УДК: 616.69-008.1-06:616-001.45]-08

Combat injuries mostly cause post-traumatic stress disorder, which is accompanied by erectile dysfunction (ED), decreased sexual desire, premature ejaculation, etc. Neurotic mental disorders, blood vessel diseases, metabolic disor-ders, and partial androgen deficiency take precedence among the many pathological conditions preceding or compli-cating ED, especially for combatants.

The objective: optimization of treatment of psychogenic and mixed forms of ED in men with combat injuries.

Materials and methods. The study included the results of the examination and treatment of 136 men aged 20–53, partici-pants in combat operations with combat injuries, with sexual dysfunction and ED as the main complaint. According to the form of ED, patients were divided into two groups: Group 1 – patients with psychogenic ED after a combat injury (n=84); Group 2 – patients with ED of mixed genesis, included patients, participants in hostilities with endothelial dysfunction, metabolic syndrome, coronary heart disease, late hypogonadism (n=52). The treatment of all patients with sexual dysfunc-tion was carried out individually, depending on the etiopathogenesis of the main diseases and the combat trauma that led to it, as well as the development and course of the leading sexological syndromes, taking into account standardized protocols that allowed dividing patients by identity into groups and carrying our significant statistical calculations.

Results. It was shown that the treatment of men with psychogenic ED, which includes lifestyle modification, rational and explanatory psychotherapy, as well as the use of a PDE-5 inhibitor, such as sildenafil, leads to an increase in the mean IIEF-5 score from 10.8±0.9 (severe form of ED) to 19.6±1.7 (mild form of ED) (р<0.05). It is also advisable to use alpha-adreno-blockers that act on both peripheral and central adrenoceptors. In the treatment of patients with ED of mixed genesis, the best results are observed when androgen replacement therapy is performed with proven androgen deficiency; taking lipid-lowering therapy for persistent dyslipidemia; withdrawal of β-blocker, in cases where it is possible; changing the patient’s harmful life-style; conducting rational and clarifying psychotherapy and its potentiation by taking sildenafil. Such treatment leads to an increase in the average IIEF-5 score from 11.5±0.9 (moderate form of ED) to 17.8±1.6 (mild form of ED) (р<0.05).

Conclusions. The disorders of general and mental health, role functioning at the physical and emotional levels are the main disorders health-related quality of life with psychogenic ED. Lifestyle modification, along with rational and explana-tory psychotherapy, as well as the use of the PDE-5 inhibitor sildenafil, gives positive results. Patients with ED of mixed genesis have impaired general and mental health, physical and emotional functioning, and vital activity. The best treat-ment results are observed when androgen replacement therapy is carried out with proven androgen deficiency; taking lipid-lowering therapy for persistent dyslipidemia; withdrawal of β-blocker, in cases where it is possible; changing the patient’s harmful lifestyle; carrying out rational and clarifying psychotherapy and its potentiation by taking sildenafil.

The development of oxidative and nitrative stress and the processes of free radical oxidation are associated with many pathological processes. Damage of any origin leads to the activation of free radical processes not only in the place of damage, but also in the whole organism. The aim of the study is to assess the state of lipid peroxidation, content of GSH and GSSG and the activity of NO-synthase and arginase in lymphocytes and peripheral blood serum in men with erectile dysfunction due to combat trauma. 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 who were treated at the Military Medical Clinical Center of the Western Region (Lviv, Ukraine). The research group of men with combat injuries was divided into two age groups: men aged 20–39 years and men aged 40–53 years. The MDA content in the blood serum of patients of both age groups was 1.35 times higher than in the control group. In peripheral blood lymphocytes, the MDA content in patients of the young age group was 1.27, and in patients of the middle age group in 1.39 times higher than in the control group. Simultaneously, no significant changes in the concentration of oxidized glutathione in blood serum and blood lymphocytes were found between men with erectile dysfunction due to combat trauma and healthy men. GSH content in blood serum in patients of both age groups was significantly lower than in the control group. The arginase/NOS ratio in blood serum was 9.75 times lower in the young age group and in 20.45 times lower in the middle age group compared to healthy men. It was established that in the blood serum and blood lymphocytes of men with erectile dysfunction due to combat trauma, processes of lipid peroxidation were intensified and the GSH level was reduced. The GSH/GSSG ratio was reduced only in blood serum. It was found that the oxidative stress is associated with development of nitrative stress. The arginase/NOS ratio was shifted towards increased NOS activity. Activation of iNOS was accompanied by significant inhibition of cNOS. Further study of biochemical mechanisms is important to understand the triggers of erectile dysfunction due to combat
trauma.
Keywords: trauma; erectile dysfunction;MDA content; glutathione;NO-synthase; arginase. 

Introduction and aim. Earlier, by applying the water-immersion and restraint stress (WIRS) model, we reproduced primary attributes of stress and found that the severity of the damage to the gastric mucosa correlates with changes in ECG parameters, which indicate myocardial dystrophy. Further, it was found that such a connection is caused by the damaging effect on both targets of increasing the level of parathyroid hormone, as well as the production of aldosterone and catecholamines by enlarged adrenal glands. In addition, an increase in the level of corticosterone and sympathetic tone with a simultaneous decrease in vagal tone as well as serum calcitonin and testosterone cause damage to the gastric mucosa, but not to the myocardium. Such a constellation of neuro-endocrine reactions to stressors determines the severity of damage to the gastric mucosa and myocardium by 73%. The purpose of this study is to find out metabolic and immune accompaniments of electrocardiogram and gastric mucosa parameters in naїve and stressed rats. Material and methods. The experiment is at 18 male and 20 female Wistar rats. Over the 10 days, one animal remained intact and 3 other rats were exposed to WIRS. The next day after stressing, immune and metabolic parameters as well as ECG and gastric mucosa injuries was recorded. Results. Serum levels of Phosphates, Сatalase and α-LP Cholesterol as well as erythrocyte level of Potassium and Na,K-ATPase activity of the erythrocyte are positively correlated with ECG markers of myocardial damage, and negatively correlated with visual markers of damage to the gastric mucosa. Erythrocyte level of Sodium and serum levels of Potassium and Alkaline Phosphatase reflect the intactness of the gastric mucosa only. While serum level of Calcium reflects damage to the gastric mucosa. Taken together, the listed metabolic factors determine the morpho-functional state of the gastric mucosa and myocardium by 72% (R=0.851). Damage to the gastric mucosa and myocardium is more severe, the lower the bactericidal activity of blood neutrophils, and the greater the mass of the thymus. The spleen mass and the content of fibroblasts in the thymus are negatively correlated only with the severity of damage to the gastric mucosa, while the percentages of reticulocytes and lymphoblasts in the spleen are positively correlated with it. Finally, the higher the percentage of macrophages in the thymus, the deeper the damage to the myocardium. The canonical correlation between the listed immune parameters and markers of the two targets of stressors is very strong (R=0.809). Conclusion. Water-immersion and restraint stress causes changes in the neuro-endocrine-immune complex, which lead to changes in the metabolome and damage to the gastric mucosa and myocardium.