SCREENING FOR ERECTILE DYSFUNCTION IN PATIENTS WITH NERVOUS SYSTEM PA-THOLOGY AS AN INTERDISCIPLINARY PROBLEM

Introduction. Neurogenic erectile dysfunction (ED) accounts for 10-19% of all forms of organic ED. The combination of ED with pathology of the nervous system is a significant psychotraumatic factor that reduces the quality of life of patients. The rapid development of the concept of interdisciplinary interaction in medicine dictates the need to involve in solving this problem not only urologists, andrologists, but also doctors of other specialties, in particular, neurologists and neurosurgeons. Aim of the research. To assess the readiness of neurologists/neurosurgeons to take an active part in screening for ED in patients with nervous system pathology, to determine the relevance of discussing erectile problems with their attending physician in this category of patients. Materials and methods. The main study group consisted of 37 men who sought medical help from a neurol-ogist or neurosurgeon in medical institutions of Irkutsk. The main inclusion criteria were: male gender, age over 20 years, clinically significant established neurological/neurosurgical disease, the presence of an established sexual partner and warm relations with her, informed consent of the patient to participate in the study. Exclusion criteria were: age over 70 years, signs of age-related androgen deficiency according to the questionnaire (AMS), abnormal anatomy of the genitals, history of pelvic surgery, diabetes mellitus or cardiovascular pathology in the decompensated stage. The control group consisted of 30 randomly selected men who underwent medical examination at an outpatient therapeutic appointment and were recognized as practically healthy. The state of erectile function of men in both groups was assessed using an abridged version of the International Index of Erectile Function (IIEF-5). The assessment of patients' awareness of ED, the impact of sexual function on their quality of life, and their willingness to discuss existing sexual problems with their physician was conducted based on a special questionnaire of respondents in the main group. Neurologists and neurosurgeons from Irkutsk and the Irkutsk region (n = 50) from both outpatient and inpatient settings took part in the medical survey. The questionnaire for physicians included 18 questions. Results. According to the IIEF-5 scale, ED was detected in 46% of patients with neurological pathology and in 20% of men from the control group. Among patients of the main group with erectile dysfunction, severe ED was found in 41% of cases. No severe disorder was observed in respondents with ED from the control group. 83% of men had mild and 17% moderate ED. The average score on the IIEF-5 scale in the study group was 18 ± 2.5 points, which is significantly (p < 0.01) lower than the same score in the control group. 81% of patients with nervous system pathology consider sexual activity an important part of their full life. All 100% of survey participants are ready to discuss their sexual dysfunction with their doctor, and 73% of them are interested in improving their sexual function. However, despite the high assessment by doctors of the relevance of sexual life for the patient, only 30% of surveyed doctors “often inquire” about the state of erection in their patient. Half of neurologists/neurosurgeons agreed with the need for active detection of ED in a patient by a doctor of his specialty. 76% of colleagues admitted that they will not undertake the obligation to detect and correct ED in their patient, and 22% of doctors consider ED therapy in patients with nervous system diseases to be futile. Conclusion. The prevalence of ED and the recognition of the important role of sexual activity in a man's life by both doctors and patients confirms the high relevance of the ED problem among patients with nervous system pathology. The survey showed a high interest of patients with nervous system pathology in discussing their sexual function problems with a doctor and receiving therapy to improve it, while neurologists and neurosurgeons, for the most part, are not ready to apply their knowledge of ED in practice. Involvement of neurologists and neurosurgeons in the primary screening of ED in patients with nervous system diseases will certainly help in the timely diagnosis of this condition, further patient routing and targeted therapy, and this, in turn, will improve the quality of life of patients in this category.