Erectile dysfunction and kidney stones 9mm,bear grylls basic survival kit fire starter lyrics,healthy eating tips to get pregnant youtube - Test Out

Once erectile dysfunction is diagnosed and psychosexual component is ruled out a review of the drugs, haemoglobulin levels and dialysis adequacy should be corrected.
Therapies that have been used to treat sexual dysfunction include phosphodiesterase-5 inhibitors (PDE5i), intracavernosal injections, intraurethral suppositories, hormonal therapy, mechanical devices, and psychotherapy.
Studies have also identified significant associations between sexual dysfunction in chronic kidney disease patients and depression, impaired quality of life, and adverse cardiovascular outcomes. In general, weight loss can be achieved using a balanced diet that neither avoids nor focuses heavily on one food group.
Puede disfrutar de sus comidas mientras hace pequenos ajustes a las cantidades de alimentos en su plato.
Very few men will admit to having issues down below a€“ ita€™s just not something you talk about at the pub.
A ERECTILE DYSFUNCTIONAccording to Dr Chong, a€?erectile dysfunction (ED) happens to one in four men over the age of 40, but treatment is easily available and quite effective, even if the condition is severe.a€?This is a very delicate matter for most men. A Can you really persuade men to put their penis under the knife?Most men are really not enthusiastic about it, but the operation is not at all difficult and only requires one night in hospital. Five tips for international money transfers after Brexit What does Britain's departure from the EU mean for the SG$?
Video: A cocktail bar where making the drinks is part of the show Watching your drink being made is half the fun, see how they do it here. Five things you should know about prenups in Singapore In Hollywood, signing a prenup agreement before tying the knot is par for the course, but here in Singapore ita€™s still relatively uncommon.
Difficulty in achieving or maintaining an erection at least once in every four times of attempting sexual intercourse, or persisting for more than one month. Penile erection is managed by two different mechanisms: The first one is reflex erection, which is achieved by directly touching the penile shaft. Type 2 Diabetes mellitus occurs when the pancreas does not make enough insulin, or when body tissues cannot utilize insulin effciently, resulting in an abnormally high blood glucose level. Advancing thirst, tiredness, weight loss, blurred vision and others are symptoms of diabetes. Smoking, physical inactivity, obesity, stress, excess alcohol intake and a family history of hypertension are risk factors of hypertension.
Cardiac Disease is one of the main killer diseases among men in Hong Kong, causing 3,442 deaths in 2008. Coronary heart disease (CHD) is a type of heart disease due to the occlusion of the coronary arteries. A number of risk factors, including smoking, high-fat diet, physical inactivity, high blood pressure, high cholesterol levels, obesity, diabetes mellitus, stress and family history of coronary heart disease, which may work independently or in combinations, can lead to coronary heart disease.
Spinal cord and brain injuries, nerve disorders such as Parkinson's disease, Alzheimer's disease, multiple sclerosis, and stroke. Characterized by belly fat, high unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance. Radiation therapy, surgery of the colon, prostate, bladder, which may damage the nerves and blood vessels involved in erection. Various antihypertensives (medications intended to control high blood pressure) and some drugs that modify central nervous system response may inhibit erection by denying blood supply or by altering nerve activity. Stress can be job-related, money-related, or the result of marital problems, among other factors. Once a man experiences unsatisfactory erection, he may become overly worried that the problem will happen again. Having strong and lasting erections in the mornings and during masturbation but not during love making.
The goals of patient evaluation, are to assess the likely cause of the erectile dysfunction and identify medical or psychologic conditions that may be contributing to the dysfunction or that may influence treatment options.
Often one can get an excellent clue to the etiology by the history and physical examination which can then be tested by precise laboratory tests.
History and Clinical ExaminationAnatomic, psychogenic, endocrinologic, neurologic, and vascular abnormalities may all contribute to impotence. A thorough history is the most important factor in the evaluation of the patient with erectile dysfunction.
Psychogenic disorders may occasionally be primary factors contributing to erectile dysfunction. Once a concern with the patient's sexual function is identified, the next step is to differentiate erectile dysfunction from other sexual problems, such as loss of libido or ejaculatory problems. The full 15 question IIEF which helps in distinguishing what type of sexual dysfunction is present can be accessed here. The shortened 5 question IIEF which helps in judging the severity of true erectile dysfunction can be accessed here.
Early recognition of psychogenic disturbances allows the physician to avoid costly and confusing evaluation for other etiologies of impotence. Because impotence is known to be associated with many common medical conditions and medications, a careful medical history may yield insights into the etiology of impotence. Careful physical examination with particular attention to sexual and genital development may occasionally reveal an obvious cause of impotence.



The cardiovascular examination should include assessment of vital signs (especially blood pressure and pulse) and signs of hypertensive or ischemic heart disease. In many cases, a careful history and physical exam will direct the physician to the most expedient cost-effective evaluation and eliminate the need for unnecessary diagnostic tests.
Kidney disease can cause chemical changes in the body affecting circulation, nerve function, hormones and energy level.
Your doctor can perform blood work to determine if your lack of interest in sex is due to your changing hormone levels.
Phosphodiesterase-5 inhibitors (PDE5i) such as viagra compared with placebo significantly increases sexual performance. Effective treatment of sexual dysfunction in CKD patients may therefore potentially lead to improvement in these patient-level outcome. But EX reporter Jade McLean wants to know all about your bits and pieces, so she put on a brave face for an in-depth chat with Dr Simon Chong and Dr Ong Chin Hu of Pacific Healthcare Specialists, about some of the weird and wonderful things that can happen as you get older. What can you say to put their mind at ease about coming to see you?Dr Chong: First of all, men need to understand that this is quite common.
Coronary heart disease accounted for approximately two thirds of all heart-disease-related deaths in men. It is postulated that the penile circulation is intrinsically precarious, being an end-artery it may not be surprising that blood flow to the penis be partially occluded as men age.
Erections may take longer to achieve, may not be as rigid or may take more direct touch to the penis to occur. At the same time, some have multiple causes, such as a person with diabetes who is also on certain antihypertensive medications.
Therefore, the evaluation of impotence begins with a comprehensive history and physical examination. Recognition of these patient characteristics should lead the clinician to entertain the possibility of a primary psychogenic etiology of impotence. The physician should use appropriate vocabulary, avoiding slang or excessively technical terminology.
Moreover, many patients complain of erectile dysfunction when they mean something lese such as premature ejaculation etc., and again this needs to be recognized before embarking on the detailed evaluation. Particular attention should be given to the cardiovascular, neurologic and genitourinary systems, as these systems are directly involved with erectile function. Careful examination of the penis may reveal an anatomic abnormality such as a micropenis, the presence of chordee, or a Peyronie's plaque. Abdominal or femoral artery bruits and asymmetric or absent lower extremity pulses are indicative of vascular disease. Patients with diabetes or neurodegenerative disorders may show evidence of peripheral neuropathy. The condition has been found to be significantly more common in men and women with chronic kidney disease (CKD) than in the general population.
Patients with kidney disease (especially patients on dialysis) face many emotional and social stressors. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. According to the Population Health Survey of the Department of Health, 60% of males with hypertension do not know they have the disease. When the arteries become narrow and stiff because of fatty plaques, blood supply to the heart will be reduced and the heart muscles will be damaged. Although this may not cause major health problems, erection problems may arise due to the hindered penile blood flow.
A careful sexual history and knowledge of concurrent illnesses and medications are essential.
Having the patient define the terms in his own words will help the physician and patient communicate more effectively. Many common medications such as psychotropic drugs and antihypertensives have been associated with impotence.
Approximately 50% of male predialysis CKD patients and 80% of male dialysis patients have erectile dysfunction.
The use of testosterone injections have shown only a small and variable response in erectile function. There are encouraging reports in the use of phosphodiestrase 5‐inhibitors use in patients with CKD. For me, there is no greater happiness than partnering with these patients in their health and emotional content.
More often than not ita€™s a combination of the two.I try to find out the underlying causes by talking about his history.
If youa€™re well hydrated, your urine is less concentrated and the chance for a stone to crystallise is less likely. In both conditions, an intact neural system is required for a successful and complete erection. The sexual history should include the duration of impotence, level of libido, and a complete inventory of sexual partners.


The International Index of Erectile Function (IIEF) is a valuable tool for defining the area of sexual dysfunction. Similarly, a patient's surgical history may also provide clues to the possible causes of impotence. Certain genetic syndromes such as Kallmann's or Klinefelter's syndrome may present with obvious physical signs of hypogonadism or distinctive body habitus. The superficial anal reflex, indicative of normal somatic function of sacral cord levels S24, is assessed by touching the perianal skin and noting contraction of the external anal sphincter muscles. Multiple factors contribute to the frequent occurrence of sexual dysfunction in CKD patients, including hormonal disturbances such as hyperprolactinemia, hypogonadism in males. He may benefit from a referral to a psychotherapist, or the couple may be advised to seek marriage guidance. A greater awareness of this common problem should be encouraged so that patients and their partners do not feel embarrassed about broaching this subject with their physicians.
Psychological factors can be simple ones such as lethargy, stress at work or an unhappy relationship. You tuck it in your pants for your day-to-day routine and straighten it out when you want to have intercourse. Certain food sources can also make you more prone, like chocolate, or certain types of nuts. Stimulation of penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. The IIEF is designed to be a self-administered measure of erectile dysfunction, but it also assesses a patient's function in other phases of sexual function. Prior radical pelvic surgery (eg, prostatectomy, abdominoperineal resection), radiation, and pelvic trauma are known to be associated with impotence. Although renal transplant may effectively reverse many of the hormonal and psychological changes of chronic renal failure, many patients will remain on a transplant waiting list for a considerable length of time. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. The IIEF also establishes a reliable baseline that can be used to monitor changes related to treatment. It is performed by placing a finger in the rectum and noting contraction of the anal sphincter and bulbocavernosus muscle when the glans penis is squeezed. Patients who develop significant vascular disease may still remain impotent even after a successful transplant. If a man masturbates and has no issues, but with his wife ita€™s not working, then ita€™s mostly psychological.If ita€™s a combination, I would need to take a multi-pronged approach to treatment. Depending on the position of the stones, we can use shock wave therapy where a high-energy ultra sound wave is applied to the surface of the skin, breaking the stone down and allowing it to pass. Based on the mechanism of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. For example, the patient could be a man with diabetes who has a relationship problem with his wife. This blockage causes pressure in the back near the kidney, resulting in the worst pain you can imagine.
Not all stones react though.I can also use an endoscopy scope with a laser, which goes up through the urethra to the kidney and breaks it down. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease. Normally, these arteries dilate in response to sexual stimulation, allowing more blood to flow into the spongy tissue of the penis to produce an erection.
The excessive pressure in these arteries may cause tiny tears, which are subsequently repaired by the body.
My advice is if you have a family history of prostate cancer, ita€™s a good idea to get checked. It could be something thata€™s physical or visual or some form of arousal that triggers the pelvic nerves, causing blood supply to the penis to increase and cause and erection. Therea€™s no strong advocate for general screening but if you want to, you should go if youa€™re over 40 years old.What are the symptoms?Unfortunately, you dona€™t have symptoms of prostate cancer until the disease is very advanced.
These thicker blood vessel walls, though, will impose extra resistance to blood flow into the erectile tissues of the penis. Symptoms at this stage will often be the squeezing of the urinary tract due to an enlarged prostate, making it difficult to pass urine and making you need to go to the toilet often. Also, it takes one hour for the tablets to work so ita€™s not spontaneous and the man will still need some stimulation.What if the drugs dona€™t work?We also have a relatively new treatment that we use concurrently alongside the tablets as it can make response to the tablets better. It works by increasing the number of blood vessels, blood supply and nerve supply to the penis.
Research has found that a course of 12 sessions over nine weeks can still be effective after two years.



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