The case of the month
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.
March 2009 case of the month
A 61 years old male presents to an Andrology clinics with erectile
dysfunction and diminished libido for 3 years. He reports
progressive loss of normal erections and significant worsening
for 1 year after initiation of medical treatment for lower urinary
tract symptoms (LUTS). He has been using an -Blocker
(Alfuzosin) and 5- reductase inhibitor (dutasteride) for LUTS
for 1 year. His IPSS decreased from 29 (5) to 8 (1) and has no
symptoms and very satisfied with treatment for LUTS.
His physical examination reveals normal penis and testes with
moderate enlarged prostate, no nodules on digital rectal examination
and 54 grams of prostate on transrectal ultrasound. His
IIEF-5 score reveals 8 (Severe ED) and AMS of 46 (Moderate
symptoms). His PSA level is 1.2 ng/ml, and serum testosterone
and bio-available testosterone levels are 2.7 ng/ml and 90 ng/
dl (36.2%) (N: >110 ng/dl), respectively.
He has now low sexual desire and is unable to achieve a rigid
erection for vaginal penetration and successful intercourse.