(611) Comparative Analysis of the Complex/Combined Treatment for 60 Men With Erectile Dysfunction Due to Metabolic Syndrome and Venogenic Dysfunction: An Evidence - Based Study

Introduction Erectile dysfunction (ED) is a prevalent male sexual disorder characterized by the persistent inability to achieve or maintain an erection sufficient for penetration. Among its multifactorial causes, metabolic syndrome (MetS) – including obesity, insulin resistance, dyslipidemia has emerged as a significant contributor to endothelial dysfunction and impaired penile vascular regulation. The venogenic form of erectile dysfunction (VFED), caused by venous leakage, represents a distinct mechanism that may be worsened by MetS-related vascular and structural changes, affecting diagnosis and treatment strategies. Objective Aim of our study is to make difference between results of treatment with ED caused by MetS and VFED. Methods Our evidence-based study included two groups of patients diagnosed with ED. Group 1 consisted of 30 patients with ED caused by MetS, and Group 2 included 30 patients with VFED. All participants underwent laboratory testing for Total Testosterone (TT), glycolysed hemoglobin HbA1c, HOMA index, Prolactin (Prl), lipid profile (LP). MetS was diagnosed according to the IDF (International Diabetes Federation), VFED diagnose was made just clinically. Erectile function was assessed using the International Index of Erectile Dysfunction (IIEF-5) questionnaire before and after treatment. All patients received first-line therapy for ED. Patients with MetS underwent treatment according to the following regimen: I stage - common aphrodisiases, vitamin B6 therapy, L-Arginin (high doses 3-5 grams and after 2-3 weeks II stage - PDE-5 inhibitors (it’s preferable to use Vardenafil) in decreasing doses 20-10-5 mg. VFED group treatment was: I stage – venotonics, vitamin B6 therapy and II stage - PDE-5 inhibitors (it’s preferable to use Sildenafil) in decreasing doses 100-50-25 mg. Statistical analysis was considered on both groups, evaluationg IIEF-5 scores. The main goal was to assess treatment effectiveness. By Wilcoxon signed-rank test P<0.001. McNemar’s test confirms significant categorical improvement from ED to No-ED status. The treatment effect was long-lasting more than 6 months. Baseline TT concentrations were significantly lower in group 1 (mean 2.97 ng/mL) compared with the group 2 (mean 3.73 ng/mL). Following treatment, TT increased in both groups. In the group 1, mean levels rise from 2.97 ng/mL to 3.51 ng/mL (P = 0.022), while in the group 2, levels increased from 3.73 ng/mL to 4.55 ng/mL (P = 0.001). Results In group 1 positive result of treatment was in 26 patients which is 87%, in group 2 positive result was in 29 patients – 97%. Paired-sample correlation analysis showed a strong positive association between pre- and post-treatment testosterone values (P < 0.001). The relative increase was greater in the group 2, suggesting a more pronounced therapeutic response compared with subjects with metabolic syndrome. Conclusions High success rate of treatment of both forms of ED that we achieved, and described in this study indicates that the first line therapy can be considered as a "Gold Standard" for patients withVFED, and for patients with ED caused by MetS.Despite the contradictory literature data our study highlights that even in case of such seriouse form of biogenic ED like VFED the therapeutic response may be more pronounced then in case of ED caused by MetS. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Medical office of Prof.