A Comprehensive Approach in the Treatment of Erectile Dysfunction in Obesity Patients

Abstract

As early as in the middle of the twentieth century, obesity became one of the most important medical and social problems in the world, especially among the population of developed countries due to its high prevalence and the enormous cost of overcoming its consequences. One of the complications of obesity is sexual dysfunction in men. The objective: to evaluate the effectiveness of udenafil in the form of 200 mg tablets in the treatment of erectile dysfunction in obese patients. Materials and methods. The clinical efficacy of udenafil PDE-5 inhibitor in 125 patients with ED and obesity was studied. The mean age of the patients was 47.4±6.7 years. When dividing patients into groups in order to objectively assess the results of different types of therapy, the groups were homogeneous in age, severity of obesity and ED, and then randomized patients into groups. Group I included 37 patients with ED and obesity who received therapy to normalize erectile function (healthy lifestyle, modification of individual risk factors, local negative pressure therapy, phosphodiesterase type 5 inhibitor udenafil) and obesity treatment aimed at weight loss; diet therapy, physical therapy, pharmacotherapy according to the indications, adequate level of physical activity). Group II – 56 patients with ED and obesity who received similar therapy to normalize erections. Group III 32 patients with ED and obesity treated with obesity without the use of phosphodiesterase type 5 inhibitors. The follow-up was 12 weeks. Criteria for assessing the clinical effectiveness of treatment: the dynamics of the International Erectile Function Index (ICEF). The diagnosis of ED was established by the total of points in the answers to questions 1–5, 15; which is 26 or less. The severity was assessed as severe – 1–10 points, moderate – 11–16 points, mild – 17–25 points; assessment of changes in cavernous hemodynamics according to Doppler data of cavernous vessels; assessment of body mass index and waist circumference; dynamics of lipid parameters (total cholesterol, triglycerides and atherogenic factor); dynamics of hormonal background indicators (testosterone, estradiol, LH, FSH, prolactin); Characteristics of the rate of onset of the effect of maximum erection and duration of action of udenafil. Statistical data processing was performed using the application package Statistica for Windows v. 6.0. Results. After 3 months, the following results were obtained. In group I, the average total ICEF score (questions 1–5, 15) increased from 17.3±3.8 to 26.7±5.3 points, ie 1.54 times (p<0.05). In group II – increased 1.33 times – from 16.4±3.2 to 21.8±4.6 points (p<0.05). In the third group – increased from 15.8±2.7 to 17.9±3.8 points, ie 1.13 times (p>0.05). BMI decreased in group I from 38.7±4.7 kg/m2 to 35.3±3.8 kg/m2 (p>0.05); in the second group of patients – from 36.4±4.3 kg/m2 to 35.0±3.9 kg/m2 (p>0.05); in group III BMI also did not undergo significant changes. (decrease from 36.4±4.3 kg/m2 to 32.4±3.4 kg/m2) (p>0.05) As a result of treatment, the indicators of total cholesterol, triglycerides, atherogenic coefficient and HDL levels improved, especially in patients of groups I and III, but they did not acquire signs of reliability. The increase in testosterone levels also did not achieve a statistically significant difference. In the study of cavernous blood flow, peak systolic velocity increased from 24.3±2.2 cm/s to 32.3±2.6 cm/s in the penis during erection (1.5-fold increase) in patients of the first group. p<0.05). In patients of the second and third groups, respectively, from 21.7±2.5 cm/s to 28.8±2.8 cm/s (p<0.05) and from 23.2±2.2 cm/s to 24,3±2.1 cm/s (p>0.05). Conclusions. According to the patients from the first and second groups taking udenafil, 74 (79.6%) of 93 patients rated the effectiveness of the drug as «excellent», 12 (12.9%) of 93 patients as «good», 4 (4.3%) as «satisfactory». The final evaluation of the effectiveness of therapy revealed «excellent» and «good» results in 95.7% of patients. Changes of indicators such as BMI, total cholesterol, triglycerides and atherogenic factor, testosterone levels, did not achieve a statistically significant difference because the observation period was too short. Udenafil can be considered a first-line drug in the treatment of erectile dysfunction in obese patients.