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.

УДК: 612.015.11:616.69-008.1:616-001

Introduction. Most military personnel survive serious injuries, but many are left to live with long-term sexual and reproductive disorders. The injuries often result in psychological trauma and post-traumatic stress disorder, which negatively affect behavioral health and sexual function. There is emerging evidence linking erectile dysfunction (ED) to oxidative stress. Overall, combat trauma is characterized by a broad response of the body to harmful effects involving all body systems, leading to significant changes in the pro-oxidant-antioxidant balance.

Materials and Methods. The study was conducted on peripheral blood lymphocytes and serum of men with ED due to combat trauma (shrapnel and bullet wounds) and healthy men (control group). Both the study and control groups were divided into two age groups (young and middle age groups). Antioxidant activity was studied by measuring glutathione peroxidase (GP), glutathione reductase (GR) and glutathione-S-transferase (GsT).

Results. A comparison of the groups using the Kruskal–Wallis method revealed a significant decrease in the GPx and GR activity in blood lymphocytes and serum in men with ED due to combat trauma compared with healthy men of corresponding age groups. It was shown that GPx activity in peripheral blood lymphocytes of patients of the young age group was 1.64-fold lower, and in patients of the middle age group 1.70-fold lower than in the control group (P <0.001). Similar changes were observed in blood serum. GR activity in blood lymphocytes in patients of the young and middle age groups was 1.42-fold lower than in healthy men (P <0.001). In blood serum, GR activity in patients of the young age group was 1.70-fold (P <0.001) and in patients of the middle age group 1.56-fold lower than in healthy men (P <0.001). GsT activity in blood lymphocytes in both age groups increases by 1.2-fold, however these changes were not significant (P >0.05).

Conclusion. Erectile dysfunction caused by combat trauma is accompanied by a significant decrease in the activities of antioxidant defense enzymes – glutathione peroxidase and glutathione reductase. There is no difference between age groups of patients with erectile dysfunction due to combat trauma. However, the activity of glutathione S-transferase practically does not change, although there is a tendency for its increase.

UDC: 612.015.11:616.69-008.1:616-001

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. 

Erectile dysfunction and the associated quality of life are a pressing social and medical problem for millions of people. The basis of
the work was the results of a survey of 298 men injured as a result of combat operations (shrapnel and bullet wounds) using the questionnaires of the International Index of Erectile Function-5 (IIEF-5) and the SF-36 Health Status Survey (SF-36) questionnaire to characterize the quality of life. The research group was divided into two: men aged 20-39 years (group 1) and men aged 40-53 years (group 2). The control group consisted of 48 clinically healthy men without complaints of sexual dysfunction or cardiac, neurological or endocrinological pathology. It is shown that men aged 20-39 years have a mild form of ED where the total score is 19.57 ± 0.44. Men of the 2nd group aged 40-53 years also have a mild form of ED, but the total score is much lower and is 17.74 ± 0.41. Patients of both age groups affected by hostilities suffer from both mental and physical health components. Indicators such as general health, role functioning due to physical condition, and pain intensity have probably lower values compared to the contol group. Lower indicators of role functioning due to physical condition indicate limitations in everyday life due to unsatisfactory physical condition. The decrease in the physical functioning index has statistically significant differences only in patients of the 2nd observed group. Thus, a mild form of erectile dysfunction is observed in men injured as a result of hostilities. No significant differences in the severity of erectile dysfunction were found betweenmale war victims of two age groups. All IIEF-5 domains were significantly reduced in men affected by combat operations. It has been proven that the physical and mental components of health suffer in victims of hostilities. Against the background of a decrease in all indicators on the scales of the physical component of health, general health and role functioning caused by physical condition lag behind the most. In the psychological domain, the most pronounced changes are recorded in such components as mental health, vital activity and social functioning. Сorrelation analysis revealed the significant correlation between physical functioning and role functioning caused by emotional state (r =+0.64; P < 0.05).
Keywords: men with shrapnel and bullet wounds; erectile dysfunction; quality of life;SF-3