Methods of diagnosis of patients with ED

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Among the special and new diagnostic methods of patients with ED, the speaker named the assessment of nocturnal penile tumescence and rigidity, the use of Androscan technology, penile pharmacodopplerography and transperineal ultrasound, assessment of the status of systemic endothelial function, electroneurophysiological examination of the penis, cavernosography (conventional and dynamic with the use of multispiral computed tomography – CT and magnetic resonance imaging – MRI), CT angiography. Further, the doctor elaborated on the description of new technologies for diagnosing patients with ED.

“The Androscan device is designed to perform a penile tumescence test by registering spontaneous penile erections for the purpose of differential diagnosis of ED–” he said. “Among the disadvantages of the device are a limited number of studies per sensor (20 studies), and among the “pros” is the ability to store information on a computer and program the start of recording from the sensor.”

Another method of studying the status of systemic endothelial function, according to the speaker, is the method of determining the status of endothelium-dependent flow-mediated dilation of vessels in the form of ultrasonographic measurement of the diameter of a. brachialis. The main “plus” of this technique is its non-invasive nature, and among the disadvantages are the assessment of the state of the endothelium in only one vessel, the lack of consideration of systemic fluctuations in the diameter of other arteries, direct dependence on the availability of professional skills of the researcher, a very small range of changes that are determined during the study.

Analysis of cavernosography technologies, which is a combination of MRI with dynamic infusion pharmacocavernosometry. Among the disadvantages of the method were the difficulties in mastering the technique and the technical difficulties of its execution, as well as the need for expensive equipment and consumables, which limits its use in everyday clinical practice. As for the “advantages”, the main one among them is high informativeness.

Treatment of patients with various forms of ED

Speaking about new methods of treating patients with various forms of ED, several modern techniques were analyzed. And first of all, we note that such treatment options include lifestyle changes, local negative pressure therapy, the use of oral medications, the use of intracavernous injections of vasoactive drugs, as well as injections of stem cells or platelet-rich plasma (PRP), falloprosthesis, the installation of penile exoprostheses, the use of microsurgical revascularization techniques, X-ray endovascular technologies, shock wave therapy.

Mentioning oral medications (phosphodiesterase type 5 inhibitors – PDE–5), the speaker noted that the combination of permanent administration of tadalafil with sildenafil on demand can lead to an improvement in erectile function, especially in men with severe ED. Of the last drugs in this pharmacological group, avanafil was registered. As for intraurethral suppositories, with certain “pluses” (these are the drugs preferred by patients who do not want to take oral medications or use intracavernous injections), they also have “minuses”. Although the intraurethral drug alprostadil improves erection compared to placebo, it is still less effective than its intracavernous injections. In addition, when using it, there is a possibility of pain in the penis or urethra.

On the topic of falloprosthesis, the speaker’s opinion was as follows: “Modern types of falloprostheses are represented by one-component models of American and Argentine production, as well as three-component systems manufactured in the USA and Switzerland. Among the new approaches in this area, the idea of creating a motorized pump drive integrated into a three-component device stands out, which can provide efficient and fast hydraulic dynamics. The advantages of existing falloprostheses are the most comfortable and accurate process of artificial erection control. And the disadvantages are the need for a reliable and adequate food source, high invasiveness and the risk of prosthetic infection.”

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