УДК: 612.014.484:012.015.1]-078.73-037-092.9

Introduction. Priapismisafrequentpainfulerectionthatlastsmorethan4hoursandisnotcaused bysexualstimulation,occurswhenbloodisblockedinthepenisandcannotleaveit.Itisbelieved thattheincreaseinthefrequencyofpriapismdirectlydependsontheprevalenceofintracavernous injectionsofvasoactivesubstancesinthetreatmentoferectiledysfunction.
Aim. Toevaluatethepathogeneticfeaturesofthedevelopmentofpriapism,asoneoftheforms
ofsexualdysfunction,inmeninjuredasaresultofcombatoperations(combattrauma)andto
optimizetreatmentmethods.
Materials and methods. Thestudy included14priapismpatientswhowere treatedat the
urologyclinicin2022‑2024.Priapismasacomplicationdevelopedin2(4.4%)of45patientsafter
intracavernousinjectionof20μgofprostaglandinE1(PGE1)(group1),in1(10%)of10patientsafter
sequentialinjectionof20μgofPGE1and0,5mgofphentolamine(group2),in3(20%)of15patients
afterinjectionof2%solutionpapaverine(group3).In5patients,priapismoccurredagainstthe
backgroundofsystematicuseofanticoagulants(lowmolecularweightheparin)inthetreatmentof
severevascularpathology(phlebothrombosis,thrombophlebitis)(group4).Inanother3patients,
thecausethatledtopriapismwasnotfound,sotheidiopathicformwasestablished(group5).
Results. Itwasshownthatin3cases,thedurationofpriapisminpatientswithpsychogenicEDwas
insignificant,sinceallpatientswerewarnedaboutthepossibledevelopmentofpriapismbefore
theinjectionofthevasoactivedrugandrecommendedtoseekmedicalhelpimmediatelyincaseof
itsoccurrence.Threeoutofthreepatientswithapreviousdiagnosisofmixederectiledysfunction
(withanorganicvascularcomponent)failedtorestoreerectilefunctionaftershunting.Threeout
offourpatientsdiagnosedwithidiopathicpriapismreportedtheabsenceoferectionsduring
severalmonthsofpostoperativefollow‑up.Innocasewastherearecurrenceofpriapisminthe
postoperativeperiod.
Conclusions. TheobtaineddataallowustorecommendprostaglandinE1asthedrugofchoice
amongvasoactivesubstancesforintracavernoususeduetoitshighestsafety.Unilateraltranscaputal
punctureofthecavernousbody(Wintershunt)inpatientswithischemicpriapismmadeitpossible
toachievedetumescencein100%ofcaseswithoutsubsequentrecurrenceandrestoreerectile
functionin40%ofpatients.
Keywords: priapism, erectile dysfunction, combat trauma, treatment, vasoactive drugs

УДК: 612.014.484:012.015.1]-078.73-037-092.9

Aim: To study the spectrum of antibiotic resistance of causative agents of wound infection in wounded men at the stage of specialized medical care.
Materials and Methods: Retrospective analysis of the results of culture of wound secretions on chromogenic media. The research involved 113 samples of biomaterial from 85 wounded. Sensitivity of antibiotics was studied by the Kirby-Bauer method.
Results: Analysis of the microflora of the wound surface made it possible to determine the dominance of gram-negative bacteria, they were isolated in 80% of cases. The microbial spectrum of gram-negative bacteria is represented by Pseudomonas aeruginosa – 31 isolates, Acinetobacter baumannii – 29 isolates, 
Enterobacter aerogenes – 21 isolates, Proteus vulgaris – 13 isolates, Escherichia coli – 7 isolates, Enterobacter cloacae – 5 isolates, Klebsiella pneumoniae – 7 isolates and gram-positive bacteria Staphylococcus aureus – 5 isolates, Enterococcus fecalis – 32 isolates. Among all tested isolates of gram-negative non-fermenting 
bacteria and enterobacteria, the highest sensitivity was observed to colomycin and polymyxin B, from 60 to 80%. When analyzing of antibiotic sensitivity of Klebsiella pneumoniae and Acinetobacter baumannii, it was found that these pathogens retain 80-100% of their actual antibiotic sensitivity to polymyxins.
Conclusions: Gram-negative strains isolated from wound infection are sensitive to antibiotics: 70% to polymyxins (colistin), 30% to aminoglycosides (amikacin), 24-16% to cephalosporins (cefoperazone-sulbactam/cefoperazone-avibactam).
KEY WORDS: combat trauma, microbiome, antibiotic resistance

УДК: 612.014.484:012.015.1]-078.73-037-092.9

Aim: To evaluate the effectiveness of selective serotonin reuptake inhibitors (SSRIs) to the treatment of patients with premature ejaculation who have been affected by combat actions.
Materials and Methods: Results of an examination of 50 men injured as a result of hostilities, with sexual dysfunction and complaints of premature ejaculation. 
Patients were divided into smaller subgroups depending on the selected serotonin reuptake inhibitors, which they received for at least 1.5 months: sertraline (n=14), paroxetine (n=12), citalopram (n=12), venlafaxine (n=12).
Results: After treatment with all serotonin reuptake inhibitors, reactive and personal anxiety symptoms, as assessed by the Spielberger-Hanan scale, were objectively reduced in men. Only treatment with paroxetine and citalopram resulted in a likely reduction in depressive symptoms in men with premature ejaculation, Paroxetine and sertraline appeared to be relatively balanced drugs with moderate efficacy but relatively few side effects. The lack of a «gold 
standard» among serotonin reuptake inhibitor drugs for the treatment of premature ejaculation on the Ukrainian market necessitates the search for new, more effective drugs with the possibility of flexible use.
Conclusions: The study demonstrates that the neurotransmitter serotonin plays a key role in the modulation of ejaculation, as the use of reuptake inhibitors increases the intravaginal latency to ejaculation. Among the selective serotonin reuptake inhibitors, venlafaxine was found to be the most effective

 616.69-008.6(079.5)

Сучасне наукове розуміння еректильної дисфункції вказує на переважну вторинність сексуальних розладів стосовно захворювань, що їх спричиняють. Це значною мірою стосується чоловіків, постраждалих внаслідок бойових дій. Основою роботи стали результати анкетування 298 чоловіків, постраждалих внаслідок бойових дій (осколкові та кульові поранення) з використанням анкет Міжнародного індексу еректильної функції-5 (МІЕФ-5). Дослідна група була розділена на дві: чоловіки віком 20–39 років (група 1) і чоловіки віком 40–53 роки (група 2). До контрольної групи увійшли 48 практично здорових чоловіків без скарг на сексуальну дисфункцію чи кардіологічну, неврологічну або ж ендокринологічну патологію. Серед чоловіків контрольної групи – 30 чоловіків віком 20–39 років (група 3) і 18 чоловіків віком 40–60 років (група 4). Показано, що у 196 чоловіків 1-ї групи віком 20–39 років спостерігається легка форма ЕД – сумарний бал – 19,57 ± 0,44. У 102 чоловіків 2-ї групи віком 40–53 роки теж наявна легка форма ЕД, однак сумарний бал значно нижчий – 17,94 ± 0,41. Показники окремих 5 компонентів статевої функції чоловіків і шкала твердості ерекції також були нижчими в пацієнтів 2-ї групи. Найбільш показово знижується домен ЕД-МІЕФ-5 зі ступенем тяжкості ЕД. Усі домени МІЕФ достовірно знижуються при ЕД порівняно зі здоровою групою респондентів, проте диференціація за тяжкістю ЕД відсутня. Тобто, при ЕД будь-якої вираженості одночасно страждають всі інші сексуальні функції – сексуальне бажання, впевненість в ерекції, твердість та підтримання ерекції, задоволення від статевого акту та статевого життя.

Background. The study of the problem of physical and mental health of people who have survived combat trauma is a component of a wide field of research on the problem of stress, which manifests itself at all levels of the organization of the body. Combat injuries, in particular those of the areas of pelvis and genitourinary system, stressful events, lead to the development of erectile dysfunction (ED). In recent decades, a sufficient number of scientific facts have been accumulated, which confirm the significant influence of stress factors on the reduction of sexual desire and sexual activity. Therefore, determination of Ca²⁺,Mg²⁺- and Na⁺,K⁺-ATPase activity on a convenient model like peripheral blood lymphocytes add complexity to the understanding of the development of the pathophysiological and pathobiochemical mechanisms of the body, the result of which is the development of ED.

Materials and methods. The research was conducted on peripheral blood lymphocytes of men injured as a result of combat operations (shrapnel and bullet wounds) in the Russian-Ukrainian war and treated at the Military Medical Clinical Center of the Western Region. The research group of men with combat injuries was divided into two subgroups: men aged 20–39 years (subgroup 1) and men aged 40–53 years (subgroup 2). The control group consisted of 48 practically healthy men without complaints of sexual dysfunction or cardiac, neurological or endocrinological pathology. Among the men of the control group were 30 men aged 20–39 years (subgroup 3) and 18 men aged 40–53 years (subgroup 4).

Results. It has been shown that in the peripheral blood lymphocytes of men injured as a result of hostilities, there is a decrease in Na⁺,K⁺-ATPase activity and Ca²⁺,Mg²⁺-ATPase activity of the plasma membrane and endoplasmic reticulum, which leads to overloading of the cytosol with Na⁺ and Ca²⁺ ions, respectively, which is characteristic of pathological processes.

Conclusion. Erectile dysfunction due to combat trauma is accompanied by a decrease in both Ca²⁺,Mg²⁺-ATPase activity of the plasma membrane and Ca²⁺,Mg²⁺-ATPase activity of endoplasmic reticulum of blood lymphocytes. As the age of patients with disorders of sexual function increases, the decrease in Ca²⁺,Mg²⁺-ATPase activities becomes more expressed. In men with erectile dysfunction due to combat trauma, the activity of Na⁺,K⁺-ATPase is also inhibited. According to the ROC curve, Ca²⁺,Mg²⁺-ATPase activity of the endoplasmic reticulum in blood lymphocytes is a potential biomarker of erectile dysfunction