Effectiveness of combined therapy Impaza and PDE5 inhibitors in prophylaxis post-traumatic erectile dysfunction
Ibishev, KS1; Krakhotkin, DV1; Krainiy, PA1; Zagirov, ZM1
1: Rostov State Medical University, Department of urology, Rostov-on-Don, Russia
Objective: Prophylaxis of erectile dysfunction in patients who had trauma urethra
Materials and Methods: We conducted the examination and treatment of 42 patients with trauma urethra without fractures of pelvic bones and interruption integrity of penile vessels complicated by stricture of urethra and who maintained erectile function. The examination included: IIEF questionnaire, clinical laboratory tests, physical examination, dopplerography of penile vessels, biopsy of cavernous bodies. All patients underwent surgical treatment of urethral stricture. Plastic surgery was performed for the first time, the history of the disease did not exceed 4-5 months. In order to prevent erectile dysfunction (ED) in patients with trauma of urethra, combined therapy was used with medications that improve oxygenation (raising the level of NO) of cavernous and spongy bodies (ultra small doses of antibodies to endothelial NO synthase (Impaza) and with inhibitors of phosphodiesterase type 5 in a dosage of 5 mg. Patients were divided into 2 groups: patients of the 1st group (n = 22) were on treatment in the clinic when the proposed the treatment approach was not used, and patients of the 2nd group (n = 20) received Impaza and phosphodiesterase 5 inhibitors type according to the developed protocol, protected by the patent of the Russian Federation No. 2308271, within 6 months.
Results: In patients of the 1 st group, ED of different degree severity was complicated in 77.2% of patients, in the 2nd group of ED only 15% of patients were registered. At the end of 8 months after trauma urethra and 3 months after the operation, the patients underwent biopsy cavernous bodies. Morphological study revealed that in the cavernous tissue of patients of the 2nd group, the walls of most caverns consisted of smooth muscle elements and were lined with endothelium, there were no signs of smooth muscle tissue atrophy. The walls of the caverns retained the scalloped condition, they were not deformed, whereas in the biopsy specimens of the cavernous bodies of the penis of patients of the 1 st group was noted the replacement of cavernous tissue by a mature fibrous connective tissue.
Conclusions: Within 6 months after trauma of the urethra in the spongy tissue and the alveolar shell of the cavernous bodies, irreversible destructive-degenerative changes develop. Early, one month after the injury of the urethra, the administration of drugs that affect the endothelial NO - synthase ("Impaza") and PDE 5 inhibitory drugs, can prevent erectile dysfunction.
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