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It is well known that among the reasons of erectile dysfunction (ED) vascular disturbances — arterial, venous or their combination [1,2] prevail. The basic methods of venous ED treatment are: therapy by inhibitors phosphodiesterase type 5 (PDE-5), vacuum-constrictors with compressing rings on the basis of a penis, surgical treatment [3,4].
Researches of last years have shown that quality of erectile function rather depends on a level of androgens.
The purpose of the study was the evaluation of the androgenotherapy efficiency with using long acting Testosterone “Nebido” in the patients with ED and androgenodeficit.
After physical examination all patients underwent ultrasound of a prostate gland and Pharmacodynamic Duplex Sonography (PDS) by a conventional technique. For topical diagnosis of the suspected venous leakage we performed Pharmaco-Cavernosography (PCG) at 9 patients and at 8 patients — Magnetic resonance imaging (МRI) with intracavernous contrast enhancement [10]. Laboratory tests included: total Testosterone, FSG, LG, Prolactinum, blood sample, Glucose, PSA level (at men after 45 years).
After signing the informed consent to all men the long action Testosterone «Nebido» (Ваer-Schering Pharma) was administrated. After 3 injections (on 20-21 week) we checked a level of total Testosterone and tested the the prostates by digital rectal examination and ultrasound. Initial inspection has shown, that all 29 patients with ED had clinical picture of androgenodeficit, but biochemical data had 21 patients. We noted a positive influence of hormonal therapy on the common status at all men of 1 and 2 groups: increasing of physical activity, improvement of mood and a vitality.
All patients paid attention to the fact, that before the finishing of Testosteron’s action (usually on 6, 10, 28-29 week), the previously achieved therapeutic effect diminished – penile rigidity decreased during sex activity and a detumescence became more quickly. 9 patients with venous leakage carried out PCG (5) or MRI (4) as control methods for checking out the grade of the leakage.
No one of patients informed about cases of inflammation or a pain in the injections places or about any other complications. It is known, that sufficient inflow in to cavernous arteries and satisfactory veno-occlusive function are two equilibrium components which are necessary for maintenance of high intracavernous pressure during an erection [9]. Veno-occlusive dysfunction (VOD) is the most frequent reason of ED at the patients who are not responded to conservative therapy [11]. Long time it was considered that testosterone acts on libido and only secondary to erectile function. It was established that deficiency of testosterone induces as functional, as structure changes of cavernous tissue.
From our point of view, as this factor, as presence and a severity of PVD at patients with veno-occlusive ED will cause response or its absence to the androgenotherapy. In this connection, the most reliable and pathogenic method of ED treatment at hypogonadal men is androgen substitute therapy by testosterone where long action Testosterone will be preferable because it provides its stable concentration in a blood for a long time and due to absence of its nonphysiological peaks [9].
At patients with ED, clinical symptoms of SLOH and a low level of testosterone was received the good clinical effect to Nebido as monotherapy, as combined with inhibitors PDE-5 during a short course (3-4 мес). The further researches in this direction should take out that restraint for assignment of Testosterone which is available now. Despite of successful introduction in a clinical practice new therapeutic agents for ED treatment or an opportunity of radical treatment by means implantations of penile prostheses, it becomes more necessary etiopatogenic approach for correction of that disease.
New data about the role of testosterone on erection phenomenon should promote development of the new concept of pathogenetic correction of veno-occlusive ED.
The further researches are necessary to find out clear indications for hormonal therapy at hupogonadal patients with veno-occlusive ED. Under normal physiological conditions, neurotransmitters in the brain initiate an erection by sending messages to the vascular (blood) system to increase blood flow to the penis. Patients suffering from erectile dysfunction often experience negative psychological side effects. These tests may involve checking hormone levels, cholesterol, blood sugar, liver and kidney function and thyroid function.
This procedure is used to analyze protein, sugar and hormone levels that can indicate diabetes, kidney problems and testosterone deficiency. This procedure is used to measure changes in penile rigidity and circumference during nighttime erection, as men typically have erections five to six times a night.

Surgical treatment for erectile dysfunction may include penile implants or vascular reconstructive surgery. Penile implantation is a surgical procedure where malleable or inflatable rods are inserted into the penis.
Semi-rigid prostheses involve the surgical implantation of a silicon-covered flexible metal rod that provides rigidity for intercourse.
Inflatable penile prostheses involve the surgical implantation of two soft silicone or plastic tubes into the penis, a small reservoir in the abdomen and a small pump in the scrotum. Self-contained inflatable prostheses consist of a pair of inflatable tubes inserted into the penis with a pump attached to the end of the implant and a reservoir located in the shaft of the penis.
Click here to learn more about penile implants as a treatment option for erectile dysfunction. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. The symptoms of veno-occlusive ED as basic or additional sign of ED, meet not less, than at 30 % of patients. However efficiency of inhibitors PDE-5 is far not high, especially at patients with a low level of plasma testosterone [5, 6]. This research is still continue, however the first positive results have caused an opportunity of their publication. All patients complained for low libido, the unstable erection, the premature ejaculation, fast detumescence. Changes of the basic parameters at hypogonadal patients of 1 group (n=20) with ED and venous leakage before the treatment by Testosterone undecanoat «Nebido». The parameter of sex desire on questionnaire IIEF-5 was enlarged from 4,5±1,2 to 8,3±2,3 points, and the parameter of erectile function enlarged from 9,4±1,8 to 25±0,4 points. The clinical symptoms of SLOH disappeared already after 1 injection of Nebido at 2 patients and after 2 injections — at the others. 10 (34, 4 %) from 29 patients, owing to an insufficient axial rigidity of a penis, combined the therapy by Testosterone with inhibitor PDE-5 – Levitra of 10 mg 2 times a week before coitus, with expanding of therapy in 3 months.
However everyone of the subsequent decreasing points was on subjectively smaller size, than previous.
Decrease of intensity of previously documented venous leakage has been confirmed in all patients ( Fig. Data obtained by means of electronic microscopy have allowed to confirm, that venous leakage is not only consequence of tunica albuginea structure damage, and a result of a degeneration of a smooth muscles of cavernous tissue, or insufficient of neurotransmitters [12].
However it was established recently the close relation between a level of plasma testosterone and a presence of VOD.
Considerable decreasing and even eradication of clinical and biochemical symptoms of SLOH after 1-2 injections of Nebido allows to consider this method of treatment as «start-up therapy» and to recommend it for a clinical practice.
This opinion proves to be true by researches of other authors applied in such cases Testosterone [24]. Not recognized reasons of ED development (in particular — androgenodeficit) can lead to a choice inadequate (psychotherapy) or unfairly aggressive kind of treatment (venous surgery, penile implantation). Elimination of androgenodeficit at hypogonadal patients with veno-occlusive ED can be surveyed as one of directions for treatment strategy.
Chronic erectile dysfunction affects approximately 5 percent of men in their 40s and 15-25 percent of men over the age of 65. The corpora cavernosa (tubes of connective tissue) and erectile tissue in the penis expand as a result of the increased blood flow and pressure. If a patient suffers from erectile dysfunction because of a psychological problem, they often have success through visits with sex therapists.
There are three forms of penile prostheses: semi-rigid prostheses, inflatable prostheses and self-contained prostheses. A patient produces an erection with this prosthesis by squeezing the pump in the scrotum to move sterile liquid from the reservoir in the abdomen into the tubes. View of the contrasted spongious body and of the defect of the cavernous body contrasting due to fibrous plague (arrows).

Thus the certain diagnostic and tactical difficulties are represented by patients with venous ED which have a pathological venous drainage (PVD) from cavernous bodies. Therefore at patients with ED, according to the international references, the investigation for revealing a hypogonadism is necessary because its frequency at screening researches is 18,3 % — 50 % [6, 7]. The second group was made by 9 patients suffered ED, but without symptoms of venous leakage. The level of total testosterone remained within the normal limits of physiological norm, the level of the total PSA remained within the normal limits as well, and volume of a prostate, despite of presence at 3 patients BPH, authentically did not increase. In other words, there was a cumulating during Nebido treatment and this fact proved the curative effect of androgenreplacing therapy. Besides it was proved, that disturbances of a smooth muscles of cavernous tissue are age-related [13], consequence of damage effect of toxins (a nicotine, a lipidemia) or damages of an innervations (a surgical intervention, a trauma, D.Mellitus) [14].
The expansibility of a cavernous tissue is critical parameter as it is obvious, that greater expansibility for maintenance of penile axial rigidity has normal cavernous tissue, rather than a tissue with low expansibility (a fibrous tissue) [17].
Thus the combination of a hormonetherapy with inhibitors PDE-5 considerably will improve results of treatment. Transient erectile dysfunction can affect up to 50 percent of men between the ages of 40 and 70. Following ejaculation, pressure in the penis decreases to reduce blood flow and allow the penis to resume its normal shape. Partners of patients suffering from erectile dysfunction may also feel the emotional strain of the diagnosis.
Medication for erectile dysfunction caused by physiological conditions can include oral enzyme inhibitors such as Viagra, Levitra and Cialis, self-injected medication, urethral suppositories or vacuum erection devices.
Mellitus reduces rate of a blood flow in penile arties and leads to development of venous leakage which successfully can be eliminated with administrating of testosterone [8]. Sexual acts became regular; at patients with the premature ejaculation the sexual act was considerably extended. The clinical normalization of the patient’s condition and restoration of quality of a life have allowed to refuse further injections of Nebido at all patients of this group (Table 2). That fact is rather significant for a necessary compression of subtunical veins, blocking of venous outflow and maintenance of an erection. Mixed type PVD: venous leakage to the deep dorsal vein, glans penis, veins of periprostatic plexus.
It has been established, what even single administration of testosterone can be sufficient for achievement of an adequate erection at 56 % of such patients, and the efficiency of PDF-5 considerably increases at patients with stably normal level of testosterone [5,6]. The diagnosis established on clinical dates, testing on standard questionnaires, dates of laboratory and radial investigation.
Thus substantial improvement of libido, qualities of erectile function at the majority of patients (table 1) has noted been.
It has been found out, that in a week after each injection the patient marked minor improvement of erectile function — the rigidity a little amplified, a detumescence became more slowly.
Mellitus itself and also age changes lead to impossibility to achieve the necessary axial penile rigidity owing to inadequate veno-occlusive mechanism [15]. Thus it was proved what even 50 % decreasing of a circulating testosterone level reduced intracavernous pressure which did not increased after administering of inhibitors PDE-5. Androgens play a key role in restoration and maintenance of structure and function of a smooth muscles of a cavernous tissue [9,21.] Aversa et al.
The expediency of a choice of long action Testosterone for replacement therapy has been caused by drug properties and pharmacodynamic features (stable conservation of testosterone in its physiological levels lasting for 3 months and absence of peak rises) are the basic differences from effect of other Testosterone with the short period of action. Due to dissatisfaction of conservative therapy the patient had the choice in favor of surgical treatment – penile prosthesis implantation. The biopsy of cavernous tissue showed the cavernous fibrosis, that was apparently the reason of unsatisfactory result of treatment.

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