There are 143 men (group I) with idiopathic infertility in the form of asthenozoospermia of the II degree living in the territories of the Kiev region (Poles’ky, Chernobylsky, Ivan’kovsky, Borodyansky, Vyshgorodsky districts) were investigated in the Department of Sexual Pathology and Andrology of the SI «Institute of Urology of the National Academy of Medical Sciences of Ukraine» and exposed to ionizing radiation due to the Chernobyl accident in 1986. All individuals in the I group were born from parents who were in the accident at the Chernobyl nuclear power station in the area of radioactive contamination and permanently resided in areas with a high level of radioactivity. The control group was made up of persons born and living in the Ivano-Frankivsk region with a similar condition (group II, n=57). The mean age of the studied group I was 28,3±2,4 years, and persons of the II group were 30,1±2,8 years. Diagnosis of II was performed ambulatory in accordance with WHO and Ministry of Health of Ukraine standards. The study was to study and compare spermogram parameters in patients from both groups. It has been established that the reproductive problems of men with idiopathic infertility living in radiation-polluted areas of the Kiev region of Ukraine consist in a significant violation of the quality indicators of ejaculate (mobility by the pool A+B is less than 1,6 times, p<0,05) correlating with modifications of physicochemicals (the average time of liquefaction is 1,4 times greater, p<0,05) and biochemical (decrease of levels of fructose by 2,2 times, citrate – by 1,6 times, p<0,01–0,05) data characterizing the effect of ionizing radiation, as one one of the leading factors of male genital function violation. The study found that the level of general indicators of spermogramm is significantly worse in the regions of Ukraine who were exposed to radioactive contamination due to the Chernobyl accident, in contrast to the indicators of persons from conditionally pure regions.
The work represents the results of analysis of spermograms in men with infertility of 420 married couples who referred during 2013–2015 to the Institute of Reproductive Medicine (Kyiv) for fertilization with the aim to restore fertility. There were revealed the parameters of dependence of the used programs of the assisted reproductive technologies. Based on the quantitative assessment in scores, the most informative significant spermograms, determining the choice of technology, were selected.
Male hypogonadism is a clinical syndrome which is the result of insufficient production of the sex hormone testosterone by the testicles and the number of spermatozoa. The article reveals modern views on the physiology and pathophysiology of testosteroneogenesis in the male organism, provides information on the etiology, pathogenesis, classification, diagnosis and modern treatment of hypogonadism in men. Literature on the results of global and European researches in recent years, as well as materials of the Guideline of the European Association of Urology for 2022, were used in the article. An individual therapeutic approach to each patient with hypogonadism was demonstrated. The importance of diagnosis of chronic and systemic comorbid diseases that cause the risk of hypogonadism, the need to determine the body mass index and the measurement of waist circumference, the size of the testicles, the penis and the presence of secondary sexual characteristic was established. The article includes necessary biochemical and instrumental studies for the diagnosis of hypogonadism. Specific contraindications for hormone replacement therapy are identified. Absolute contraindications for testosterone therapy are indicated: topically widespread or metastatic prostate cancer (PC), breast cancer of men; men who desire to have children; hematocrit level >54%; uncontrolled or poorly controlled stagnant heart failure. Relative contraindications include IPSS>19, initial hematocrit of 48-50 %, venous thromboembolism in a family history. The article also provides recommendations for testosterone therapy. It has been proven that testosterone therapy improves mild forms of erectile dysfunction (ED) and libido in men with hypogonade states; improves the frequency of sexual intercourses, orgasm and general pleasure; increases low-fat mass, reduces fat and improves insulin resistance; normalizes body weight, waist circumference and lipid profile; relieves the symptoms of depression in men with hypogonadism; improves bone mineral density. It has been demonstrated that the use of testosterone therapy in eugonadal men is not indicated. Testosterone therapy should be used as first-line treatment in patients with symptomatic hypogonadism and moderate ED. In addition, it is necessary to use a combination of type 5 phosphodiesterase inhibitors and testosterone treatment in more severe ED forms. It is also necessary to use standard medical treatments for severe symptoms of depression and osteoporosis. The therapy of hypogonadism, non-medication and medication, the necessary medicines and the peculiarities of their use are widely described. The article shows that weight loss due to low calorie diet and regular physical activity leads to a slight improvement in testosterone levels, testosterone gels and prolonged injection drugs are testosterone drugs have the best safety profile, and gonadotropin treatment can be used in men with secondary hypogonadism. It is noted that before the treatment with testosterone, it is necessary to treat organic causes of hypogonadism (for example, pituitary tumors, hyperprolactinemia, etc.), improve lifestyle and reduce body weight in persons with obesity; cancel drugs that can impair testosterone production. Much attention is paid to the risk factors by the treatment with testosterone. Testosterone therapy is contraindicated for men with secondary hypogonadism who wish fertility, men with active PC or breast cancer. Restoration of testosterone concentration in serum relieves the symptoms and signs of hypogonadism in men after 3 months of treatment. Therefore, testosterone therapy leads to improvement of the quality of patient’s life.
The study investigated the clinical efficacy of the drug Eroton in the treatment of sexual disorders, shows the effect of the study drug on the state of the sexual functions of patients; the degree of patient satisfaction with treatment was assessed; studied the tolerability and possible side effects of the study drug in men in a group of 110 patients. After a course of one month of treatment, all the integrative indicators of ICEF significantly increased in patients. The indicator «erectile function» increased from 12.54±0.87 to 25.12±1.32 (p<0,01), «satisfaction with intercourse» from 7.97±0.40 to 14.63±0.84 (p<0,01), «orgasm» – from 4.52±0.18 to 9.02±0.32 (p<0.01), «general satisfaction» – from 4.03±0.22 up to 8.27±0.46 (p<0,01). The clinical efficacy of the treatment of erectile dysfunction showed «excellent» and «good» results in 92.7 % of patients. When studying the effect of the drug Eroton on the hormonal background in patients, there is a certain tendency to an increase in the content of testosterone in the serum of peripheral blood. This, from our point of view, is due to an improvement in the quality of sex life and an increase in its frequency. The indicator of «sex drive» of the ICEF questionnaire increased by 63.2 %. Improvement of the data on the ejaculatory component of sexual intercourse, which was assessed by the indicator of premature ejaculation in 61 men with this pathology, the clinical effectiveness of the course of treatment was 88.5 %. The time of the refractory period of sexual intercourse in patients decreased, which made it possible to carry out repeated sexual intercourse during the day in 34.5 % at the age of 22 to 34 years, and in 11.8 % of patients aged 22–29 years, 3 sexual intercourses were performed during the day. The frequency of sexual activity in patients with ED increased 2.1–2.4 times, and the quality of life index improved 3.8 times. Patients well tolerated treatment with Eroton. The drug Eroton can be considered as a first-line drug in the treatment of erectile dysfunction.
Every year, the number of patients with chronic prostatitis (CP) in the world is increasing and improving the effectiveness of treatment of this pathology is becoming a priority topic in modern urology. One of the complications of CP is sexual dysfunction, primarily premature ejaculation, as well as erectile dysfunction (ED). Treatment of CP and its sexual complications is an individual and complex complication. It is undeniable that sildenafil citrate plays an important role in the treatment of ED as a complication of CP. The hypothetical mechanism of the effectiveness of PDE-5 in CP is mediated by the relaxation of the smooth muscles of the ducts of the software, the effect of increasing the drainage of the components that are formed due to reflux in the interstitial tissue. The above phenomenon can suppress inflammation and cause a reduction in prostatic symptoms. Increased activity of NO-synthetase and PDE-5 in the tissues of PO promotes the formation of muscle relaxant effects, drainage of the acinus, reduced activity of the autonomic nervous system and activation of vascular circulation in the PVC and structures of the lower urinary tract. Current scientific evidence indicates that PDE-5 inhibitors can improve lower urinary tract symptoms by relaxing bladder smooth muscle fibers and PO, by signaling NO / cGMPc, or by improving RhoA / Rho kinase. Some results suggest that in addition to the effects of reducing the hyperactivity of the autonomic nervous system, dilation of cavernous vessels and antiproliferative effect, PDE-5 have a direct anti-inflammatory effect, increasing the level of cGMP. The accumulation of the latter can inhibit inflammation and can be a potential mechanism for preventing the development of diseases in which inflammation plays a central role. Given that inflammation is a major factor in the progression of CP, sildenafil citrate is able to restore PO function because they act as potent anti-inflammatory drugs. Thus, PDE-5 inhibitors can not only mediate smooth muscle relaxation, but can also directly reduce inflammation in the software by increasing cGMP levels. Based on theoretical data on the positive effect of sildenafil on the erectile component and symptoms of the lower urinary tract in persons with CP with complications such as ED, it can be considered that the inclusion of sildenafil citrate in sequential standard therapy for CP reduces indicators of erectile function. The appointment of sildenafil citrate in patients with complications of CP in the form of ED improves the quality of erections in patients, and also has a positive effect on various other indicators of male sexual function (enhances orgasm, increases the duration of sexual intercourse).
The work demonstrates the influence of undifferentiated connective tissue dysplasia on male reproductive function, shows which dysplastic-dependent pathology of the male genital area affects the spermogram indices in men. Shown are local problems of deep pathophysiological and histological prerequisites in their development of the male factor of infertility in a married couple. The paper demonstrates the importance of the principles of joint work of related specialists at various stages of diagnosis, treatment and subsequent dispensary observation of patients with DSTS, taking into account the polyetiology and multifactorial nature of the pathologies of the genitourinary system caused by DSTS. The main diagnostic criteria for collagenopathies are minor anatomical anomalies of development, namely, the presence of three or more minor anatomical anomalies of development indicates a high probability of morphogenesis disorders in the form of congenital malformations of the male genital area. The role of the unfavorable course of the early prenatal period, during which the influence of an unfavorable factor can lead to one or another anomaly, for many organs, including the reproductive organs in men, has been revealed, since they are associated with DSTS pathology and are caused by a wide representation of connective tissue. It also demonstrated a great role in the development of non-hereditary forms of exposure to environmental factors, which makes it possible to make a correction with the help of appropriate recommendations. The data presented in the robot can be considered as a certain stage in the study of DSTS problems and its impact on the male reproductive system.
Metabolic syndrome is a symptom complex that combines abdominal obesity, insulin resistance, hyperglycemia, dyslipidemia and arterial hypertension. One of the complications of metabolic syndrome is sexual dysfunction in men. The objective: is to evaluate the efficacy and tolerability of udenafil 200 mg in the treatment of erectile dysfunction in patients with metabolic syndrome. Materials and methods. The clinical efficacy of the IV generation PDE-5 inhibitor medicine udenafil in 76 patients with erectile dysfunction of mixed origin and with metabolic syndrome in dynamics was studied. The average age was 51,6±8,2 years. The observation period was 12 weeks, but the control of metabolic syndrome parameters (anthropometry, review, biochemical blood tests) and the assessment of erectile function were carried out for 6 months. Results. After 12 weeks, patients achieved positive results in weight loss, BMI and waist circumference, although not significantly. It is necessary to note the positive changes in the indicators of the cardiovascular system. The downward trend was demonstrated by such indicators as heart. Diet therapy and taking statins have improved the indicators of fat metabolism. Correction of metabolic disorders in patients was accompanied by an increase in total and free testosterone. However, there was no statistically significant difference in the degree of increase in the concentration of androgens. Correction of metabolic disorders in patients was accompanied by an increase in total and free testosterone. During treatment, almost all integrative indices of IIEF increased. Specifically, the index «erectile function» improved 2,26 times (p<0,01), «satisfaction with intercourse» 2,59 times (p<0,001), «orgasm» 2,0 times (p<0,01), «libido» – 2,9 times (p<0,001), «general satisfaction» 2,3 times (p<0,01). According to various indicators, the sexual function of men with metabolic syndrome and erectile dysfunction improved 2–2,9 times. Changes in cavernous blood flow on Doppler ultrasonography showed an increase in peak systolic blood flow rate by 1,5 times, which is associated with the udenafil half-life. Our data indicate that the use of the medicine udenafil is perspective in men with erectile dysfunction and metabolic syndrome and in those who do not have stable family-sexual relations to ensure spontaneity of sexual relations. Conclusions. Udenafil can be considered as a first-line medecine in the treatment of erectile dysfunction in patients with metabolic syndrome.
Nowadays men’s health remains in priority. It is given no less attention than to the cardiovascular disorders and cancer. Low urinary tract symptoms (LUTS) accompany most urological diseases and thus are among the most significant syndromes in urology. The medico-social significance of the syndrome puts the development of protocols for its effective detection and drug treatment with long-term efficacy in a number of priority tasks, stimulating the pharmaceutical industry to search for promising candidates.. Restrictions of COVID-19 Pandemic prevent routine procedures by urologists, prompting them to provide online counseling. Under these circumstances, recommendations were made on the strategy and tactics of treatment of urological diseases during a pandemic, as well as strategic directions in the urology of the future were identified. There is a worldwide consensus among experts on minimizing invasive treatments for benign prostatic hyperplasia (BPH) to maximize the protection of medical personnel from the potential risk of COVID-19 infection, while direct contact with patients is not always possible to avoid. It is known from scientific sources that, in contrast to 2019, in 2020 there was a tendency of increase the share of hospitalizations for emergency urological conditions as well as the share of critical conditions, requiring the strengthening of anti-epidemic measures. Over the past year the ability of the SARS-CoV-2 virus to increase the severity of LUTS in men with urological pathology was reported. Furthermore the development of severe urogenital symptoms (COVID-19-associated cystitis) with a high content of proinflammatory cytokines not only in blood plasma but also in urine was registered. This allows to include LUTS «de novo» in the complex of symptoms of COVID-19. Physicians should be aware of urogenital manifestations COVID-19 and include verification of bladder dysfunction to diagnostic program. Strict adherence to WHO and EAU anti-epidemic recommendations and algorithms is extremely important, so we provide online counseling to patients with symptomatic BPH, ensuring the continuity of the specialized treatment process and minimizing direct contact. The proposed method of treatment of moderate to severe BPH associated LUTS involves tamsulosin monotherapy or in combination with finasteride. The results of the use of tamsulosin hydrochloride in cases of LUTS in BPH indicate that the percentage of acute urinary retention in patients receiving monotherapy is almost similar to that when using combination therapy (tamsulosin + finasteride) and is about 7.0% per year. The obtained data suggest that the observation of patients at a distance can be justified only temporarily, but requires strict adherence to an individually designed treatment plan, which should be based on the guidelines of the Ministry of Health of Ukraine and WHO standards. The problem of BPH is a very important issue in modern medicine and requires clear treatment algorithms, with different contexts of modern realities, such as the latest data on certain links in the pathogenesis of urinary tract obstruction caused by BPH on the background of COVID-19.
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