Knigavko O. Renovation of sexual and fertilе function men with ejaculatory disorders.

The dissertation presents theoretical substantiation and new solution of issues - enhancement of sexual and reproductive health of men by optimization of diagnostics and treatment of diseases of the male reproductive system, including ejaculatory disorders, using medical, minimally invasive and surgical methods. High efficiency of mosaic selective neurotomy in primary premature ejaculation based on the results of biothesiometry has been determined, substantiated and proved. In this case, the expediency of crossing the nerve branches of the penis at a sensitivity of 4-6 mA and supplementing with electrocoagulation of the edges of the nerve at a sensitivity of 3 mA and less was established. The dependence of the development of secondary premature ejaculation on the presence of chronic congestive prostatitis on the background of bilateral varicocele and prostatic venous hyperemia with an increase in the diameter of paraprostatic veins to 3.5 mm and slowing the blood flow velocity less than 2.0 cm / s. Possibility of 82.8% delay time of ejaculation with normalization of sexual intercourse in patients with chronic prostate vesiculitis and obstruction of semilial vesicles by transurethral catheterization and balloon dilatation of the ejaculatory ducts to restore their patency in cases of diminution of the volume less than twice as results of TR USD. It is established that with premature ejaculation and veno-occlusive erectile dysfunction surgical blocking of pathological venous outflow through the veins of the penis allows to prolong the phase of rigidity of the penis, as well as to improve the subjective assessment of erection quality on a scale IIEF to 7.3 points, that in 2.5 time better than conservative treatment of patients. The effectiveness of correction of retrograde ejaculation with consideration of the reasons for its development by using ultrasound diagnostics, urethrocystoscopy and neurological examinations is determined. Given the morphological changes, the expediency of submucosal introduction of hyaluronic acid gel into the posterior part of the prostatic urethra was proved, patients with RE by functional changes are rational to use of uridine phospholipids and midodrine. In conservative neuroregenerative delayed ejaculation therapy for nonorganic reasons, the anxiolytic buspirone has been shown to be more effective than the serotonin reuptake inhibitor sertraline, increasing efficacy by up to 68.2% and reducing IVL by 2.6 time. The dependence of the development of sexual and ejaculatory dysfunction on the severity of anxiety-depressive and pchyhoneurological disorders has been determined. It is established that psychotherapeutic correction, nootropic agents, small doses of antidepressants and PDE-5 inhibitors, contribute to reducing the level of psychoneurotic manifestations on the HDRS scale by 83.6%, while significantly improving the sexual function of patients with borderline personality disorders, increasing by 8.9 points of IIEF. The etiological component of magnesium deficiency (less than 0.75 mmol / l in blood and 95 mg / l in semen) has been determined as a factor in the development of premature ejaculation. an average of 45.3% and contributes to the recovery of sexual function.