Comparative Evaluation of Conservative and Operative Techniques of Veno-Occlusive Erectile Dysfunction Treatment

Erectile dysfunction (ED) is a multifactorial disease which has not only medical but also social significance. Epidemiological studies confirmed that from 5 to 20% of men have either moderate or severe degrees of this pathology. Veno-occlusive dysfunction is a clinical syndrome caused by the imbalance between the arterial inflow and venous outflow from the cavernous bodies, which develops as a result of pathological bypass through the proximal veins or cavernous-spongy shunts, intracavernous block disorders, active drainage restriction disorders or combinations of these mechanisms. The urgency of the problem of veno-occlusive ED is due to the prevalence of venous ED. According to different authors, it ranges from 17.6% to 75.3%. The aim of the study was a comparative assessment of the conservative and surgical approaches to treatment of the veno-occlusive form of ED. Materials and methods. We performed examination and treatment of 64 patients with veno-occlusive form of ED in "Regional Clinical Center of Urology and Nephrology named after V. I. Shapoval" during 2014-2017. Patients were divided into 3 groups: The 1st group consisted of 45 patients with venous form of ED who underwent conservative therapy; The 2nd group comprised 47 patients with venous form of ED who underwent operative treatment; The 3rd group (control) involved 30 healthy men to determine reference values. Results and its discussion. In all the cases we first diagnosed ED and one- or two-sided varicocele, which subsequently, when comparing the entire clinical picture, led to the establishment of the veno-occlusive form of ED. Observed patients revealed changes in venous hemodynamics while forming pharmaco-erection with fixation of the venous discharge. Comparing conservative and operative techniques of treatment of patients with veno-occlusive ED it was revealed that in the early periods of observation in the first group of conservative treatment the efficiency was 51.2%. Subsequently, the number of patients with positive results was reduced both at the expense of patients with good, and satisfactory results. By the 6th month of observation, the frequency of good results decreased from 51.2 to 22.2%, and the absence of effect on the contrary increased from 15.5 to 46.7%. After 12 months, positive results of treatment were preserved only in 13.8% of men, and the number of patients with satisfactory results decreased to 20.0%. Higher efficacy in both the early and the postoperative periods was demonstrated by a modified Marmara surgery with dressing of pathological shunts. Positive results in this group remained stable throughout the follow-up, despite the fact that the frequency of good results decreased to 6 months of observation from 82.9% to 80.8%. Conclusions. Thus, in the observation period there was established a significant difference in the results of treatment of patients with veno-occlusive ED in the study groups. In the long term, 80.8% of the patients in the surgical treatment group had a positive effect, and only 15.6% from a conservative (p <0.05) therapy group had positive results.