Changes in the penile microcirculation in the treatment of mixed erectile dysfunction on the background of arterial hypentension in locomotive team workers

BACKGROUND: Railway workers constantly experience stress in the workplace, associated with the need to maintain high attention and be ready for emergency action, which provokes a persistent increase in blood pressure. A significant number of such patients have erectile dysfunction. Most patients require complex therapy for stress-induced arterial hypertension and erectile dysfunction.

AIM: To evaluate the dynamics of penile microcirculation indicators in the treatment of erectile dysfunction against the background of arterial hypotension in locomotive team workers.

MATERIALS AND METHODS: A comprehensive examination and treatment of 65 young and middle-aged men from 30 to 55 years old (mean age 48.1 ± 0.7 years), working as machinists or assistant machinists, was carried out. All observed patients complained of erectile dysfunction of varying severity and were registered with a general practitioner and (or) a cardiologist for controlled hypertension stage I–II. The patients were divided into three groups. Patients of the 1^st group (n = 20) were prescribed basic treatment with antihypertensive drugs, as well as the drug Afalasa sublingually, 2 tablets 2 times a day. Patients of the 2^nd group (n = 25) also received basic antihypertensive therapy, Afalasa (2 tablets 2 times a day sublingually) and the 5-PDE inhibitor tadalafil 5 mg once a day. Group 3 included 20 patients receiving basic antihypertensive therapy. The course of treatment for patients in each group was 4 months. The control 4^th group consisted of 20 healthy men. In all patients before and after treatment and representatives of the control group, the state of microcirculation of the penis was assessed by laser Doppler flowmetry.

RESULTS: According to the Doppler flowmetry technique, microcirculatory disorders of varying severity were detected in the penis before treatment. The most pronounced positive dynamic at 4 months after the start of treatment was noted in patients of the 2^nd group who received complex treatment, which included antihypertensive therapy, a 5-PDE inhibitor, and Afalasa. In patients, the index of microcirculation significantly increased, the index of hypoxia and tissue ischemia decreased, an increase in the inert mechanism of blood flow regulation was noted, which was expressed in an increase in the index of microcirculation efficiency from 0.79 ± 0.08 to 2.01 ± 0.29 c.u. (p < 0.05) and an increase in the bypass rate from 0.69 ± 0.13 to 1.06 ± 0.33 c.u. (p < 0.05). The improvement in microcirculation was accompanied by an improvement in erectile function, most pronounced in patients of the 2^nd group.

CONCLUSIONS: Locomotive team workers with arterial hypertension have a mixed form of erectile dysfunction caused by a psychogenic factor and disruption of the vascular endothelium. The monitoring revealed significant violations of the penile microcirculation. The most pronounced improvement in penile hemodynamics and erectile function was noted with complex treatment, including basic antihypertensive therapy, a NO synthase activator, and a 5-PDE inhibitor.