EFFECT OF SATVAVAJAYCHIKITSA (COUNSELLING AND ASSURANCE) AND SHIRODHARA IN THE MANAGEMENT OF PSYCHOGENIC ERECTILE DYSFUNCTION: A CASE STUDY

Any stimulus (intrinsic or extrinsic) that triggers a biological response is known as stress. Stress can exert various negative effects on the body ranging from alterations in homeostasis to life-threatening effects and death. Erectile dysfunction can be a manifestation of chronic stress. ED is the most common male sexual dysfunction that affects 10-25% of middle-aged and elderly men. ED may result from many etiologic factors like psychogenic, endocrino- logic, neurogenic, arteriogenic or venoocclusive dysfunction. These factors are not mutually exclusive and multi- ple factors contribute to ED in many patients. According to modern science Psychogenic factors frequently coex- ist with other etiologic factors and should be considered in all cases. A patient aged 35 years came to the OPD of A&U Tibbia college with complaints of inability to initiate and maintain erection along with abnormal vision, dizziness, retrosternal burning, indigestion, heaviness in chest and disinterest. He was advised for Shirodhara along with counselling (Satvvajaychikitsa) and after a couple of days, there was a significant improvement in pa- tient. In this case study, we are trying to highlight the contribution of stress & psyche on male sexual dysfunction and its management through Satvavajaychikitsa (counselling) and Shirodhara. Keywords: Erectile dysfunction, Satvavajaychikitsa, Shirodhara.

Evaluation of the efficacy and patient satisfaction of the intracavernosal alprostadil in the treatment of erectile dysfunction following robot-assisted radical prostatectomy

Objective: Erectile dysfunction (ED) following robot-assisted radical prostatectomy (RARP) is an important problem. The purpose of this study was to evaluate the effectiveness of and patient satisfaction with intracavernosal alprostadil used in the treatment of ED. Material and Methods: Patients using intracavernosal alprostadil in the treatment of ED following RARP were assessed retrospectively. Patients’ demographic characteristics, pre- and postoperative International Index of Erectile Function (IIEF) scores, and general satisfaction evaluated using questions 13 and 14 of the IIEF form were all recorded. Complications developing during treatment, dosages used, and reasons for discontinuation were investigated. Results: Thirty-four patients with a mean age of 61.73±5.80 years were included in the study. Preoperative ED was determined in 52.9% (n=18) of patients. The mean IEFF of the patients who used preoperative, postoperative 1st month, postoperative 3 months after tadalafil use and intracavernosal alprostadil was 20.64 ± 3.46, 15.08 ± 2.09, 15.32 ± 2.18, 26.67 ± 2.30, respectively. The mean length of use of intracavernosal alprostadil was 8.20±2.48 months, and full erection was achieved in 70.58% of patients. Hematoma associated with intracavernosal alprostadil use developed in 2.9% of patients, ecchymosis in 8.8%, and pain in 8.8%. In addition, 73.5% of patients continued to take their medication during the follow-up process. Patients’ general satisfaction following alprostadil therapy was statistically significantly high. Conclusion: Intracavernosal alprostadil therapy following RARP represents a good therapeutic option due to its high success in achieving full erection, low complication rates, and high patient satisfaction. Keywords: erectile dysfunction, Alprostadil, robot-assisted radical prostatectomy

Prevalence of Erectile Dysfunction among men of the Uzbek Population who were on the Inpatient Examination and Treatment

In order to study the prevalence of erectile dysfunction (ED) in men of the Uzbek population, an anonymous survey of men who were on a stationary examination and gave consent was conducted. 648 questionnaires were analyzed. It was found that ED symptoms were present in 587 (90.6%) men. Age-related symptoms (according to the AMS questionnaire) were detected in 259 (44.1%) patients, and most of them were aged 45-60 years. It is necessary to actively detect ED in men, since it can be one of the early manifestations of serious diseases. Erectile dysfunction (ED) - a continuing inability to achieve and/or maintain an erection sufficient for satisfactory sexual activity. ED is a symptom complex that is part of the clinical picture of a number of somatic diseases, which in its severity directly depends on them. Numerous risk factors are known that create favorable conditions for the development of ED: systemic diseases (atherosclerosis, cardiovascular diseases, renal and liver failure), nervous diseases (neurosis, multiple sclerosis, Alzheimer's disease), mental illness (depression, astheno-depressive and hypochondria) endocrine diseases (diabetes mellitus, hypo- and hyperthyroidism, androgen deficiency, hyperprolactinemia). The risk of developing ED increases with age due to the process of increased comorbidity. ED is a common disorder affecting men of all ages; it often does not lend itself to proper diagnosis and treatment. There are numerous well-reasoned evidences that ED is functionally reversible damage to the arteries - endothelial dysfunction (EnD). Currently, EnD is considered as a functional stage in the development of atherosclerosis [1-3]. EnD is a generalized process that occurs due to: oxidative stress, impaired metabolism of nitric oxide, processes of redox phosphorylation of blood vessels, in particular endothelium. A manifestation of EnD can be disturbances in the mechanisms of normal blood flow in the pelvis, which can manifest as erectile dysfunction, lower urinary tract syndrome (LUTS), interstitial cystitis, and overactive bladder (OAB) [4]. EnD as a manifestation of endothelial dysfunction can be a predictor of cardivascular diseases, which means that it can be used as a screening assessment of the cardiovascular system in men after 35-40 years. The social and psychological discomfort of the modern world, the prevalence and increased mortality from cardiovascular disease (CVD), the increase in ED have become one of the main health problems of men of the XXI century. Keywords: Erectile dysfunction; Andrology; Male health

THE EFFECT OF TESTOSTERONE DEPRIVATION ON ATHEROPLAQUE FORMATION, TESTOSTERONE RECEPTORS, AND COLLAGENIZATION IN WISTAR PENILE TISSUE

Objective: To evaluate the association between testosterone deprivation and atheroplaque formation, testosterone receptors, and collagenization in Wistar penile tissues. Material & method: Two months after orchiectomized bilaterally, penile tissue of eight Wistar were harvested for semi-quantitative analysis of atheroplaque formation using hematoxyllin-eosin staining. Similar analysis were also conducted to look for collagenization by collagenase staining as well as the expression of testosterone receptors by immunohistochemistry staining. Control group were eight Wistar underwent Sham surgery. Statistical analysis for atheroplaque formation in Wistar compare to control group used was Chi-square, Fishers’ exact test was used for the expression of testosterone receptors, and independent t-tests for evaluating collagenization. Results: A significant decline in the testosterone receptors and increase collagenization were obtained in orchiectomized Wistar, while atheroplaque formation was not significantly different. Conclusion: Testosterone deprivation revealed a significant decline in the expression of testosterone receptors, and a significant increase in collagenization while atheroplaque formation was not significantly changed. Keywords: Erectile dysfunction, testosterone receptors, collagenization, atheroplaque formation, orchiectomy.

ENDOTHELIN-1, NITRIC OXIDE, AND RATIO OF ET1/NO IN ERECTILE DYSFUNCTION

Objective: The aim of this study was to observe the level of Endothelin-1 (ET-1), Nitric oxide (NO), and the ratio of ET-1/NO in Erectile dysfunction (ED) and normal subjects. Material & method: This case-control study was carried out in Makassar with subjects recruited from outpatient clinic at Wahidin Sudirohusodo Hospital and divided into 2 groups (56 subjects DE and 34 subjects normal). ET-1 and NO plasma were measured by ELISA technique according to protocol. Results: The data showed that mean value of ET-1 in erectile dysfunction subjects was significantly higher (p < 0,05), while NO was significantly lower (p < 0,05) in DE groups compared to normal groups. The ratio of ET-1/NO was also significantly different between both groups. Conclusion: We concluded that level of plasma ET-1, plasma NO, and the ET-1/NO ratio are important factors involved in ED pathomechanism. Keywords: Erectile dysfunction, plasma endothelin-1, plasma nitric oxide, ratio ET-1/NO.