with 3 different partners unsuccessfully. He can achieve hard erections, but he can not maintain an erection for a successful intercourse. He masturbates regularly, although the last year he feels low libido and he avoids sexual relationship. The primary care physician is requiring a hormonal profile (FSH, LH, testosterone, prolactin) with normal results. He advises the patient that he is having a psychogenic ED and he prescribes sildenafil 100mg with moderate results (5/10 successful intercourse). The patient is then referred to a specialized urologist. He advises the patient to have a hemodynamic evaluation based on penile triplex examination. Peak systolic velocity was 41cm/sec, end-diastolic velocity was 45cm/sec and the resistance index was 0.63.