Search

Aim: To determine the possibilities of nocturnal penile tumescence (NPT) monitoring in the detection of coronary heart disease (CHD)., Materials and Methods: A total of 100 patients were included in the study, of them 50 men had a confirmed diagnosis of CHD and 50 patients consisted the control group. In all patients, flow-dependent vasodilation of the brachial artery and pulse wave velocity were evaluated. The assessment of the quality of erection was carried out using IIEF-15 questionnaire (erectile domain) and Androscan NPT monitoring device. The relative increase in the diameter of the penis (rIn), the duration of NPT with rIn greater than or equal to 30% and 20%, respectively (dNPT with rIn more or equal 30% and dNPT with rIn more or equal 20%) were estimated., Results: The age of the patients in both groups was comparable with a median of 58.0 years. Patients with CHD had a higher body mass index (BMI) than patients without CHD (29.2 kg/m2 vs. 26.9 kg/m2, respectively; p=0.011). In those without CHD, erectile function was better, both according to the IIEF-15 questionnaire and according to the monitoring of NPT. The model with the maximum coefficient of determination (R2 =32.1%) predicting the probability of having CHD included age, BMI, rIn and dNPT with rIn more or equal 20%. The chance of having CHD increased by 10.5% and 1.6% with a decrease in rIn by 1% and a decrease in dNPT with rIn more or equal 20% for 1 minute. The sensitivity and specificity of the model was 74% and 65.3%, respectively., Conclusion: Monitoring of the NPT is an important tool for the diagnosis of vascular ED. Based on the results, it is possible to assess the probability of CHD. In contrast to the IIEF-15 questionnaire, NPT, dNPT with rIn more or equal 20% and rIn are more likely to suggest the presence of CHD. The lower the OP and dNPT with rIn more or equal 20%, the higher the probability of having CHD.

Introduction: Erectile dysfunction is often a consequence of stressful situations, lack of adequate sleep and rest, and sedentary lifestyles. The profession of locomotive engineer implies the presence of these negative factors, which in addition provoke high blood pressure and the development of hypertension., Materials and Methods: A total of 85 patients of the urological and therapeutic departments of the "Clinical Hospital "Russian Railways Medicine" in the city of Barnaul", working as locomotive drivers or assistant drivers, were examined. 65 men with erectile dysfunction and hypertension of 1-2 stages (all received antihypertensive therapy) were randomly divided into 3 groups: in the group 1, an activator of endogenous nitric oxide synthase (NOS) was added to the treatment of hypertension; in group 2, a combination of an endogenous NOS activator and a phosphodiesterase-5 inhibitor (PDE-5) was used. Patients of group 3 did not receive additional treatment. The efficiency of treatment was assessed using markers of endothelial dysfunction, including plasminogen activator inhibitor type 1 (PAI-1), endothelin-1 (ET-1), homocysteine, high-selective C-reactive protein (hs-CRP). In addition, the International Index of Erectile Function and male copulatory function scores were filled out. Moreover, laser doppler flowmetry (LDF) with determination of blood flow in penile vessels was done. Follow-up examination was carried out after 2 and 4 months. Twenty of the persons were healthy and referred to the control group., Results: There were no significant changes in markers and LDF values after 2 months in groups 1 and 3. In group 2, ET-1 and hs-CRP returned to the reference limits, which indicated a decrease in ischemia. After 4 months, there was an improvement in hemodynamics and marker values in group 2. The mean blood flow increased in group 1, while hs-CRP returned to the reference limits. In patients of group 2, a higher total IIEF and male copulatory function scores was documented. In group 3, there was no improvement., Conclusion: The combination of hypotensive drugs, PDE-5 inhibitor and NOS activator showed the best effect, improving blood flow, reparative properties of endothelium with preventing of thrombus formation. Treatment with an NO synthase activator partially eliminates pathological processes in the endothelium.

Aim: To investigate the factors influencing the choice of penile prosthesis and to evaluate the results of surgical treatment of patients suffering from erectile dysfunction (ED)., Materials and Methods: Surgical results of penile prosthesis implantation in 348 patients were reviewed. The analysis included such factors as age, weight, height, body mass index (BMI) and the type of prosthesis., Results: It was found that younger patients who tended to have an active lifestyle preferred three-piece prostheses, while older patients tended to favor one-piece prostheses. Weight, height and BMI do not affect the development of ED. A direct correlation between low patient height and increased risk of prosthesis failure and subsequent complications was found. When the patient was circumcised, there were no infections or mechanical failure after implantation., Discussion: Our results emphasize the importance of an individual approach to the selection of a penile prosthesis, taking into account the physical characteristics and preferences of each patient. Such a factor as short stature is associated with a more limited space for placing the prosthesis pump, which requires consideration when selecting a prosthesis and preparing it for implantation during procedure. Young patients usually choose three-piece prostheses owing to their ability to enlarge the penis during sexual intercourse and to reduce its rigidity and size after sexual intercourse. For older patients, one-piece prostheses are the primary choice due to the age-related surgical risks and affordability of this type of prosthesis., Conclusions: Our results show the importance of further investigation and taking into account all the different factors that influence the development of ED and the outcome of penile prosthesis implantation.

Aim: To evaluate the results of using Sildenafil in the form of an oral spray (Gent) for the treatment of erectile dysfunction (ED) in men with type 2 diabetes mellitus (DM) and prediabetes., Material and Methods: A total of 60 patients were divided into two groups of 30 people. The group 1 included patients with prediabetes, while group 2 consisted of patients with type 2 DM. All men had proven ED. The severity of ED was assessed using the International Index of Erectile Function (IIEF-5). To assess the state of penile blood flow, all patients underwent Doppler ultrasound before and after treatment. Patients with prediabetes used Sildenafil in the form of oral spray (Gent) 25 mg (2 doses) 1 time per day for 1 month, patients with type 2 diabetes received 50 mg (4 injections) every other day for 1 month. In addition, most of the subjects took metformin and followed diet therapy., Results: In patients of both groups, the administration of Sildenafil oral spray led to a decrease in body weight, waist circumference, a decrease in insulin and Hemoglobin A1C level without changing of hypoglycemic therapy in those with type 2 DM. In men with prediabetes, a decrease in fasting insulin levels was found. During treatment, half of the persons with impaired glucose metabolism had an increase in the testosterone level. According to IIEF-5, a decrease in the severity of ED in both groups of patients was seen. In men with prediabetes, the average IIEF-5 score increased from 15.98 to 21.57 points (p<0.05), while in patients with type 2 DM it improved from 12.18 to 18.44 points (p<0.05). Doppler ultrasound indicated a significant increase in the maximum systolic blood flow velocity and arterial resistivity index after treatment with Sildenafil oral spray in patients with both prediabetes and type 2 diabetes., Conclusion: Sildenafil oral spray can be effectively used for the treatment of ED in men with type 2 DM and prediabetes.

Injury of iliac vessels is one of the most disastrous complications of penile prosthesis implantation. There are no detailed descriptions of such cases in world literature. In this article, we present the clinical case of injury to the external iliac vein during the implantation of a three-piece penile prosthesis with particular emphasis on the consequences of such complication in the postoperative period. The article comprises a brief review of the literature on the methods of ectopic placement of the penile prosthesis reservoir.

Objective: To evaluate the efficacy and safety of radical prostatectomy (RP) with nerve-saving technique (NST) in patients more or equal 65 years of age compared with a younger group of patients., Materials and Methods: The study group comprised 117 patients more or equal 65 years old, the control group - 333 patients <65 years old, who underwent RP with unilateral or bilateral NST from January 2012 to December 2019. The analysis of pathomorphological results, complications rate, recurrence free survival (RFS) and the restoration of erectile function (EF) in both groups was performed., Results: The majority of older patients belonged to intermediate and high risk groups of biochemical recurrence. Extracapsular tumor extension was significantly more often observed in the group more or equal 65 years of age: 16.2% and 6.9%, p=0.028. There were no differences between the two groups in the frequency of serious postoperative complications ( more or equal III class according to the Clavien-Dindo classification): 2.55% and 2.7%; p=0.94. The five-year RFS after RP was 95.4% in the group <65 years old and 92.1% in the group more or equal 65 years old (p=0.31). There was a moderate tendency to a slower recovery of EF in older patients: sufficient EF after 6 and 12 months was observed in 21.9% and 59.4% versus 33.3% and 73% in the group <65 years old (p=0.12). Minimal differences in EF were observed 24 months after RP with bilateral NST (84.2% and 87.9%), and more relevant differences with unilateral NST: 53.8% and 66.7% in the study and control group (p=0.033)., Conclusions: The performance of RP with NST in elderly patients is not associated with additional oncological risks, while the restoration of EF is somewhat slowed down in comparison with a group of patients <65 years of age. Bilateral NST provides high potency recovery results regardless of age.

Introduction: Erectile dysfunction (ED) is a condition characterized by the inability to achieve or maintain an erection sufficient for sexual intercourse. The prevalence of ED ranges from 6% to 64% depending on age. Obesity is one of the factors leading to ED, which is widespread in the world. Men with obesity are 30% more likely to develop ED compared with men with normal body weight., Aim: The aim was to identify morphological changes in the cavernous tissue of the penis of patients with obesity using the biological model of laboratory rats as an example., Materials and Methods: In vivo modeling of diet-induced obesity was performed. A total of 22 laboratory sexually mature white rats weighing 140-160 g were included in the study. The animals were divided into two groups, the control group (n=10) and experimental group, which included rats with diet-induced obesity (n=12). After 12 weeks, the experiment was completed. All rats underwent: 1) calculation of the Lee index (body mass index in rats); 2) determination of blood glucose level; 3) determination of the level of total cholesterol and triglycerides in the blood; 4) sampling of the penis with fixation in 10% formalin; histological sections 6-8 m thick were stained with hematoxylin and eosin, and frozen sections were prepared with subsequent staining with Sudan 3 to identify adipose cells., Results: In the experimental group, alimentary obesity developed. There were no differences in glucose and total cholesterol levels between two groups. However, a significant difference was found in the serum triglycerides level (1.24+/-0.05 mmol/L in the control group vs. 1.6+/-0.1 mmol/L in the experimental group). In the control group, the average number of adipocytes was 10+/-5 per sample; in the experimental group, their number increased by 3 times (p<0.01). In obese rats, there was an increase not only in the number of adipose cells, but also in their area compared with the control group (17.7+/-7.5 m and 12.9+/-5.3 m, respectively, p<0.01)., Conclusion: In rats with alimentary obesity, deposition of adipose tissue is observed not only in the visceral and paratesticular regions, but also in the cavernous tissue of the penis, which can negatively affect erectile function.

Aim: To study the efficacy and safety of using sildenafil in patients with erectile dysfunction (ED) and concomitant cardiovascular diseases (CVD) who underwent transurethral resection of the prostate (TURP)., Material and Methods: A total of 59 patients (age from 50 to 75 years) with a diagnosis of benign prostatic hyperplasia (BPH), requiring surgical treatment due to inefficiency of drug therapy, I-PSS score more than 20 points), who were sexually active, but had erectile dysfunction (IIEF score < 21), coronary heart disease (NYHA class I) and stage 1-2 hypertension with stable blood pressure. All patients underwent bipolar TURP. From the first day after the TURP, therapy was prescribed as following: tamsulosin 0.4 mg once a day for 90 days, ciprofloxacin 500 mg twice a day for 10 days. In addition, the patients received treatment for comorbidities. In the main group (n=30), men additionally received sildenafil (EFFEX Sildenafil Evalar) 50 mg daily for 60 days, starting from the 30th day postoperatively. We have chosen this drug from an economic standpoint., Results: At baseline, all patients in both groups had hemodynamic and microcirculatory disorders in the prostate, which got worse in the early postoperative period. During the long-term follow-up, hemodynamic and microcirculatory impairments decreased. This effect was more pronounced in patients who received sildenafil. In addition, patients had an improvement in sexual function. During follow-up, there was no adverse effects of sildenafil on hemodynamic parameters (blood pressure, heart rate)., Conclusion: Our results allow to recommend sildenafil in order to restore sexual function postoperatively in patients with BPH, including those with concomitant cardiovascular disorders.

Introduction: Radical prostatectomy (RP) remains the main treatment method of localized prostate cancer. Satisfactory functional results after RP are essential for both urologist and patient. Preservation of sexual function, particularly orgasmic function (OF) after RP is of the utmost importance today for patients and their sexual partners., Materials and Methods: An analysis of 3- and 6-months functional results of 91 patients who underwent RP for prostate cancer is presented in this study. The influence of surgical approach, nerve-sparing surgery (NSS) and other factors for OF recovery was evaluated., Results: OF recovered in 53,8% and 56% patients 3 and 6 months postoperatively, respectively. Positive influence of younger age and NSS on OF recovery was found., Conclusion: OF recovered in more than half of patients after RP. The young age, NSS were found to be predictors of RP recovery. Further research is required to determine the more relevant factors for OF recovery after RP.

Erectile dysfunction (ED) significantly deteriorates the quality of life of patients with Parkinson's disease (PD). Until recently, treatment of ED received insufficient attention. Management of ED in patients with PD requires an integrated and multidisciplinary approach. Pharmacotherapy with apomorphine or sildenafil (or other inhibitors of phosphodiesterase-5) has shown encouraging results in most patients with PD and ED. This review of literature addresses problems of ED in patients with PD.

Relevance: Erectile dysfunction (ED) associated with radical prostatectomy (RP) affects 25-75% of patients and has a significant negative impact on their quality of life AIM: To analyze the maintenance of erectile function after RP depending on the type of endoscopic access and nerve-sparing., Materials and Methods: This retrospective study comprised 231 patients with localized prostate cancer, who underwent surgery between February 2015 and February 2016. Surgery was performed using one of three approaches: laparoscopic, extraperitoneoscopic or robot-assisted. Nerve-sparing surgery was chosen were based on the Briganti nomogram (low risk of extraprostatic extension), Partins table, and taking into account the patients desire to maintain EF. EF and the quality of life were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire and the QoL (Quality of Life) scale., Results: Nerve-sparing RP was performed in 153 patients. Nerve-sparing RP did not differ significantly from non-nerve sparing RP with regard to operative time (p=0.064) and blood loss (p=0.073). According to the pathomorphological study, the prostatic capsule was intact, and surgical margins were negative in all cases. The incidence of significant ED and complete loss of erectile function was greater in patients after non-nerve sparing RP compared with nerve sparing RP [(5.0 (0-10.0) vs. 6.5 (0.8-19,0) points according to the IIEF-5 scale, p=0.271)]; 96.2% versus 72.2% (p<0.001). Nerve-sparing RP had a statistically significant better effect on the quality of life: 1.63+/-1.16 points against 1.88+/-1.02 points (p=0.035)., Conclusion: The best outcomes were observed in patients undergoing robot-assisted RP. Nerve-sparing RP resulted in a lower rate of ED. This advantage without compromising the completeness of resection allows us to consider nerve-sparing RP as an appropriate and validated modality of preventing erectile dysfunction in properly selected patients.

Prostate cancer (PCa) is one of the most common maligmancies and causes of death among men. Radical prostatectomy (RP) is optimal and recommended treatment modality for localized prostate cancer. More than half of all men undergoing surgery experience problems with erectile function and existing treatments do not provide a positive effect. Thus, there is a need for new approaches to the restoration of erectile function in patients after RP. One of these is the use of cell technologies, namely the stromal-vascular fraction and autologous platelet-rich plasma. This review examines the results of preclinical and clinical studies investigating the efficacy and safety of these treatment options in erectile dysfunction.

The article reviews the results of various conservative treatments for concomitant benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Phosphodiesterase type 5 (PDE5) inhibitors remain the first-line therapy for this category of patients taking into account their positive effect on both ED and BPH. The preferred treatment scheme includes PDE-5 inhibitor co-administered with 1-adrenoblocker. However, other combination treatments are considered promising, for example, a PDE-5 inhibitor with a 5-reductase inhibitor or a three-component treatment regimen: 1-adrenoblocker + 5-reductase inhibitor + PDE-5 inhibitor. All these approaches to treating patients with BPH and ED have demonstrated high efficiency and safety. Nevertheless, a limited number of randomized clinical trials and short-term observations suggest the need for further studies investigating the long-term outcomes of different treatment options for such patients.

Nerve-sparing radical prostatectomy remains the optimal curative treatment of prostate cancer in patients who want to maintain erectile function. Since its development, there has been a gradual decline in its effectiveness concerning the prevention of ED, which was associated with the currently more objective assessment of erectile function at both the pre- and post-operative stage. There is a knowledge gap in the precise understanding of which specific neural structures should be preserved with the nerve-sparing technique. At the same time, there have been proposed effective methods for visualizing the elements of the preserved vascular-neural bundle and estimating the degree of nerve-sparing.

Aim: To compare the functional outcomes of bilateral nerve-sparing robot-assisted radical prostatectomy (RARP) and radical retropubic prostatectomy (RRP) at 12 months after surgery., Materials and Methods: This is a retrospective study of two groups, each of 50 sexually active patients with localized low risk prostate cancer. The first group comprised patients who underwent RRP, while the second underwent RARP. All operations were carried out sequentially from January to August 2015 using nerve-sparing technique. The study involved only two surgeons each having a total caseload of over 1000 prostatectomies of one of the two types. Patients of each group were operated on only by one of the two surgeons. Adjusted for negative treatment outcomes, the between-group comparison was conducted regarding the number of continent patients, temporal changes in urinary function, the number of patients with restored erectile function and temporal changes in its recovery., Results: At 12 months after surgery, complete continence was reported in 49 (98%) patients of the RARP group and in 48 (96%) patients of the RRP group. Among patients with restored continence, the time to attain complete continence was 4 months in the RARP group and 6 months in the RRP group (p<0.05). Sexual function recovery at 12 months follow-up after surgery was found satisfactory in 37 (74%) patients of the RARP group and in 12 (24%) of the RRP group. Recovery of erectile function after RARP was faster: in the RARP group erections at 3 months were reported in 32% of patients, while in the RRP group only in 4% (p<0.05)., Conclusions: The study findings showed the superiority of RARP over RRP performed by nerve-sparing technique in restoring continence and erectile function.

Introduction: Erectile dysfunction (ED) and urinary incontinence (UI) following radical prostatectomy (RP) adversely impact patients psycho-emotional status reducing the quality of life and treatment satisfaction., Aim: To investigate the rates of regaining continence and erectile function (EF) after nerve-sparing radical retropubic prostatectomy (NS-RRP) and nerve-sparing laparoscopic radical prostatectomy (NS-LRP) in the early postoperative period., Materials and Methods: The study comprised 116 patients who preserved sexual activity and the ability to have sex. 64 patients underwent standard resection of NVB (34 RRP and 30 LRP) and in 52 patients the NVB resection was performed using a waterjet dissector (WD) (30 RRP and 22 LRP). All operations were performed by one surgeon with the experience of over 350 RRP and 150 LRP. The study patients had low and moderate risk prostate cancer, according to DAmico risk classification., Results: Our study findings showed that patients who underwent the WD of NVB had significantly greater IIEF-5 scores (by 2.8 scores) at 8 weeks than after the standard NS-RP. After 6 month follow-up the scores increased by 3.5 points. Patients who underwent NS-RP + WD achieved a successful sexual intercourse 3 months after surgery (regardless of the use of PDE5 inhibitors). In the group of patients who underwent standard NS-RP, it took a longer time to achieve a successful sexual intercourse. Sixty-seven percent of patients who underwent NS-RP + WD were fully continent at one month follow-up after removal of urethral catheter, while most patients treated with standard NS-RP (41%) had mild stress UI. After 3 months follow-up, among patients who underwent NS-RP + WD only one patient had mild stress UI and the vast majority (95%) of patients were fully continent. At 6 months after removal of the urethral catheter there were no significant differences between the groups in regaining urinary continence., Conclusions: Waterjet dissection of NVB significantly improves patients postoperative quality of life due to early recovery of urinary continence and EF.

A comparative examination of 100 patients at different ages, suffering from disorders of micturition, erectile function and pelvic pain, identified age-related peculiarities of these pathological manifestations. Irritative disorders of urination was detected significantly more frequently among persons of young and middle age than the elderly, and obstructive-related disorders were more frequent in the elderly. In elderly and senile age more prevalent was reducing of the contractility of the detrusor, and at a younger age - increased tone of striated sphincter of the urethra and bladder hyperactivity. It was shown that the participation of long-existing spasm of some muscle formation of the lumbar, pelvic and femoral region in the genesis of urinary symptoms, erectile dysfunction and pelvic pain. When using manual therapy, physiotherapy and botuline-therapy high effectiveness against disorders of micturition, erectile function and pelvic pain was achieved regardless of the age of the patients. It is recommended for the diagnosis of urological pathology to involve specialists in the field of neurology and manual therapy. In cases of diagnosis of musculo-tonic disorders not etiologically associated with pathological processes in the organs of the urogenital system, in the complex of therapeutic measures it is recommended to include methods such as manual-therapy, physiotherapy, botuline-therapy.

This study examines the efficacy and safety of phosphodiesterase type 5 (PDE-5) inhibitors in treating erectile dysfunction after transvesical prostatectomy. The study involved 63 men aged 55 to 68 years, divided into two groups--29 and 34 patients, respectively. Patients in group 1 received 50 mg of sildenafil citrate (Ereksezil®) on a daily basis, in group 2--100 mg of sildenafil citrate (Ereksezil®) on demand. Postoperative visits were scheduled at the stage of screening, then after a month of treatment and on day 14 after treatment completion (3 visits altogether). Changes of patients' complaints according to IIEF-15 questionnaire showed a significant improvement in erectile function and its components of sexual life satisfaction in both groups of patients, but more significantly with regular medication intake, which has a positive impact on patients' quality of life. At the same time, treatment by PDE-5 inhibitors did not affect the maximum urinary flow rate and residual urine volume. Given the high incidence of the postoperative erectile dysfunction, postoperative administration of PDE-5 inhibitors is relevant and promising.

Erectile dysfunction is closely linked to the general state of both physical and psychological wellness. Among the major risk factors are heart disease, arterial hypertension, diabetes, hyperlipidemia, as well as sedentary lifestyle, smoking and alcohol abuse. Also, the disease is more frequently found in men undergoing radiation therapy or surgery for prostate cancer. Psychological correlates include anxiety, depression and irritability. Despite a higher prevalence among older men, erectile dysfunction is not considered an inevitable part of aging. Due to polyetiology of the disease, sildenafil is regarded as the gold standard of treatment, and new high quality generic drugs are marketed. The article covers the use of sildenafil in patients with diseases of the cardiovascular system, diabetes, hypogonadism. Effectiveness of sildenafil in patients on chronic hemodialysis as well as in patients undergoing radical prostatectomy is discussed. The issue of addiction to sildenafil is outlined.

Radical prostatectomy (RP) is deemed to be the most effective standard treatment option for men with prostate cancer (PC). However, RP is accompanied by a number of complications leading to a substantial decline in the quality of sexual life of operated patients. Major complications of RP include: decreased sex drive, deterioration of erectile function, deformation of the penis, abnormal ejaculation and orgasmic dysfunction. Based on the current literature, the article deals with the issue of prevention and rehabilitation of patients after radical prostatectomy, describes the methods of conservative and surgical correction of complications, associated with surgical treatment of PC.

Treatment for prostate cancer remains a significant social problem due to the continuing trend of growth of morbidity and mortality in Russia from this disease. In recent years a real alternative to surgical treatment is radiotherapy. In treatment of locally advanced stages of prostate cancer radiotherapy plays a dominant role. At our institution from 2005 till 2011, 105 patients with locally advanced prostate cancer underwent complex and combined treatment comprising in the first group the concomitant radiotherapy with Ir-192 and the control group--radical prostatectomy followed by adjuvant remote radiotherapy. In patients treated with concomitant radiotherapy compared to the control group there were occurred fewer number of genitourinary complications according to the RTOG scale (5,8% vs. 32,7%). In patients who had undergone radical prostatectomy followed by adjuvant radiotherapy urinary incontinence was met significantly often.

In recent years, treatment of men with testosterone deficiency has become an important part of andrological and urological practice. Clinical manifestations of testosterone deficiency syndrome are usually diverse. Testosterone deficiency and erectile dysfunction often occur against the background of some systemic diseases, and sometimes are markers or predictors of these diseases. It is important that erectile dysfunction and testosterone deficiency syndrome are closely interrelated, and the correction of these conditions requires account of specific treatment of both diseases.

Currently, the relationship between the sleep and erectile function (EF) is not in doubt; therefore, evaluation of this relationship in the context of sleep medicine (somnology) is the most informative diagnostic method. The article presents the results of polysomnography with the option of simultaneous monitoring of spontaneous episodes of nocturnal erections in 51 men aged 46-55 years without complaints of violation of the EF. The main group (n = 37) consisted of patients with obstructive sleep apnea syndrome (OSAS). The violation of pattern (quantitative and qualitative characteristics) of nocturnal episodes of spontaneous erections in this group of men was revealed, which was regarded as the initial (pre-clinical) manifestation of erectile dysfunction. Thus, modern diagnostic capabilities of sleep medicine allow to effectively evaluate the EF in patients with OSAS and timely assign pathogenetically justified therapy.

According to the results of epidemiological studies of prevalence of erectile dysfunction in the Russian Federation, the search for the determinants of risk of its development was performed. It was found that the leading risk factors for the development of erectile dysfunction, in descending order of statistical significance, include the amount of accumulation of points according to the IPSS score, arterial hypertension, L(IPSS) quality of life index, age, diabetes, and overweight and obesity.

The study included 59 patients with benign prostate hyperplasia (BPH) and erectile dysfunction (ED), inhibited inflammation in the prostate gland and with normal or medically normalized levels of total testosterone. All the patients underwent conservative therapy using dutasteride and tamsulosin, 21 of them (group 2) additionally received tadalafil 5 mg daily. Efficacy of treatment was assessed by self-assessment questionnaire of patients before treatment and 12 weeks after therapy. In group 1 of patients, the dynamics of the erectile function, sexual satisfaction and quality of life for patients was not revealed. In the group 2, improvement in erectile function in an average of 19 points was shown (IIEF-5 questionnaire). According to the AMS questionnaire, improvement in sexual function was demonstrated; in patients with compensated androgen deficiency, however, response to the treatment with tadalafil was less pronounced. According to BSFI score after 3 months of therapy with tadalafil, indicator of overall satisfaction of sexual life improved to 2.4 points (p < 0.002). According to the Hospital Anxiety and Depression Scale, anxiety in patients was reduced to the permissible values (p < 0.0002), the level of depression was decreased by almost 2-fold (p < 0.0002). The total IPSS score decreased from 13 to 9 points in average. The inclusion of tadalafil in complex of combined conservative therapy of patients with BPH not only improves sexual function but has a positive effect on symptoms of the disease and the psychological state of the patient.

The study was aimed to the evaluation the effect of NO- synthase inducer impaza on endothelial function and erectile function in patients undergoing coronary artery bypass grafting (CABG). The study involved 127 men with stable coronary artery disease (CAD), aged 55.8 +/- 5.3 years, which were planned on CABG. The survey included assessment of IIEF score and blood lipid levels, registration of nocturnal penile tumescences, postcompression tests on the shoulder and cavernous arteries. Endothelial function was assessed as the plasma levels of nitric oxide (NO) and endothelin-1 (ET-1). The comparison group of patients (n = 67) were treated with standard rehabilitation program, and the study group (n = 67) additionally has received impaza 1 tablet a day for 24 weeks. It is shown that in patients with erectile dysfunction (ED) undergoing CABG, the use of impaza for 24 weeks facilitates optimal dynamic expression of the ED. But a year after the operation, there were marked deterioration in erectile function, indicating a short-term effect of action of impaza that may require its longer use. In addition, 6 months after CABG, patients receiving impaza had better indicators of functional activity of the endothelium in shoulder and cavernous arteries compared with patients who received conventional rehabilitation; one year after surgery, however, there were no significant differences in these parameters. Restorative treatment using impaza in CAD patients after myocardial revascularization operations has positive influence on the NO, ET-1 levels, which is reflected in the functional state of the endothelium and characterized by an increase in vasodilator properties and decrease in vasoconstrictor properties.

The study was aimed to the evaluation of vascular endothelium status in patients with stress-induced arterial hypertension, coupled with erectile dysfunction (ED). 51 patients underwent examination. Laurent--Segal Male Copulative Function Questionnaire (MCF), and International Index of Erectile Function (IIEF) were used for the detection of ED and assessment of its severity. Microcirculation in penile vessels was evaluated by laser Doppler flowmetry. Markers of endothelial function--endothelin 1 and asymmetric dimethylarginine-were measured. For the correction of violations identified, the drug udenafil (zydena) was used at a dose of 50 mg daily for 1 month. Against the background of therapy with udenafil, restoration of function of endothelial cells was detected. This suggested the functional nature of the violations in the genital sphere, and was regarded as a manifestation of stress-induced ED. Elimination of endothelial dysfunction led to significant reduction in ED symptoms.

It was studied the erectile dysfunction (ED), the severity of depression and stress in patients with diabetes mellitus (DM) in the stage of compensation and decompensation, also investigated the relationship between the duration of the disease and the clinical manifestation of the various forms of ED. On a material of 293 male patients aged 17-60 years. The duration of diabetes ranged from 6 months to 30 years (at avarage - 17,4±17,5 years). Performed routine and special methods of investigation (pharmacodopplerography), also fixed psychogenic, organic and mixed forms of erectile dysfunction in correlation with the clinical form of the current CD according International index of Erectile function (EF) and the tables of Juneman et al. Found that in patients with type I and II diabetes anxiety and depression were found in 32.1 % of cases, and were accompanied by ED. In the state of decompensation of diabetes mellitus manifestation of anxiety, depression and erectile dysfunction were observed more often than in a state of long-term compensation. Between the increase in the period of limitation of the DM and the incidence of organic and mixed forms of ED there is a direct correlation, and between the increase of diabetes duration and the frequency of occurrence of psychogenic form of erectile dysfunction - inversly relationship.

The arsenal of professionals providing assistance to men with erectile dysfunction includes a new, mouth dissolving dosage form of the vardenafil--levitra ODT. This form is effective, safe, and has a higher bioavailability as compared to vardenafil in the form of coated tablets. POTENT I and POTENT II studies revealed that levitra ODT equally successfully corrects erectile dysfunction in men younger and older than 65 years regardless of concomitant diseases and metabolic disorders: hypertension, diabetes, dyslipidemia. In addition, it was found that this drug helped to successfully carry out sexual intercourse in the first 15 minutes after dosing in 62.5% of patients. This allows to widely recommend levitra ODT for the treatment of erectile dysfunction in young men and older men.

The article presents the results of treatment of 155 patients with BPH aged 48-65 years, who received conservative treatment for this disease. The patients were divided into three groups. Group 1 consisted of patients with BPH and erectile dysfunction (ED), who underwent conservative treatment (5alpha-reductase inhibitors in combination with alpha1-adrenoblocker) and phosphodiesterase inhibitor (tadalafil 20 mg) on demand. Group 2 consisted of patients with prostatic adenoma and ED, who received only conservative therapy. Group 3 consisted of BPH patients without ED, who received only conservative therapy. The effectiveness of treatment was assessed using patient self-assessment questionnaire. I-PSS score was used for the assessment of symptoms of the disease, for assessment of sexual function--AMS questionnaire for the age-related symptoms in men (specific section), short BSFI questionnaire, and International Index of Erectile Function (IIEF-5). Questionnaire survey was performed before treatment and 3, 6 and 9 months after therapy. Analysis of the results showed that there were significant impairments of sexual function in BPH. The use of phosphodiesterase inhibitor against the background of conservative therapy improves erectile function, and reduces the intensity of urination disorders.

The review considers the relationship between obesity and erectile dysfunction (ED). Obesity is associated with the high prevalence of ED; however, the pathophysiological link between these conditions has yet to be adequately investigated. Visceral obesity leads to the enhanced activity of inflammatory responses and, thus, endothelial dysfunction and decreased plasma testosterone levels, which favors the development of hypogonadism and increases the risk of vascular diseases. Endothelial dysfunction and androgen deficiency in turn give rise to ED.

The paper gives the results of a study evaluating the degree of androgen deficiency and erectile function in patients with Grades 1 and 2 pneumatic hammer disease arising from exposure to local and general vibration. Their examination involved the evaluation of the clinical picture of the disease, by using various male androgen status questionnaires such as the androgen deficiency questionnaire, the androgen reduction rating scale (after Morley); the androgen deficiency in the aging male questionnaire; a scale for assessment of erectile dysfunction (International Index of Erectile Function (IIEF-5)); the Beck depression inventory. Exposure to vibration was ascertained to play a role in the development of androgen deficiency and erectile dysfunction in patients with pneumatic hammer disease resulting.

The study included 92 men with stable coronary heart disease (CHD) aged 39-61 (mean 55 +/- 5.3) years. Groups 1 and 2 were comprised of 63 patients with erectile dysfunction (ED) and 29 ones without it respectively. It was shown that most patients with CHD suffer ED (68.5%). The probability of ED increases in the presence of such risk factors as diabetes mellitus, multifocal atherosclerosis, disturbances of lipid metabolism. Severity of ED grows with CHD duration and body mass. Parameters of endothelium-dependent dilation of brachial and cavernous arteries were impaired in ED patients which suggests the compromised ability of these vessels to respond to mechanical deformation. ED is a marker not only of functional disturbances of the vascular tone but also of severity of atherosclerotic lesions. Correlation analysis revealed the relationship between mean endothelium-dependent dilation of brachial artery and severity of ED; the latter also correlated with such markers of cardiovascular risk as multifactor atherosclerosis, obesity, and disturbances of lipid metabolism.

The 15-year clinical experience with falloendoprosthetic operations (FEPO) in patients with erectile dysfunction is reviewed including algorithm of diagnostic examination, prostheses of different generations, indications and contraindications for falloendoprosthetic surgery. The results of 117 FEPO are outlined with special emphasis on 19 cases of postoperative complications. The conclusion is made that FEPO is most effective in erectile dysfunction by the presented criteria of the erectile dysfunction treatment efficacy.

Thirty train drivers with erectile dysfunction (ED) and arterial hypertension were examined : physical examination, blood count, urinalysis, penile laser Doppler flowmetry (LDF). ED severity was assessed by Loran-Segal questionnaire of male copulative function (MCF) and international index of erectile function (IIEF). Zidena was used in a dose 100 mg 30 min before coitus twice a weak. Examinations have detected mild and moderate ED, spastic disorders of penile microcirculation. MCF significant improvement (p < 0.05), rise of IIEF score were seen after 30 days of zidena treatment. A positive trend was observed after 15 days of treatment. LDF registered a significant (p < 0.05) improvement of microcirculation. Tissue hypoxia and ischemia lowered, blood inflow in the system of microcirculation increased. A passive mechanism of blood flow regulation, vasodilation almost corresponded to physiological standards. Administration of zidena in patients with stress-induced hypertension has improved libido, quality and duration of erection, penile microcirculation due to better tissue perfusion with blood, reduction of ischemia and blood congestion in the venules. Duration of coitus increased.

To ascertain relations between angiotensin converting enzyme (ACE) gene polymorphism and erectile dysfunction (ED) in male citizens of Russia with metabolic syndrome, we made a retrospective comparative analysis of ACE gene polymorphism incidence rate in two groups of males with metabolic syndrome: with ED (n=385) and free of ED (n=152). We discovered that ED patients have DD genotype and D-allele more frequently (68.3 vs. 38.2%, p < 0.001 and 81.3 vs 63.8%, p < 0.001, respectively). Moreover, severe ED is associated with significantly more frequent incidence of genotype DD compared to moderate and mild ED. Incidence of allele D is also more frequent in patients with severe ED (93.4%). Thus, D-allele of ACE gene is an ED risk factor in males with metabolic syndrome. Therefore, ED can be considered as one of vascular complications of metabolic syndrome.

Demographic situation in male population of Russia is analyzed in this review. The role of diseases of cardiovascular system and urogenital diseases including sexual disorders and androgen deficiency state in lowering of quality and duration of life of reproductive age men is shown. Modern outlook on metabolic syndrome, erectile dysfunction and androgen deficient state is presented. Meta-analysis of clinical studies of systemic effects of hormonal replacement therapy with the use of testosterone is conducted and problems of safety of its long term use are studied. An integrated scheme of diagnosis and treatment of erectile dysfunction, androgen deficient state and cardiovascular diseases is presented in this paper.

To verify the etiopathogenic structure of erectile dysfunction in alcohol dependence, we have investigated 80 men with erectile dysfunction and alcohol dependence (the main group) and 40 men with erectile dysfunction without alcohol dependence (the control group). Endocrine and vasculogenic forms of erectile dysfunction were more frequent in men with alcohol dependence as compared to men without alcohol dependence, and the presentation of sexual disorder was complicated due to the increase in the number of accompanying syndromes. At the same time, as alcohol dependence progresses, the part of organic forms of erectile dysfunction and the number of syndromes which accompany erectile dysfunction increase.

A prospective trial of the methods of sexual rehabilitation of 31 men with pituitary tumors has shown that therapy with testosterone and chorionic gonadotropin effectively corrects hypogonadism and sexual disorders. In insufficient efficacy normalization of sexual function is achieved with tadalafil. Both methods of treatment had no negative effect on the size of the prostatic gland and PSA level except 2 patients with somatotropinoma on testosterone. In the course of chorionic gonadotropin treatment pituitary tumor increased in size in 3 patients.

Retropubic radical prostatectomy (RPPE) is the most aggressive method of treatment in patients with prostate cancer (PC), but maximally radical. The observations of men after RPPE have shown that 10.13% (40 patients) died: half of them (5.06%)--due to progress of PC, the rest because of coexisting diseases. The total, corrected and relapse-free 5 and 10 years survival was 90%, 95%, 65% and 84%, 91%, 55%. The quality of life of the men after RPPE was investigated at long-term periods of followup. RPPE is an effective method of treatment of PC patients. The most frequent complication of this intervention was erectile dysfunction and urinary incontinence which made the quality of life of such patients considerably worse. Postoperative dynamic follow-up of such patients is necessary for early detection of relapses and determination of indications for medicamentous and/or surgical treatments of the complications.

Until recently, erectile dysfunction (ED) has been considered to be psychogenic in nature in most cases. Advances in our knowledge about the physiology of erection and the pathophysiology of ED have clarified that it is due to organic causes in most cases. Atherosclerosis-associated intraorgan lesion is most frequently encountered. ED is closely related to common cardiovascular risk factors, such as diabetes mellitus, arterial hypertension, dyslipidemia, smoking, physical inactivity. Endothelial dysfunction is of great and universal importance for the genesis of cardiovascular diseases (CVD) and ED. As a manifestation of endothelial dysfunction, ED is an independent risk factor for CVD since vascular endothelial damage is one of the first stages of atherosclerotic plaque formation. ED is an early symptom that is suggestive of atherosclerotic lesion of arterial vessels, coronary arteries in particular. The first manifestation of atherosclerosis in the large arteries is frequently the life-threatening complications myocardial infarction or stroke, which underlines the importance of timely detection of early-stage vascular system lesions. Understanding ED of arteriogenic origin as an early sign of vascular lesion gives a clinician the unique chance to take preventive measures that can prevent complications of CVD.

It has been demonstrated in a series of studies that erectile dysfunction (ED) appears to be one of risk factors and predictors of ischemic heart disease (IHD). According to the SSRC PM data in a cohort of 300 men with high cardiovascular risk ED was diagnosed in 61% of cases, while among 300 men with verified diagnosis of IHD was detected in 92.7% of cases. According to recommendations of the European Society of Urology changes of life style and correction of risk factors should precede therapy of ED or be components of complex therapy. It is known that some antihypertensive drugs (nonselective beta-adrenoblockers, thiazide diuretics) can negatively affect erectile function. According to data of comparative randomized clinical study average therapeutic doses of thiazide-like and thiazide diuretics in combination with ACE inhibitors do not worsen erectile function. Data on effect of lipid lowering therapy on erectile function are equivocal. Type 5 phosphodiesterase inhibitors (PDI) are first line preparations for the treatment of patients with ED. Safety of combination of type 5 PDI with main groups of antihypertensive drugs has been demonstrated in persons with risk factors of CVD and ED. The use of type 5 PDI in men depends on degree of compensation of cardiovascular system. In unstable cardiovascular events preparations of this group can be also carefully used. Simultaneous administration of nitrates is a contraindication for type 5 PDI.

We performed a pilot study of PDE-5 inhibitors efficacy in the treatment of diabetic genital neuropathy. A total of 16 diabetic males (type 1 diabetes mellitus) having erectile dysfunction with symptoms of genital neuropathy entered the trial. These patients received tadalafil for 3 months. The results were assessed with sexological questionnaires and dynamics of genital neuropathy symptoms. Tadalafil treatment was found effective.

Morbidity of erectile dysfunction among men of every age is 10%. It's supposed that now-days in the world about 100 mln of men have organic erectile dysfunction. Specialist of the 6th MMCH of Ministry of Defense have elaborated a rehabilitation program for military service men with erectile dysfunction. This program includes a complex clinical-psychological checkup, methods of reconstruction of copulative capacity, evaluation of effectiveness of realized treatment. Evaluation of quality of result of phalloendoprosthesis has shown that 92,3% of patients estimate the result as excellent and good, 5,2%--as satisfactory, 2,5% have not sex life.

Both radical and combined radiotherapy for locally-advanced prostate cancer may be followed by complications involving the upper and lower urinary tracts. Such conditions are generally reversible but still they may turn chronic and even call for surgery. Our study used the data gathered in the course of examination and treatment of 107 patients with prostate cancer T3-4N0-1M0, some of them suffering from post-radical treatment complications.