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. While there are no definite causes and risk factors related to prostate enlargement in men, a number of explanations have been stipulated for the occurrence of the condition also known as BPH (Benign Prostatic Hyperplasia). Urologists also believe that BPH results from the presence of greater amounts of estrogen in older males, which usually causes greater prostate gland activity and heightened cell growth. Acute Urinary Retention is a form of prostate enlargement that is often caused by over-the-counter medicines and certain allergy medications.


St Pete Urology is a team of medical professionals who specialize in the diagnosis and treatment of urological diseases and conditions.
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.
For instance, it is known that BPH occurs in older men, especially above age 60, but never in those men who have undergone testes removal before they reach puberty.
Further, urologists believe that various types of prostate enlargement result from the loss of ability of aging males to produce di-hydrotestosterone (DHT), a hormone which helps to control the growth of the gland. Such drugs contain the decongestant drug sympathomimetic, which prevents the opening of the bladder from relaxing and emptying urine.
Most of the symptoms of the condition are associated with the increased urethra obstruction and the gradual loss of functional efficiency of the bladder. While 8 out of every 10 such problems typically indicate BPH, other more severe disorders such as prostate cancer, bladder stones, kidney damage or incontinence may also be indicated. 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.
Therefore, various types of prostate enlargement are believed to be related to the testes and the aging process. Partial prostate enlargement can result from cold temperatures, alcohol, or longer durations of immobility. The symptoms vary from person to person, but the common ones are usually an interrupted, hesitant and weak stream of urine, increased frequency of urination, and dribbling or leaking. Consult the St Pete Urology experts in St Petersburg for help with BPH and urinary tract disorders. 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. The severity of symptoms and the obstruction is not usually related to the size of the prostate, and some men will experience few symptoms and little obstruction while others will experience greater problems and massive blockage. Mark Stein, MD specializing in Prostate, Kidney Stones, Erectile Dysfunction, Prostate Cancer, Kidney Cancer, Enlarged Prostate, Bladder Problems, Incontinence, and Female Urology Serving Manhattan, the Bronx, and the greater New York City area. 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]. In fact, some men do not realize that they have the condition until they are completely unable to urinate. 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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