The possibility of application of endovascular and two-stage combined revascularization of the penis in the arteriogenic ED treatment is shown. Twenty male patients with multifocal atherosclerotic lesions of the aorto-iliac-femoral segments underwent the analysis of the branching patterns of the IPA according to the classifcation by Adachi and Yamaki followed by the interventional endovascular intervention (angioplasty, stenting) of the iliac arteries. Seventeen patients underwent the unilateral and three patients – bilateral stenting of the common and external iliac arteries. Three patients out of the total number of the operated ones additionally underwent an open revascularization of the penis by epigastric-penic anastomosis. A complex preoperative examination of patients – candidates for revascularization of the penis for arteriogenic erectile dysfunction was performed and included ultrasound, МCT-angiography of the pelvic arteries, and electroneuromyographic examination of atherosclerotic lesions of the pool vessels of the inner pudental artery. Subsequently, endovascular and combined open revascularization operations were performed on the iliac and penis vessels. The erectile function improvement according to the IIEF-5 scale (8–12 scores before the operation vs 16–19 points after the operation) was noted in 1, 3, 6, 12 months (p< 0.05). Combined revascularization operations on the iliac and penis arteries (endovascular and open “bypass”) allow an adequate arterial blood perfusion to the penis in the steno-occlusive lesions of the pool vessels of the IPA affected by atherosclerosis.

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The study objective is to evaluate the effectiveness of the Speroton complex therapy in combined treatment of oligoasthenospermia in patients with varicocele after microsurgical phlebectomy of varicose veins of the spermatic cord.Materials and methods. Microsurgical phlebectomy of the spermatic cord was performed in 40 men (mean age 33.0 ± 2.3 years) with oligoasthenospermia and varicocele. The patients were divided into 2 groups: the main group included 20 men who were treated with the Speroton complex for 3 months in the postoperative period, and the control group included 20 men who did not take Speroton. The spermogram parameters were evaluated before and after the operation.Results. Three months after the start of treatment, a statistically significant improvement in spermogram indicators was noted in all study groups. It was determined that combined therapy that included the Speroton complex administration for 3 months, statistically significantly led to the more considerable increase in sperm parameters than in control group: the sperm concentration increased to 38.6 and 28.9 mln/ml, respectively, the percentage of progressive motile sperm – to 49.2 and 39.4 %, the percentage of motile forms – to 72.2 and 43.8 %, viable forms – to 67.8 and 58.1 %, and the percentage of sperm with DNA fragmentation decreased to 12.1 and 17.2 %, respectively, in the main and control groups.Conclusion. Combined treatment with postoperative Speroton therapy for men of reproductive age with infertility and varicocele determines the more significant improvement in the parameters of sperm than performing only surgical correction of varicocele.

Objective: Analysis of the causes of sexual disorders in patients with prostate cancer after combination therapy. Material and Methods: 30 patients with prostate cancer were examined after 1-2 years of antitumor treatment including radical prostatectomy and/or radiation and glandular therapy. The comparative group consisted of 15 healthy men. Immuneenzyme analysis was used for detection of sexual hormone status; ultrasound and dopplergraphic methods as well as radiation method were conducted for angiographic study of pool vessels of the inner pudendal artery. Denervation disturbances in the pool of the inner sexual artery were diagnosed by the conduction of the applicative electroneuromyographic studies of the penis. Results: According to research conducted in 100% of cases within patients with prostate cancer erectile and sexual dysfunction were detected after combination therapy, which was not detected before therapy. Sporadic usage of the Vth type of phosphodiesterase inhibitors by patients with erectile dysfunction of severe form did not lead to improvement of potency. The main cause of erectile and sexual dysfunction in patients with prostate cancer was an aggressive antitumor therapy, which led to the development of stenosis in 100% of cases, occlusion in the pool of internal pudendal artery and in 100% cases to sensory-motor disorders of innervation of the penis. Maximum androgen blockade aggravated sexual dysfunctions within the patients with prostate cancer. Conclusion: Denervation and hemodynamically significant perfusion disturbances in the pool of the inner pudendal artery within the patients with prostate cancer after surgical and combination therapy lead to erectile and sexual dysfunction. The only possible mean of sexual rehabilitation of patients with prostate cancer after antitumor treatment is the endoprosthesis of penis.

Цель исследования-изучить эффективность комбинированной эктомии варикозно расширенных вен полового члена и вен семенного канатика при лечении веногенной эректильной дисфункции дистального типа в сочетании с варикоцеле (как андрогенитальной формы варикозной болезни вен малого таза). Материалы и методы. Выполнено 5 комбинированных флебэктомий у пациентов с андрогенитальной формой варикозной болезни вен малого таза, клинически проявлявшейся эректильной дисфункцией, варикозом полового члена, варикоцеле. Результаты. Предоперационное комплексное обследование пациентов, включавшее мультиспиральную компьютерную, магнитно-резонансную ангио-и фармакокавернозографию с ультразвуковым дуплексным сканированием сосудов полового члена, мошонки, простатического венозного сплетения позволило верифицировать варикозную болезнь вен малого таза, клинически проявлявшуюся эректильными, дисморфофобическими нарушениями в сочетании с варикоцеле. Комбинированная эктомия поверхностных вен полового члена в сочетании с операцией Мармара (эктомией вен семенного канатика) и с блокированием венозного оттока от полового члена в сафенофеморальный бассейн путем перевязки наружных половых вен во всех случаях дала положительный результат. После комбинированной флебэктомии международный индекс эректильной функции у всех пациентов увеличился с 12 ± 2 балла и составил 21 ± 1 балл (р <0,05). Заключение. Разобщение поверхностной и глубокой вен полового члена путем обнажающей циркумцизии с эктомией поверхностной вены полового члена, перевязкой ретрогландулярных вен в области венечной борозды полового члена, а также высокая перевязка поверхностной вены полового члена и ее ветвей (v. pudenda externa) в пахово-бедренной области в сочетании с эктомией вен семенного канатика (операцией Мармара) позволяет восстановить гемодинамическое равновесие между артериальным притоком к половому члену и венозным оттоком от него.