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Abstract. Military personnel who have received combat injuries experience long-term consequences of severe injuries that have a significant impact on 
quality of life and sexual function. There is growing evidence that post-trau matic stress disorder, which develops secondary to injury, is associated with 
higher rates of erectile dysfunction, decreased sexual desire, and premature  ejaculation. Combat-related injuries may also have significant consequences for  male fertility, as they typically serve during their peak sexual activity years.

The aim of the work was to comparative analysis of the International Index  of Erectile Function and quality of life indicators in men with combat injuries 
and sexual dysfunction accompanied by chronic pelvic pain and premature  ejaculation, before and after treatment.
Methods. The study was based on the results of a questionnaire survey of  76 men aged 20–53 years, injured as a result of combat operations (mostly as a  result of polytraumatic injuries) before and after treatment using the Interna tional Index of Erectile Function-5 questionnaire and the SF-36 questionnaire  to assess the quality of life. After establishing the appropriate diagnoses, the patients were divided into two groups. Group 1 incluted patients with erectile  dysfunction of mixed genesis, accompanied by chronic pelvic pain, included  combat participants with endothelial dysfunction, metabolic syndrome, dyslipid emia, hypertension, coronary artery disease, late hypogonadism (n = 48); Group  2 incluted patients with erectile dysfunction of mixed genesis and premature  ejaculation combatants with endothelial dysfunction, metabolic syndrome, dyslipidemia, hypertension, coronary heart disease, late hypogonadism (n = 28).
Results. It was shown that the elimination of pelvic pain after successful  etiotropic therapy of patients in group 1, along with multifaceted treatment of 
ED (pathogenetic therapy), leads to a significant improvement in the indicators  of general health, role-physical functioning, role-emotional functioning, life  activity, mental health, and the absence of pain. Elimination of the cause of  erectile function through psychotherapy with potentiation of the effect by takng sildenafil leads to a significant increase in the average score of all MIEF-5  domains, and therefore an improvement in sexual function as a whole. After  treatment of patients in group 2, a significant increase in the average score of  the absence of pain from 84,9 to 95,1 is observed. The average score for vital  activity significantly increased from 63,9 to 70,2 (p < 0,05), and there was also  a trend towards improvement in the mental health domain from 68,1 to 74,3. 
Conclusions. The results of the study indicate a significant prevalence  of mixed forms of erectile dysfunction, accompanied by chronic pelvic pain or  premature ejaculation, which bothers men after suffering combat injuries. As  a result of the treatment of erectile dysfunction of mixed genesis with chronic  pelvic pain, indicators of general health, role-physical functioning, role-emo tional functioning, life activity, mental health, absence of pain sensation and  sexual function in general improve. After comprehensive treatment of men with  erectile dysfunction of mixed genesis and premature ejaculation, indicators of  pain sensation, life activity, satisfaction from sexual intercourse and sexual life  significantly improve, and there is also a tendency to improve mental health.
Key words: combat trauma, erectile dysfunction, quality of life, MIEF-5  questionnaire, SF-36 questionnaire.

As a result of severe injuries and post-traumatic stress disorder, sexual dysfunction and fertility disorders are among the complications men experience. The mechanisms of the effects of combat trauma are complex and include an imbalance of the immune system, which leads to severe inflammatory reactions and other immunomodifying effects after injury. An early r e sponse to an acute inflammatory injury, such as wound healing, is the production of nitric oxide (NO) as a result of L-arginine metabolism. NO is an important regulator of cellular functions throughout the wound healing process, stimulating fibroblasts to produce collagen, promoting matrix deposition, remodeling, and angiogenesis. However, insufficient or excessive NO synthesis negatively affects wound healing. The aim of the study was to investigate the prognostic power of arginase activity parameters and individual NO synthase isoforms as potential biomarkers of nitrosative stress in men with combat trauma. The study e x amined 68 men with combat trauma, including 42 men aged 20 – 39 years and 26 men aged 40 – 53 years. Criteria for inclusion in the control groups: 30 healthy men aged 20 – 39 years and 18 men aged 40 – 53 years with normal levels of cNOs, iNOs and arg i nase activity, somatically healthy, without sexual dysfunction. In all groups, the activity of NO synthases and arginase as markers of nitrosative stress was measured spectrophotometrically in blood serum and lymphocyte samples. The prognostic power of the parameters of cNOS, iNOS and arginase activity in the combat trauma and control groups was determined by the receiver opera t ing characteristic curve (ROC curve). Based on the ROC analysis, the threshold value of cNOS activity in blood lymphocytes was determined, which is an integral highly sensitive criterion for unfavorable prognosis in combat trauma. For men aged 20 – 39 years, this figure is ≤37.5 nmol NADPH(H + )/min. mg with a sensitivity of 61.9% and a maximum specificity of 100 . 0 %, while for the group of men aged 40 – 53 years, the cutoff value is ≤38.4 nmol NADPH(H + )/min. mg with a sensitivity of 65. 4 % and a maximum specificity. In the ROC analysis of iNOS activity in lymphocytes of men with combat trauma in relation to healthy men, an excellent model quality was obtained with the maximum area under the ROC curve for patients of both age groups. The lymphocyte arginase activity in the two age groups of men with combat trauma were characterized by the very good diagnostic accuracy of the test. Thus, the parameters of oxidative-nitrosative stress, in particular the activity of constitutive and inducible isoforms of NO synthase and arginase in blood serum and lymphocytes can be potential markers in distinguishing pathological changes in men affected by combat (bullet and shrapnel wounds). The inducible isoform of NO synthase has been shown in studies to be a highly sensitive and highly specific marker regardless of the age of men.