Erectile dysfunction is one of the widespread problems of contemporary society. There is a strong connection between pampinocele and erectile dysfunction which is caused by the lack of venoocclusive apparatus of penis and systemic changes in venous vessels. Erectile dysfunction is characterized by pathological venous discharge and also by significant outflow of venous blood through pathological bypass (through main subdermal or dorsal veins) and it is impossible to get orgasm during erection. Materials and methods: 64 patients with venoocclusive form of erectile dysfunction were examined and treated from 2015 to 2017 and 18 patients were examined for control. Ultrasound diagnostics of penis and Doppler sonography and cavernosonography of scrotum are the main methods of erectile dysfunction and varicocele examination. The approach to the treatment was complex using physiotherapeutic methods also the treatment of concomitant diseases, (multidisciplinary approach), psychotherapy and symptomatic therapy. Surgical intervention and varicocelectomy were done to patients with venoocclusive form of erectile dysfunction and comparative characteristics of parameters of erectile function were also done. Efficacy of treatment was determined by the Doppler sonography results and further examination of penis and also based on subjective estimation of scale IIEF-5. Results: In patients with venous form of erectile dysfunction such changes of venous hemodynamics were detected. The presence of bidirectional flow which changes from respiration and pressure of abdominal wall was detected during Doppler sonography of vessels of bunchy plexus of testicles in 44 patients with varicocele was identified. Generally Doppler sonography has such characteristics such as increase of blood outflow through the veins of penis in tumescence and full erection and also permanent blood outflow during stabile erection. Based on surgeries it was determined that subjective evaluation of erectile function in 2 weeks increased on 7,6 grades, and it was in 2,5 times more effective than conservative treatment (scale indices increased on 3,1 grades). Data of Doppler sonography detected that in 78% of postoperative examinations pathological outflow was not manifested. Subjective improvement was manifested in 30% patients, and ultrasound investigations demonstrate 20% of improvement during the first month of treatment in patients who received conservative therapy. Conclusions: Doppler sonography is the main method of penis and serotum organs hemodynamics. Varicocele in patients with erectile dysfunction is marker of venooclusive form of erectile dysfunctions. Treatment of penis venous insufficiency contains limit of pathological shunt from cavernous bodies during erection. It can be done due to surgeries and also by Marmar modified operation which manifests high efficacy.
Keywords: erectile dysfunction, venoocclusive mechanism, varicocele, Marmar’s operation, cavernosonography
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