New technologies in the treatment of ED

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The analysis is devoted to new approaches and technologies in the diagnosis and treatment of various forms of erectile dysfunction (ED). ED at the present stage is a very significant clinical and social problem that has a significant negative impact on the quality of life of men. The importance and relevance of the ED problem dictates the need to search for and develop new, more effective technologies for the verification and treatment of ED.

New technologies in the diagnosis of ED

At the present stage of medical development, the study of patients with ED is a wide range of laboratory and instrumental tests. So, in addition to complaints, anamnesis, changes in sexual function, questionnaires (international Index of erectile function (ICEF-5), questionnaire of age-related symptoms of androgen deficiency (AMS), male copulatory function scale (MCF), hospital anxiety and depression scale), laboratory tests (blood glucose, testosterone fractions, lipid spectrum, etc.) use special techniques. This is an assessment of nocturnal penile tumescence and rigidity (including with theusing Androscan technology), penile ultrasound with pharmacodopplerography, assessment of the status of systemic endothelial function, electrophysiological penile examination, cavernography (conventional and using multispiral computed tomography and magnetic resonance imaging technologies).

New directions and technologies in the diagnosis of ED will be discussed below.

Treatment of ED: Electroneurophysiological studies

J. Ponseti et al. it was found that in the vast majority of cases, the electroencephalographic activity of the central nervous system (brain) correlated with the indications obtained during cavernous electromyography, which allowed us to conclude that the electrical activity of the penis is under direct control of the brain, and the vegetative signal reaches the cavernous bodies within a very short time interval after the initiation of sexual stimulation. This technique can be used in the diagnosis of psychogenic ED in order to objectify the data. Other researchers have studied the electrical potentials of cavernous bodies in patients with arteriogenic ED, based on the results of penile pharmacodopplerography.

Ultrasonographic verification of erectile dysfunction associated with a decrease in the activity of electrical signals, according to cavernous electromyography, demonstrated 66.7% sensitivity and 92.9% specificity of this combined technology in the diagnosis of arteriogenic ED. Due to the high specificity of the electromyographic reaction to the injection of prosta- glandin E1, this method can be used as a screening method for the diagnosis of ED due to insufficiency of the arterial component. According to the assumption of some authors, further improvement of the technique of cavernous electromyography will allow its use in the differential diagnosis of neurogenic imiogenic ED.

Currently, cavernous electromyography is not one of the main methods for the diagnosis of ED and is used only in some cases: with post-traumatic genesis of ED (blunt perineal trauma), postoperative development (radical prostatectomy), as well as in patients with DM.

New technologies in the treatment of various forms of ED

Since erectile function has a complex relationship between psychological and physiological factors, according to the recommendations of the American Urological Association (AUA), patients are recommended to consult a specialist sexologist or psychotherapist as an additional therapy for ED.

treatment of ED

It has been demonstrated that this interdisciplinary approach improves adherence to treatment plans and improves erectile function when used as primary therapy and can potentiate the effects of additional treatment options. It has also been shown that the partner’s readiness for different treatment options increases the likelihood of restoring sexual function. These methods of treatment are divided into non-invasive and invasive. Although noninvasive ED therapy options may be preferable for many patients, all treatment options should be thoroughly and comprehensively discussed in conversation with the patient. According to the AUA recommendations, any treatment option for ED can be used as a first-line therapy.

Treatment options for ED currently include lifestyle changes, local negative pressure therapy, oral medications, intracavernous injections of vasoactive drugs, falloprosthetics, as well as newer approaches such as implantation of an external penile prosthesis, microsurgical revascularization techniques and X-ray endovascular technologies. In addition, additional new technological and pathogenetic approaches to the treatment of ED are being actively developed and implemented, such as shock wave therapy of the penis, injections of stem cells or platelet-rich plasma (PRP). These treatments have shown promising initial results and may become part of the ED treatment algorithm in the future. Below we will provide an overview of new technologies and approaches in the treatment of ED, the ultimate goal of which is to improve the erectile function of patients while improving the quality of life.

Treatment of ED: Lifestyle changes

Physical inactivity, obesity, unhealthy diet, smoking are the most important factors contributing to the development of ED. Other factors include somatic pathology such as diabetes mellitus, cardiovascular diseases, hypertension, hyperlipidemia, metabolic syndrome and hypogonadism, as well as mental and psychological disorders. Thus, lifestyle changes can prevent progression or improve regression in early manifestations of ED. In addition to eliminating risk factors, some other lifestyle changes may also play a role in managing erectile function. For example, some couples may eroticize certain routines to make them more successful.

Oral medications

Oral medications taken before coitus (on demand) or in a permanent mode are the first line of ED therapy resistant to lifestyle changes. This group of drugs inhibits phosphodiesterase type 5 (PDE-5), which leads to an increase in the concentration of cyclic guanosine monophosphate (cGMP) and promotes the onset of erection. Among the new approaches in oral therapy, it should be noted that the combination of permanent administration of tadalafil and sildenafil on demand can lead to an improvement in erectile function, especially in men with severe ED.

Recently, there has been disagreement as to whether these drugs can initiate melanoma or prostate cancer pathology, but currently there is no evidence to support this, and PDE-5 inhibitors remain very common and are recommended as a first-line treatment for ED. Of the latter, avanafil was registered in this pharmacological group.

Conclusion

The review study presented above confirms the fact that the main diagnostic task of ED is to establish its true etiological component. It is advisable to use diagnostic technologies with proven effectiveness, since it is this circumstance that provides effective treatment of ED. There is a need to create a personalized diagnostic algorithm aimed at assessing the state of the cardiovascular system, endothelial function, hormonal status, angioarchitectonics, etc. This will increase the effectiveness and safety of treatment for men with various types of ED.

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