Vorobets' D. Pathogenetic mechanisms of sexual dysfunction in men and its possible complex correction.

The thesis is dedicated to the efficiency improvement of male sexual dysfunction diagnostics and treatment on the basis of complex study of different forms of erectile dysfunction and their combinations (clinically and in the context of biochemical studies of endothelial dysfunction) as well as ejaculatory disorders, especially after urologic operations in the pelvis, with development of therapeutic algorithms. 712 men with sexual dysfunction were examined: 297 patients with different forms of erectile dysfunction, 236 patients with premature ejaculation, 179 patients with orgasm-associated pain, and 48 healthy volunteers. New data were obtained concerning the pathogenetic mechanisms of sexual dysfunction in men: the complex disturbance of libido, erectile and ejaculatory function, health-related quality of life, accompanied by the metabolic changes - dyslipidemia, late onset hypogonadism, dysfunction of NO-synthase, arginase, ATP-hydrolase systems, responsible for the adequate endothelial function. Relationship between disturbances of libido, erectile and ejaculatory disorders was established; it was proved that the primary complaint about erectile dysfunction adversely affected other aspects of sexual health. Hence the sexual disorder is more accurately described by the term "sexual dysfunction". Different treatments for sexual dysfunction in men were compared, highlighting the most effective therapeutic strategies aimed at restoring the endothelial function and nerve conduction. The algorithm for diagnosis and treatment of men with sexual dysfunction was developed, based on the integrated diagnosis and appropriate correction of erectile and ejaculatory disorder, taking into account the etiopathogenetic factors.