Erectile dysfunction in railway station workers: principles of treatment (prospective randomized study)

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction. Erectile dysfunction is often a consequence of stressful situations, lack of adequate sleep and rest, and sedentary lifestyles. The profession of locomotive engineer implies the presence of these negative factors, which in addition provoke high blood pressure and the development of hypertension.

Materials and methods. A total of 85 patients of the urological and therapeutic departments of the “Clinical Hospital “Russian Railways Medicine” in the city of Barnaul”, working as locomotive drivers or assistant drivers, were examined. 65 men with erectile dysfunction and hypertension of 1–2 stages (all received antihypertensive therapy) were randomly divided into 3 groups: in the group 1, an activator of endogenous nitric oxide synthase (NOS) was added to the treatment of hypertension; in group 2, a combination of an endogenous NOS activator and a phosphodiesterase-5 inhibitor (PDE-5) was used. Patients of group 3 did not receive additional treatment. The efficiency of treatment was assessed using markers of endothelial dysfunction, including plasminogen activator inhibitor type 1 (PAI-1), endothelin-1 (ET-1), homocysteine, high-selective C-reactive protein (hs-CRP). In addition, the International Index of Erectile Function and male copulatory function scores were filled out. Moreover, laser doppler flowmetry (LDF) with determination of blood flow in penile vessels was done. Follow-up examination was carried out after 2 and 4 months. Twenty of the persons were healthy and referred to the control group.

Results. There were no significant changes in markers and LDF values after 2 months in groups 1 and 3. In group 2, ET-1 and hs-CRP returned to the reference limits, which indicated a decrease in ischemia. After 4 months, there was an improvement in hemodynamics and marker values in group 2. The mean blood flow increased in group 1, while hs-CRP returned to the reference limits. In patients of group 2, a higher total IIEF and male copulatory function scores was documented. In group 3, there was no improvement.

Conclusion. The combination of hypotensive drugs, PDE-5 inhibitor and NOS activator showed the best effect, improving blood flow, reparative properties of endothelium with preventing of thrombus formation. Treatment with an NO synthase activator partially eliminates pathological processes in the endothelium.

Full Text

Restricted Access

About the authors

A. Yu. Arhipova

Consultative and diagnostic clinic No. 14

Author for correspondence.
Email: plotnickova.anjelika2015@yandex.ru
ORCID iD: 0000-0001-7191-1379

urologist

Russian Federation, Barnaul

B. A. Neymark

NUZ KB “RJD-Medicine”; FGBOU VO "Altai State Medical University" of the Ministry of Health of Russia

Email: neimark.b@mail.ru
ORCID iD: 0000-0001-8009-3777

Ph.D., MD, Professor, Head of the Department of Urology of NUZ KB “RJD-Medicine”

Russian Federation, Barnaul; Barnaul

A. I. Neymark

FGBOU VO "Altai State Medical University" of the Ministry of Health of Russia

Email: urologagmu@mail.ru
ORCID iD: 0000-0003-4925-0126

Ph.D., MD, professor, Head of the Department of Urology and Andrology with a course of Specialized Surgery

Russian Federation, Barnaul

A. P. Momot

Regional consultative clinic No. 1

Email: xyzan@yandex.ru
ORCID iD: 0000-0002-8413-5484

Ph.D., MD, professor, chief of Altai Branch of National Research Center for Hematology of the Ministry of Health of Russia, Head of the Laboratory of Hemostasis of the Clinical Research Center of the Scientific Cluster, Altai State Medical University of the Ministry of Health of Russia

Russian Federation, Barnaul

A. V. Davydov

FGBOU VO "Altai State Medical University" of the Ministry of Health of Russia

Email: urologagmu@mail.ru

Ph.D., MD, associate professor, professor at the Department of Urology and Andrology with a course of Specialized Surgery 

Russian Federation, Barnaul

References

  1. Furchgott R.F., Zawadszki J.V. The obligatoryrole of endotnelial cells in the relazation of arterial smooth muscle by acetylcholine. Nature. 1980;288:373–376.
  2. Shestakova M.V. Endothelial dysfunction – the cause or consequence of metabolic syndrome? RMJ. 2001;(2):88. Russian (Шестакова М.В. Дисфункция эндотелия – причина или следствие метаболического синдрома? РМЖ. 2001;(2):88).
  3. Chubukov J.A. Willebrand factor and endothelial dysfunction under stress. Health and environmental issues. 2012:40–45. Russian (Чубуков Ж.А. Фактор Виллебранда и дисфункция эндотелия при стрессе. Проблемы здоровья и экологии. 2012:40-45).
  4. Buvaltsev V.I. Endothelial dysfunction as a new concept of prevention and treatment of cardiovascular diseases. International Medical Journal. 2001;(3):202–209. Russian (Бувальцев В.И. Дисфункция эндотелия как новая концепция профилактики и лечения сердечно-сосудистых заболеваний. Международный медицинский журнал. 2001;(3):202–209).
  5. Zadionchenko V.S., Adasheva T.V., Sandomirskaya A.P. Endothelial dysfunction and arterial hypertension: therapeutic possibilities. BC. 2002;(10)1:11–15. Russian (Задионченко В.С., Адашева Т.В., Сандомирская А.П. Дисфункция эндотелия и артериальная гипертония: терапевтические возможности. РМЖ. 2002;(10)1:11–15).
  6. Ostroumova O.D., Kochetkov A.I. Arterial hypertension in the workplace as a variant of stress-induced arterial hypertension. Therapeutic Archive. 2018;(9):123–132. doi: 10.26442/terarkh2018909123-132. Russian (Остроумова О.Д., Кочетков А.И. Артериальная гипертония на рабочем месте как вариант стресс-индуцированной артериальной гипертонии. Терапевтический архив. 2018;(9):123–132. doi: 10.26442/terarkh2018909123-132).
  7. Chazova I.E., Zhernakova Yu.V. Diagnosis and treatment of arterial hypertension. Systemic hypertension. 2019;16(1):6–31. Rusian (Чазова И.Е., Жернакова Ю.В. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019;16(1):6–31).
  8. Chazova E.I. et al. Diseases of the cardiovascular system. Handbook of Cardiology in four volumes. Vol. 3. «Practice», 2014. 864 p. Russian (Чазова Е.И. и др. Заболевания сердечно-сосудистой системы. Руководство по кардиологии в четырёх томах. Т. 3. «Практика», 2014. 864 с.).
  9. Alekseeva T.A., Litvin A.Yu., Elfimova E.M., Mikhailova O.O., Larina V.N., Shpot E.V., etc. The consensus of experts of the Russian Medical Society on arterial hypertension. Arterial hypertension and erectile dysfunction. Systemic hypertension. 2021;18(2):69–79. Russian (Алексеева Т.А., Литвин А.Ю., Елфимова Е.М., Михайлова О.О., Ларина В.Н., Шпоть Е.В. и др. Консенсус экспертов Российского медицинского общества по артериальной гипертонии. Артериальная гипертония и эректильная дисфункция. Системные гипертензии. 2021;18(2):69–79).
  10. Montorsi F., Briganti A., Salonia A., et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol. 2003;44:360–364.
  11. Vertkin A.L., Vilkovisky F.A., Skotnikov A.S., Zvyagintseva E.I., Skotnikova E.V. Angiotensin II type 1 receptor blockers and erectile function. Arterial hypertension. 2011;17(2):133–140. Russian (Вёрткин А.Л., Вилковыс-кий Ф.А., Скотников А.С., Звягинцева Е.И., Скотникова Е.В. Блокаторы рецепторов 1 типа ангиотензина II и эректильная функция. Артериальная гипертензия. 2011;17(2):133–140).
  12. Fogari R., Zoppi A., Poletti L., et al. Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens. 2001;14:27–31.
  13. Korenkov D.G., Tumanov D.V., Toropov V.A. The effectiveness of Tadalafil-C in the treatment of erectile dysfunction in patients with type 2 diabetes mellitus and prediabetes. Urology reports (St.-Petersburg). 2019;9(3):33–38. Russian (Кореньков Д.Г., Туманов Д.В., Торопов В.А. Эффективность Тадалафила-СЗ в лечении эректильной дисфункции у пациентов с сахарным диабетом 2-го типа и с преддиабетом. Урологические ведомости. 2019;9(3):33–38).
  14. Eardley I., Mirone V., Montorsi F., et al. An open-label, multicentre, randomized, crossover study comparing sildenafil citrate and tadalafil for treating erectile dysfunction in men naïve to phosphodiesterase 5 inhibitor therapy. BJU Int. 2005;96(9):1323–1332.
  15. Pushkar D.Yu., Berdnikov A.N., Zhivov A.V. Efficacy, safety and prospects of long-term use of the drug Cialis (tadalafil) once a day in patients with erectile dysfunction. Literature review. RMJ. 2011;5:317. Russian (Пушкарь Д.Ю., Берников А.Н., Живов А.В. Эффективность, безопасность и перспективы длительного использования препарата Сиалис (тадалафил) в режиме один раз в сутки у пациентов с эректильной дисфункцией. Обзор литературы. РМЖ. 2011;5:317).
  16. Hatzichristou D., Gambla M., Rubio-Aurioles E., et al. Efficacy of tadalafil once daily in men with diabetes mellitus and erectile dysfunction. Diabet Med. 2008;25:138–146.
  17. Statsenko M.E., Turkina S.V., Tishchenko I.A., Kostromeev S.A. The effect of Tadalafil on the endothelial function of patients with erectile dysfunction. Urologiia. 2021;(1):36-42 DOI: https://dx.doi.org/10.18565/urology.2021.1.50-54. Russian (Стаценко М.Е., Туркина С.В., Тыщенко И.А., Костромеев С.А. Влияние Тадалафила на эндотелиальную функцию пациентов с эректильной дисфункцией. Урология. 2021;(1):36-42 DOI: https://dx.doi.org/10.18565/urology.2021.1.50-54).
  18. Arkhipova A.Yu., Neymark B.A., Neymark A.I. and others. Correction of endothelial disorders in patients with erectile dysfunction that developed against the background of stress-induced hypertension. Pharmacology pharmacotherapy. 2023;(1):58–64. Russian (Архипова А.Ю., Неймарк Б.А., Неймарк А.И. и др. Коррекция эндотелиальных нарушений у пациентов с эректильной дисфункцией, развившейся на фоне стресс-индуцированной артериальной гипертензии. Фармакология фармакотерапия. 2023;(1):58–64).
  19. Vlachopoulos C., Ioakeimidis N., Stefanadis C. Biomarkers, erectile dysfunction, and cardiovascular risk prediction: the latest of an evolving concept. Asian J Androl. 2015;17:17–20.
  20. Mareev O.V., Svistunov A.A., Fedosov I.V. Laser Doppler flowmetry and the possibilities of its application in otorhinolaryngology: Saratov Medical University Press. 2012. 84 p. Russian (Мареев О.В., Свистунов А.А., Федосов И.В. Лазерная допплеровская флоуметрия и возможности ее применения в оториноларингологии: Издательство Саратовского медицинского университета. 2012. 84 с.).

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2024 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies