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The objective: to study the state of androgen supply and erectile function in men with chronic distress. Materials and methods. We examined 30 internally replaced males (Average age, M±σ=50.50±3.83) with manifestations of chronic distress (Group I) and 20 practically healthy males (Group II), (Average age, M±σ=51.95±4.60). All men underwent general clinical examination, body mass index evaluation, assessment of depression according to Hospital Anxiety and Depression Scale (HADS), assessment of symptoms of androgen deficiency according to the Aging Males' Symptoms (AMS). Severity of erectile dysfunction was evaluated according to the International Index of Erectile Function scale (IIEF). The following parameters were determined in blood serum: luteinizing hormone (LH), folliclestimulating hormone (FSH), total testosterone (TT), free testosterone (TF), estradiol (E), cortisol (K). Results. According to the HADS scores in group I men, the average anxiety domain score was 12.03±1.50 points, the average depression domain score was 13.93±1.49, and the total score was 26.0±2.64 points. In patients of group II, the average anxiety domain score was 2.20±0.88 points, the average depression domain score was 2.60±1.00, and the overall score was 4.80±1.40 points. The comparison of the total score of group I and the total score of group II is statistically significant (p<0.05). According to the AMS, in men of group I, androgen deficiency was more expressed comparing to the control group (45.93±3.30 and 13.30±2.04 points, respectively, p<0.001). Analysis of the IIEF-15 questionnaire revealed a decrease in all indicators of erectile function in men of group I comparing to group II. A study of the hormonal state showed a decrease in the level of TT in men of group I compared to the indicators of group II: 9.30±2.84 and 15.27±0.96 ng/ml, respectively (p<0.001). The average TF levels in group I were reduced comparing to group II and reached 10.23±1.38 and 17.39±1.03 pg/ml, respectively (p<0.001). The levels of LH and FSH in men of group I were within normal age-related fluctuations and did not differ statistically significantly from similar levels of group II. The average E level in men with chronic distress was significantly increased comparing to the control group and reached up to 0.25±0.05 versus 0.11±0.03 nmol/l, respectively (p<0.001). The average C level in men with chronic distress was significantly increased comparing the control group and reached up to 13.33±2.19 versus 6.72±1.33 μg/dL, respectively (p<0.001). Conclusions. 1. The survey results indicate that chronic distress is a factor that worsens sexual function in men. In addition to erectile dysfunction, as evidenced by a decrease in the corresponding IIEF integrative indicator 15 «erectile function», the survey found a decrease in both the frequency of occurrence and the degree of sexual desire, a deterioration in orgasmic sensations in the form of a decrease in the frequency of ejaculation and orgasms. 2. Cortisol is an important hormone that forms protective reaction in stressful situations, but loses its positive properties during chronic distress. A prolonged increase in cortisol levels can lead to a pathological condition accompanied by an increase in BMI, depression, anxiety, decreased testosterone levels and ED. 3. A decrease in testosterone levels in chronic distress and visceral obesity in men is not accompanied by a compensatory increase in LH and FSH levels. This can be explained by increased aromatization of testosterone in visceral adipose tissue and a decrease in the pituitary gland's response to the development of androgen deficiency as a result of combined damage to the central and peripheral parts of the regulation of testosterone synthesis. [ABSTRACT FROM AUTHOR]

Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spinal cord. However, they remain an undiagnosed pathology and, in case of untimely treatment cause significant disability. SDAVFs can debut with urination disorders, erectile dysfunction, and mimic different pathologies. At the same time, the vast majority of cases are difficult to diagnose. The urological aspects of SDAVFs are important for proper evaluation and management of patients with urological disorders. The objective: to analyze the urological disorders in patients with spinal dural arteriovenous fistulas and their course after surgical treatment. Materials and methods. From June 2009 to January 2023, 67 patients with arteriovenous malformations of the spinal cord were surgically treated at the SI «Research and Practical Center for Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine». 44 (65.7%) patients were diagnosed with SDAVFs (arteriovenous malformations of the spinal cord type I according to Anson-Spetzler). Among the studied group were 30 (68.2%) men and 14 (31.8%) women aged 32-67 years (average age - 59.6 years). Treatment options for SDAVFs included endovascular embolization, microsurgical debridement, or their combination. A modified Aminoff-Logue scale was used to compare clinical results before and after treatment. After treatment, patients were divided into three categories: patient's condition was improved, patient's condition remained unchanged, or worsened. Results. As a result of the study, it was established that SDAVFs of the cervical spine was diagnosed in 6 (13.6%) patients, thoracic one - in 20 (61.9%), lumbar - 15 (21.1%), and sacrum - 3 (6.8%). The main initial symptoms of SDAVFs were gait disturbances, sensory disturbances, and paresthesias. The most common symptoms at the time of the final diagnosis were urination disorders in 36 (81.8%) patients, paraparesis - in 37 (84.1%), sensitivity disorders - in 30 (68.1%), defecation problems - in 17 (38.6%), pain in the back and legs - in 21 (47.8%) patients, erectile dysfunction - in 11 (25.0%) patients. After the total separation of the fistula, a favorable clinical result was observed in 31 (93.9%) of 33 patients. Improvement of urinary problems and erectile dysfunction was determined in 19 (52.7%) patients. Residual symptoms were found in 17 (47.3%) patients. Conclusions. Early intervention and elimination of pathologic arteriovenous shunting is necessary for neurological improvement in patients with SDAVFs, but urination disorders persist in half of patients even after successful treatment. [ABSTRACT FROM AUTHOR]