UDC 615.69-008.3-092-02:355.422-057]-085.214:615.036-042.2

Premature ejaculation is one of the most common male sexual disorders and occurs with a frequency of 21-33% in various populations. The etiology of premature ejaculation is practically not established, although it is a fairly common type of sexual dysfunction. According to various data, sexual dysfunction occurs in 49.1-80% veterans of combat-actions with post-traumatic stress disorder. Premature ejaculation can interfere with sexual satisfaction, leading to a reduced quality of life for men and their partners. It has been shown that serotonin reuptake inhibitors may be the drugs of choice in the treatment of premature ejaculation. The aim of the work was to improve methods of treating sexual dysfunction accompanied by premature ejaculation in men injured as a result of hostilities. 56 men injured as a result of hostilities with sexual dysfunction and complaints of premature ejaculation were examined. Patients were divided into two groups depen­ding on the selected selective serotonin reuptake inhibitors – venlafaxine (n=24) and dapoxetine (n=32) which they had been receiving for at least 1.5 months. After treatment with both serotonin reuptake inhibitors, reactive and personality anxiety symptoms objectively decreased, as assessed by the Spielberger-Hanan scale. Treatment with venlafaxine and paro­xetine resulted in a significant reduction in depressive symptoms in men with premature ejaculation. They turned out to be relatively balanced drugs with satisfactory efficacy and relatively few side effects. However, venlafaxine, compared to dapoxetine, produced 2.1 times fewer side effects and 20% fewer relapses. The average duration of sexual intercourse after treatment with both drugs positively correlated with the overall improvement of sexual function according to the IIEF-5 scale (r=0.70; p<0.05 for the first group; r=0.85; p<0.05 for the second group). An inverse correlation was found between the average duration of sexual intercourse and the score of anxiety symptoms on the Spielberger-Hanin scale in patients of both study groups (r= -0.69; p<0.05 for the first group; r= -0.68; p<0.05 for the second group). Although dapoxetine is considered the “gold standard” among serotonin reuptake inhibitors for the treatment of premature ejaculation, the drug is used by the patient only on demand, and other drugs in this group, which are antidepressants, may have a more positive effect on patients with depression and concomitant premature ejaculation, who have suffered as a result of hostilities. The study demonstrates that the neurotransmitter serotonin plays a key role in the modulation of ejaculation, as the use of its reuptake inhibitors, in particular dapoxetine and venlafaxine, contributes to an increase in intravaginal latency time to ejaculation.

УДК: 612.015.11:616.69-008.1:616-001

Introduction. To study the predictive ability of using the quantitative value of the level of a single indicator to detect oxidative stress, ROC analysis was performed with the calculation of the optimal cut-off threshold selected according to the criterion of maximum balance between sensitivity and specificity.The aim of this research is to analyze the diagnostic sensitivity and specificity of pro- and antioxidant system indicators in men injured as a result of combat operations.Materials and methods. 116 samples of peripheral blood lymphocytes and serum from men, which were divided into two groups by age, were analysed for the sensitivity and specificity of pro- and antioxidant system indicators.Results. The results of ROC analysis for indicators of the pro- and antioxidant system of lymphocytes and peripheral blood serum demonstrated their predictive ability for detecting oxidative stress. Malondialdehyde of blood lymphocytes for the age group 20–39 years, reduced serum glutathione and total glutathione of blood lymphocytes for all examined men were characterized by excellent discriminatory ability. Malondialdehyde of blood lymphocytes for the age group 20–39 years showed itself as a highly sensitive marker with a slightly lower specificity value. Reduced glutathione of blood serum of men of all age groups is characterized as a highly specific marker with a slightly lower sensitivity value. Total glutathione of blood lymphocytes is simultaneously characterized by high sensitivity and specificity for all examined men.Conclusions. The concentration of malondialdehyde in blood lymphocytes and the levels of total and reduced glutathione in blood serum were the most significant predictors for the detection of oxidative stress based on the ROC analysis. These markers demonstrate high sensitivity and specificity as indicators of the pro- and antioxidant balance.Keywords: erectile dysfunction, combat trauma, pro- and antioxidant system, ROC analysis.

UDC 616.69-008.1-06:616-001.45]-08

Participants in hostilities often face long-term effects of severe injuries, which can markedly impair both quality of life and sexual function.
The objective: to assess the effectiveness of treatment for mixed genesis erectile dysfunction (ED) accompanied by chronic pelvic pain (CPP) or premature ejaculation (PE) in men with combat injury.
Materials and methods. The examination of 60 men aged 20–53, participants in hostilities, with sexual dysfunction was performed. The main complaints were ED accompanied by CPP or PE. According to the form of ED, patients were divided into groups: Group 1 included patients with ED of mixed etiology associated with CPP (n = 32); Group 2 consisted of patients with ED of mixed origin accompanied by PE (n = 28).
Results. It has been demonstrated that lifestyle modification is an effective treatment method for ED, which is accompanied by CPP in men with a combat injury. 62.5% of patients have a significant improvement in erectile function, and 31.2% have a slight improvement. The efficacy of treatment of ED associated with PE is linked to serotonin reuptake inhibitors (SRIs), confirming the key role of the neurotransmitter serotonin in the modulation of ejaculation. Significant improvement in this group was observed in 53.6% of patients, and insignificant in 39.3%.
Conclusions. The most effective method of treatment is lifestyle modification for patients injured as a result of hostilities, with ED of mixed genesis, accompanied by the leading syndrome of CPP. This group demonstrated an improvement in International Index of Erectile Function (IIEF)-5 score from 13.5 ± 2.3 to 21.6 ± 2.1 (p < 0.05). Serotonin is a key neurotransmitter involved in the regulation of ejaculation in patients with ED and coexisting PE, as treatment with SRIs prolongs intravaginal ejaculatory latency. This group also demonstrated an improvement in IIEF-5 score from 13.8 ± 2.1 to 22.0 ± 1.9 (p < 0.05).
Keywords: erectile dysfunction, combatants, combat trauma, chronic pelvic pain, premature ejaculation, treatment.

UDC: 612.015.1:616.65:616-007.61

Background. Benign prostatic hyperplasia (BPH), which is mostly prevalent in older men, is associated with compression of the prostatic urethra and manifests as lower urinary tract symptoms. Its pathological characteristics include abnormal proliferation of stromal and glandular epithelial cells, leading to prostate enlargement. Current data highlight additional factors in the pathogenesis of this disease, notably oxidative stress and chronic inflammation.
Materials and Methods. Prostate tissue was obtained from 35 patients aged 58–72 years via transurethral resection. Prostate tissue from three patient groups was utilized. Group 1 consisted of patients with BPH (n = 7) weighing up to 40 grams (control group); Group 2 included patients with BPH (n = 14) weighing 45–98 grams; Group 3 comprised patients with benign prostatic hyperplasia and chronic inflammation (adenoprostatitis) weighing 45–98 grams (n = 14). The levels of malondialdehyde and reduced glutathione, as well as the activities of glutathione peroxidase and glutathione reductase, were determined in the tissues.
Results. In large-scale prostate hyperplasia and prostate hyperplasia associated with prostatitis, lipid peroxidation processes escalate in prostate cells, as indicated by an increase in malondialdehyde concentration. The elevation in lipid peroxidation levels is accompanied by a decrease in the activity of antioxidant defense enzymes glutathione peroxidase and glutathione reductase, alongside a reduction in the concentration of reduced glutathione. The balance within the pro-/antioxidant system is more significantly disrupted in cases of prostate hyperplasia associated with prostatitis.
Conclusion. In large-scale prostate hyperplasia and hyperplasia associated with histologically confirmed prostatitis, lipid peroxidation processes intensify within the cells, which is confirmed by rising levels of malondialdehyde. The increase in lipid peroxidation is accompanied by a decline in glutathione peroxidase and glutathione reductase activities, as well as a decrease in the concentration of reduced glutathione. In prostate hyperplasia accompanied by adenoprostatitis, the balance in the pro-/antioxidant system is disrupted to a greater extent.

The molecular and stromal mechanisms associated with the pathogenesis of prostate hyperplasia as a metabolic disorder are not yet fully understood, but it is believed that the etiology of hyperplasia is influenced by a number of factors, including aging, hormonal changes, metabolic syndrome, dietary factors, inflammation, oxidative stress, and, more recently, suppression of apo p tosis in prostate tissue. A number of studies emphasize the disruption of pro/antioxidant status in the development of prostate hyperplasia. The aim of the research is to study the activity and kinetic characteristics of glutathione-S-transferase (GsT) in pro s tate biopsies from patients with benign hyperplasia and hyperplasia with chronic prostatitis. The prostate tissue (biopsies) from two groups of patients were used. Group 1 consisted of patients with benign prostatic hyperplasia (n = 14); group 2 consisted of patients with benign prostatic hyperplasia and chronic prostatitis (n = 14). It was shown that GsT activity in the soluble fraction of prostate biopsies from patients with benign hyperplasia with chronic prostatitis was 1.60 times higher than in patients without chronic prostatitis. It was found that the kinetics of the GsT reaction is consistent with the patterns of a zero-order reaction in the range of 0–3 min: in this time interval, the dependence graph of the product formation on the incubation period was practically linear. It was shown that the value of V 0 in patients with prostatic hyperplasia with chronic prostatitis wa s almost twice as high as that in patients without chronic prostatitis. Over the entire range of GSH concentrations, enzyme activity in samples from patients with inflammation was higher than in patients without chronic prostatitis. Similar changes were also observed with an increase in the concentration of 1-chloro-2,4-dinitrobenzene in the incubation medium at a constant GSH concentrations. Calculation of the kinetic parameters of GsT activity shows that the maximum reaction rate of accumulation of the optically active dinitrobenzene conjugate, determined by GSH, was 1.44 times higher in patients with chronic prostatitis compared to the first group. The affinity constant for GSH in this group of patients was 2.28 times higher compared to patients without chronic prostatitis. When interpre t ing the obtained kinetic parameters determined by GSH, it is shown that GsT activity in patients with benign prostatic hyperplasia without chronic prostatitis is reduced both due to a decrease in the enzyme reaction rate (V max decreases) and due to a increase in the enzyme's affinity for GSH (KGSH decreases).