DC Yatsenko, Centre for Sexology and Andrology EDO, Kemerovo, NE Naidenov, EDO, Tomsk
For the first time the relationship between the deterioration of erectile function and arterial lesions found Rene Leriche. In 1923, he described the syndrome in which, apart from the classic symptoms of lower limb ischemia, is impotence. At the same time, we know that the erection of all manifestations of male sexuality differs greatest protection from the damaging factors of organic nature. Found that, in ontogeny Chubby detected even in utero, that is, long before the appearance of libido, ejaculation and orgasm. Contrary to the proper ontogenetic stability, Chubby paradoxically sensitive to numerous psychogenic factors.
The development of microsurgical techniques in the 80 years allowed to proceed to surgical treatment of vasculogenic impotence. However, the good results of surgery for vascular impotence not solve the problem of the underlying disease, the more prevention of obliterating diseases of lower limbs, accompanied by high disability. Therefore, the etiopathogenesis of erectile dysfunction (ED) should be regarded as poorly. Let us at establishing obliteration. Complexity represent stages of transition and the relationship of functional neurotic to organic somatic. Known criteria, shared state preexisting diseases and illnesses, with the result that dramatically changes the tactics of treatment and rehabilitation.
Today in the treatment of ED due to psychogenic, there are mainly two fundamentally different approaches: one is the method (psychotherapy) and the other - drug therapy. Pharmacotherapy, initially took up their position because of the availability and ease of achievement, reducing time between doctor and patient to "solve" the problem with erectile dysfunction, is effective only on the local level. Hopes for drugs of prostaglandin E1, and "Viagra" can be considered not fully realized. Unfortunately, the development of the genital surgery and "boom" advertising pharmacotherapy overshadowed the personal status of the patient with his sexological status, leaving the patient alone with the architecture of the system experiences.
Today, doctors are focused on the diagnosis of psychogenic and organic ED. Psychogenic ED requires a differential diagnosis within the state: a neurotic or endogenous, as well as with organic ED. The diagnosis is sufficient complex sexological and andrological practices. When neurotically conditioned ED experienced seksologpsihoterapevt help the patient. When organic ED highly angio-surgeon operation will great anastomosis inferior epigastric artery dorsal artery of the penis. In both cases, this assistance at the level of permissions the etiology of a symptom, not disease. Prevention of organic ED, attributed to drug therapy, remains closed to researchers region, as well as the possibility of conservative treatment of obliterating diseases of lower limbs. Moreover, prevention of disease.
For dynamic observation were selected 180 men with ED. All patients were initially approached sexologist about erectile dysfunction. Classic complaints indicating ischemia of lower extremities in patients was not. The patients' age from 20 to 75 years. Of these, 30 to 46 years - 73%. Excluded bacterial nature of inflammation in the prostate, psychosomatic dysfunction caused by prostate, testicular interactions, as well as the possible impact of comorbidity in an erection. All examined mental status, especially psychosexual development and the formation of libido, as well as the nature of personal relationships with his wife. In the analysis of the scale of "male sexual function (SPS) (Vasilchenko GS, 1967) isolated the interest component of the Penis copulatory cycle was detected in 23 persons (12,7%), which coincided with the clinical data.
The results of Doppler ultrasound in 56 (31%) showed different degrees of arterial vascular causes of ED. Angiography aorto-iliac zone discovered obliterative changes in the pool iliac artery in 21 persons (11,6%). In connection with the retention of high value sexual function in 6 men, after talking with their wives, underwent surgery in two stages (the second - revascularization of the penis in two months). Mikroanastamoza thrombosis was detected in one patient. All patients underwent surgery with removal of affected areas of vascular intima and different versions of arterial reconstruction. Further observation of sexologist has shown that reconstructive surgery on the iliac arterial segment may provide a short-term improvement in erection. All the patients had spontaneous erections disappeared within a month after the operation. Four of the operated patients (19%) who received the second stage, complete restoration of adequate erections, assess the sexual life as normal for 12 months.
In the treatment group was taken 159 patients (88%) with neurotic due to erectile dysfunction, including the detection of ultrasound vascular reactions. The basic method - differentiated psychotherapy, with the involvement of his wife as "soterapevta. Conditions of treatment: a healthy lifestyle and the complete exclusion of tobacco.
Based on the fact that fear of failure leads to changes in the alpha-adrenergic system, breaches in the vascular system, appointed by the biologically active food additives (BAA), aimed both at improving the erection and removal of a neurotic state, and the main treatment - diet, medical Training and constantly antisclerosic ART LIFE (lecithin, ESSENTSIAL OIL, COMPLEX WITH VITAMIN C and others).
Comprehensive treatment and rehabilitation assessed positively in 87% of patients on a scale of SPS, and then the ICF (Loran OB, AS Segal, 1998), which must be considered more convenient for the analysis of indicators of the stability of the immediate results. The negative results associated with submissive variants relations of spouses, lack of adaptation, preventing entry into the quasi-physiological rhythm (UVR) sexuality. Established that in a situation of lack of SBC 34 men (21,4%) are easily "slipped" in the former neurotic condition due to personal characteristics.
1. Complaint men on erectile dysfunction may be one of the first signs of the presence of organic vascular pathologies.
2. Functional, neurotic disorders caused by erectile dysfunction, may lead not only to a breach of the vascular tone of the penis, but due to the high value of sexual activity in men (always directed stress) may contribute to the transition and functional disorders in organic disorders.
3. There is no doubt that a healthy lifestyle, stopping smoking, taking regular supplements, the culture of sex between men and women maintain sexual health of the spouses
4. Multifaceted problem of arterial vascular disease, which causes erectile dysfunction, is relevant and requires further development of prevention and conservative therapy.