Взаимосвязь эректильной дисфункции с параметрами ожирения
Взаимосвязь эректильной дисфункции с параметрами ожирения
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Аннотация
Цель исследования. Изучить взаимосвязь выраженности эректильной дисфункции (ЭД) с параметрами ожирения у больных артериальной гипертензией (АГ).
Материалы и методы. В исследование включен 71 больной с ЭД различной степени выраженности, избыточной массой тела и ожирением 1-й степени и АГ. Анализировались антропометрические параметры, оценивались степень и особенности ожирения по данным мультиспиральной компьютерной томографии (МСКТ), а также проводилась предварительная оценка эректильной функции методом анкетирования с использованием опросника МИЭФ-5. В дальнейшем данные анкетирования сопоставлялись с углубленным урологическим исследованием: сбором анамнеза, осмотром и проведением фармакодопплерографии сосудов полового члена.
Результаты и обсуждение. При сравнительном анализе выявлены статистически значимые связи между антропометрическими данными и степенью абдоминального ожирения по результатам МСКТ (p<0,005), антропометрическими показателями ожирения и параметрами пенильного артериального кровотока, а также выраженностью эректильной дисфункции по степени эрекции и данным допплерографии с оценкой скоростных показателей пенильного кровотока (p<0,05). Помимо этого, выявлена статистически значимая отрицательная взаимосвязь между качеством пенильного кровотока и степенью АГ (p=0,02). В результате применения многофакторной линейной регрессии показано, что при увеличении отношения окружности талии к окружности бедер и более высоком уровне систолического артериального давления ухудшается состояние пенильного артериального кровотока, а именно – отмечается снижение пиковой систолической скорости кровотока, (β=-0,377, р=0,05; β=-0,478, р=0,02 соответственно). При сравнительном анализе субъективной оценки эректильной функции по данным опросника МИЭФ-5 с результатами объективного обследования статистически значимой связи не выявлено (p=0,07). Статистически значимых связей между объективными данными эректильной функции и параметрами ожирения по МСКТ также не обнаружено.
Заключение. Сочетание избыточной массы тела, ожирения с АГ позволяет с высокой вероятностью заподозрить наличие ЭД различной степени выраженности.
Ключевые слова: эректильная дисфункция, ожирение, артериальная гипертензия.
Materials and methods. The study included 71 patients with different severity of erectile dysfunction, overweight and grade 1obesity and arterial hypertension. The anthropometric parameters were analyzed, the degree and characteristics of obesity were assessed according to data of multispiral computed tomography (MSCT), a preliminary assessment of erectile function was performed using the IIEF-5 questionnaire. Later the data of the questionnaire was compared with the in-depth urological study: the collection of anamnesis, examination and conduction of the pharmacodopplerography of the penis vessels.
Results and discussion. Comparative analysis revealed statistically significant links between anthropometric data and the degree of abdominal obesity based on MSCT results (p<0.005), anthropometric indicators of obesity with parameters of penile arterial blood flow, as well as severity of erectile dysfunction by degree of erection and dopplerography with an estimation of the rate of penile blood flow (p<0.05). In addition, a statistically significant negative relationship between the quality of penile blood flow and the degree of arterial hypertension was revealed (p=0.02). As a result of multifactorial linear regression, it is shown that with an increased the ratio of the waist circumference to the hip circumference and a higher level of systolic blood pressure, the condition of penile arterial blood flow worsens, namely, the peak systolic velocity (PSV) decreases (β=-0.377, p=0.05; β=-0.478, p=0.02, respectively). In a comparative analysis of the subjective evaluation of erectile function according to the data of the IIEF-5 questionnaire, we showed no statistically significant association with the results of an objective examination (p=0.07).There were also no statistically significant links between objective data of erectile function and obesity parameters in MSCT.
Conclusion. The combination of overweight or obesity with arterial hypertension gives ground to suspect the presence of different severity of erectile dysfunction.
Keywords: erectile dysfunction, obesity, arterial hypertension.
Материалы и методы. В исследование включен 71 больной с ЭД различной степени выраженности, избыточной массой тела и ожирением 1-й степени и АГ. Анализировались антропометрические параметры, оценивались степень и особенности ожирения по данным мультиспиральной компьютерной томографии (МСКТ), а также проводилась предварительная оценка эректильной функции методом анкетирования с использованием опросника МИЭФ-5. В дальнейшем данные анкетирования сопоставлялись с углубленным урологическим исследованием: сбором анамнеза, осмотром и проведением фармакодопплерографии сосудов полового члена.
Результаты и обсуждение. При сравнительном анализе выявлены статистически значимые связи между антропометрическими данными и степенью абдоминального ожирения по результатам МСКТ (p<0,005), антропометрическими показателями ожирения и параметрами пенильного артериального кровотока, а также выраженностью эректильной дисфункции по степени эрекции и данным допплерографии с оценкой скоростных показателей пенильного кровотока (p<0,05). Помимо этого, выявлена статистически значимая отрицательная взаимосвязь между качеством пенильного кровотока и степенью АГ (p=0,02). В результате применения многофакторной линейной регрессии показано, что при увеличении отношения окружности талии к окружности бедер и более высоком уровне систолического артериального давления ухудшается состояние пенильного артериального кровотока, а именно – отмечается снижение пиковой систолической скорости кровотока, (β=-0,377, р=0,05; β=-0,478, р=0,02 соответственно). При сравнительном анализе субъективной оценки эректильной функции по данным опросника МИЭФ-5 с результатами объективного обследования статистически значимой связи не выявлено (p=0,07). Статистически значимых связей между объективными данными эректильной функции и параметрами ожирения по МСКТ также не обнаружено.
Заключение. Сочетание избыточной массы тела, ожирения с АГ позволяет с высокой вероятностью заподозрить наличие ЭД различной степени выраженности.
Ключевые слова: эректильная дисфункция, ожирение, артериальная гипертензия.
________________________________________________
Materials and methods. The study included 71 patients with different severity of erectile dysfunction, overweight and grade 1obesity and arterial hypertension. The anthropometric parameters were analyzed, the degree and characteristics of obesity were assessed according to data of multispiral computed tomography (MSCT), a preliminary assessment of erectile function was performed using the IIEF-5 questionnaire. Later the data of the questionnaire was compared with the in-depth urological study: the collection of anamnesis, examination and conduction of the pharmacodopplerography of the penis vessels.
Results and discussion. Comparative analysis revealed statistically significant links between anthropometric data and the degree of abdominal obesity based on MSCT results (p<0.005), anthropometric indicators of obesity with parameters of penile arterial blood flow, as well as severity of erectile dysfunction by degree of erection and dopplerography with an estimation of the rate of penile blood flow (p<0.05). In addition, a statistically significant negative relationship between the quality of penile blood flow and the degree of arterial hypertension was revealed (p=0.02). As a result of multifactorial linear regression, it is shown that with an increased the ratio of the waist circumference to the hip circumference and a higher level of systolic blood pressure, the condition of penile arterial blood flow worsens, namely, the peak systolic velocity (PSV) decreases (β=-0.377, p=0.05; β=-0.478, p=0.02, respectively). In a comparative analysis of the subjective evaluation of erectile function according to the data of the IIEF-5 questionnaire, we showed no statistically significant association with the results of an objective examination (p=0.07).There were also no statistically significant links between objective data of erectile function and obesity parameters in MSCT.
Conclusion. The combination of overweight or obesity with arterial hypertension gives ground to suspect the presence of different severity of erectile dysfunction.
Keywords: erectile dysfunction, obesity, arterial hypertension.
Список литературы
1. Humphreys G, Fiankan-Bokonga C. Europe’s visible epidemic. Bull World Health Organ. 2013;91:549-50. doi: 10.2471/BLT.13.020813
2. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urology. 1994;151:54-61.
3. Laumann EO, Paik A, Rosen RC. Sexual Dysfunction in the United States: Prevalence and Predictors. J Am Med Association. 1999;281:537-44. http://dx.doi.org/10.1001/jama.281.6.537
4. Hatzimouratidis K, Giuliano F, Moncada I, et al. EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism. European Association of Urology; 2016.
5. Rosen RC, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822-30.
6. Abdelrahman EM, Gadallaha AA, Abdelaala A, et al. Can the International Index of Erectile Function (IIEF-5) be used as a diagnostic tool to the severity of vasculogenic erectile dysfunction? Middle East Fertil Soc J. 2012;17(2):101-4.
7. Kassouf W, Carrier S. A comparison of the International Index of Erectile Function and erectile dysfunction studies. BJU Int. 2003 May;91(7):667-9.
8. Пушкарь Д.Ю. Эректильная дисфункция – современные методы диагностики и лечения. Справочник поликлинического врача. 2004;6(7):43-8 [Pushkar’ DYu. Erektile disfunction – modern methods o diagnosis and treatment. Spravochnik Poliklinicheskogo Vracha. 2004;6(7):43-8 (In Russ.].
9. World Health Organization. Cardiovascular diseases (CVDs). Fact sheet, 2017. http://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
10. Kirby M, Jackson G, Betteridge J, Friedli K. Is erectile dysfunction a marker for cardiovascular disease? Int J Clin Pract. 2001;55(9):614-8.
11. Pittaras F, Manolis AJ, Zacharopoulou I, et al. Erectile Dysfunction in Hypertension and Cardiovascular Disease: A Guide for Clinicians. J Hypertens. 2011;29:403-7.
12. Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D, et al. The triad: erectile dysfunction-endothelial dysfunction-cardiovascular disease. Curr Pharm Des. 2008;14:3700-14.
13. Okabe H, Hale TM, Kumon H, et al. The penis is not protected-in hypertension there are vascular changes in the penis which are similar to those in other vascular beds. Int J Impot Res. 1999;11:133.
14. Mulvany MJ. Small artery remodeling in hypertension. Curr Hypertens Rep. 2002;4:49.
15. Giugliano F, Esposito K, Di Palo C, et al. Erectile dysfunction associates with endothelial dysfunction and raised proinflammatory cytokine levels in obese men. J Endocrinol Invest. 2004 Jul-Aug;27(7):665-9.
16. Kaiser DR, Billups K, Mason C, et al. Impaired brachial artery endothelium-dependent and independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol. 2004 Jan 21;43(2):179-84.
17. Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13:275-86.
18. Pasquali R, Macor C, Vicennati V, et al. Effects of acute hyperinsulinemia on testosterone serum concentrations in adult obese and normal-weight men. Metabolism. 1997;46(5):526-9.
19. Haring R, Völzke H, Steveling A, et al. Low testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20–79. Eur Heart J. 2010;31:1436-7.
20. Khaw KT, Dowsett M, Folkerd E, et al. Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men. European Prospective Investigation Into Cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation. 2007 Dec 4;116(23):2694-701. doi: 10.1161/CIRCULATIONAHA.107.719005 [Published online Nov 26, 2007].
21. Rosen JC, Cappelleri J.C., Gendrano N. The International Index of Erectile Function (IIEF): a state-of-the-science review. Intern J Impot Res. 2002;14:226-44.
22. Hirshkowitz M, Karacan I, Gurakar A, Williams RL. Hypertension, Erectile Dysfunction, and Occult Sleep Apnea. Sleep. 1989;12(3):223-32.
23. Гамидов С.И., Тажетдинов О.Х., Павловичев А.А. и др. Особенности патогенеза, диагностики и лечения эректильной дисфункции у больных с гипогонадизмом. Проблемы эндокринологии. 2010;(5):33-42 [Gamidov SI, Tazhetdinov OH, Pavlovich AA, et al. Features of pathogenesis, diagnosis and treatment of erectile dysfunction in patients with hypogonadism. Probl. endocrinol. 2010;(5): 33-42 (In Russ.)].
24. Schipilliti M, Caretta N, Palego P, et al. Metabolic syndrome and erectile dysfunction: the ultrasound evaluation of cavernosal atherosclerosis. Diabetes Care. 2011;34(8):1875-7.
25. Roth A, Kalter-Leibovici O, Kerbis Y, et al. Prevalence and risk factors for erectile dysfunction in men with diabetes, hypertension, or both diseases: a community survey among 1412 Israeli men. Clin Cardiol. 2003;26(1):25-30.
26. Montorsi P, Ravagnani PM, Galli S, et al. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2005;96(26):19-23 [Epub 2005 Nov 4].
2. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urology. 1994;151:54-61.
3. Laumann EO, Paik A, Rosen RC. Sexual Dysfunction in the United States: Prevalence and Predictors. J Am Med Association. 1999;281:537-44. http://dx.doi.org/10.1001/jama.281.6.537
4. Hatzimouratidis K, Giuliano F, Moncada I, et al. EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism. European Association of Urology; 2016.
5. Rosen RC, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822-30.
6. Abdelrahman EM, Gadallaha AA, Abdelaala A, et al. Can the International Index of Erectile Function (IIEF-5) be used as a diagnostic tool to the severity of vasculogenic erectile dysfunction? Middle East Fertil Soc J. 2012;17(2):101-4.
7. Kassouf W, Carrier S. A comparison of the International Index of Erectile Function and erectile dysfunction studies. BJU Int. 2003 May;91(7):667-9.
8. [Pushkar’ DYu. Erektile disfunction – modern methods o diagnosis and treatment. Spravochnik Poliklinicheskogo Vracha. 2004;6(7):43-8 (In Russ.].
9. World Health Organization. Cardiovascular diseases (CVDs). Fact sheet, 2017. http://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
10. Kirby M, Jackson G, Betteridge J, Friedli K. Is erectile dysfunction a marker for cardiovascular disease? Int J Clin Pract. 2001;55(9):614-8.
11. Pittaras F, Manolis AJ, Zacharopoulou I, et al. Erectile Dysfunction in Hypertension and Cardiovascular Disease: A Guide for Clinicians. J Hypertens. 2011;29:403-7.
12. Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D, et al. The triad: erectile dysfunction-endothelial dysfunction-cardiovascular disease. Curr Pharm Des. 2008;14:3700-14.
13. Okabe H, Hale TM, Kumon H, et al. The penis is not protected-in hypertension there are vascular changes in the penis which are similar to those in other vascular beds. Int J Impot Res. 1999;11:133.
14. Mulvany MJ. Small artery remodeling in hypertension. Curr Hypertens Rep. 2002;4:49.
15. Giugliano F, Esposito K, Di Palo C, et al. Erectile dysfunction associates with endothelial dysfunction and raised proinflammatory cytokine levels in obese men. J Endocrinol Invest. 2004 Jul-Aug;27(7):665-9.
16. Kaiser DR, Billups K, Mason C, et al. Impaired brachial artery endothelium-dependent and independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol. 2004 Jan 21;43(2):179-84.
17. Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13:275-86.
18. Pasquali R, Macor C, Vicennati V, et al. Effects of acute hyperinsulinemia on testosterone serum concentrations in adult obese and normal-weight men. Metabolism. 1997;46(5):526-9.
19. Haring R, Völzke H, Steveling A, et al. Low testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20–79. Eur Heart J. 2010;31:1436-7.
20. Khaw KT, Dowsett M, Folkerd E, et al. Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men. European Prospective Investigation Into Cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation. 2007 Dec 4;116(23):2694-701. doi: 10.1161/CIRCULATIONAHA.107.719005 [Published online Nov 26, 2007].
21. Rosen JC, Cappelleri J.C., Gendrano N. The International Index of Erectile Function (IIEF): a state-of-the-science review. Intern J Impot Res. 2002;14:226-44.
22. Hirshkowitz M, Karacan I, Gurakar A, Williams RL. Hypertension, Erectile Dysfunction, and Occult Sleep Apnea. Sleep. 1989;12(3):223-32.
23. [Gamidov SI, Tazhetdinov OH, Pavlovich AA, et al. Features of pathogenesis, diagnosis and treatment of erectile dysfunction in patients with hypogonadism. Probl. endocrinol. 2010;(5): 33-42 (In Russ.)].
24. Schipilliti M, Caretta N, Palego P, et al. Metabolic syndrome and erectile dysfunction: the ultrasound evaluation of cavernosal atherosclerosis. Diabetes Care. 2011;34(8):1875-7.
25. Roth A, Kalter-Leibovici O, Kerbis Y, et al. Prevalence and risk factors for erectile dysfunction in men with diabetes, hypertension, or both diseases: a community survey among 1412 Israeli men. Clin Cardiol. 2003;26(1):25-30.
26. Montorsi P, Ravagnani PM, Galli S, et al. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2005;96(26):19-23 [Epub 2005 Nov 4].
2. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urology. 1994;151:54-61.
3. Laumann EO, Paik A, Rosen RC. Sexual Dysfunction in the United States: Prevalence and Predictors. J Am Med Association. 1999;281:537-44. http://dx.doi.org/10.1001/jama.281.6.537
4. Hatzimouratidis K, Giuliano F, Moncada I, et al. EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism. European Association of Urology; 2016.
5. Rosen RC, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822-30.
6. Abdelrahman EM, Gadallaha AA, Abdelaala A, et al. Can the International Index of Erectile Function (IIEF-5) be used as a diagnostic tool to the severity of vasculogenic erectile dysfunction? Middle East Fertil Soc J. 2012;17(2):101-4.
7. Kassouf W, Carrier S. A comparison of the International Index of Erectile Function and erectile dysfunction studies. BJU Int. 2003 May;91(7):667-9.
8. Пушкарь Д.Ю. Эректильная дисфункция – современные методы диагностики и лечения. Справочник поликлинического врача. 2004;6(7):43-8 [Pushkar’ DYu. Erektile disfunction – modern methods o diagnosis and treatment. Spravochnik Poliklinicheskogo Vracha. 2004;6(7):43-8 (In Russ.].
9. World Health Organization. Cardiovascular diseases (CVDs). Fact sheet, 2017. http://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
10. Kirby M, Jackson G, Betteridge J, Friedli K. Is erectile dysfunction a marker for cardiovascular disease? Int J Clin Pract. 2001;55(9):614-8.
11. Pittaras F, Manolis AJ, Zacharopoulou I, et al. Erectile Dysfunction in Hypertension and Cardiovascular Disease: A Guide for Clinicians. J Hypertens. 2011;29:403-7.
12. Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D, et al. The triad: erectile dysfunction-endothelial dysfunction-cardiovascular disease. Curr Pharm Des. 2008;14:3700-14.
13. Okabe H, Hale TM, Kumon H, et al. The penis is not protected-in hypertension there are vascular changes in the penis which are similar to those in other vascular beds. Int J Impot Res. 1999;11:133.
14. Mulvany MJ. Small artery remodeling in hypertension. Curr Hypertens Rep. 2002;4:49.
15. Giugliano F, Esposito K, Di Palo C, et al. Erectile dysfunction associates with endothelial dysfunction and raised proinflammatory cytokine levels in obese men. J Endocrinol Invest. 2004 Jul-Aug;27(7):665-9.
16. Kaiser DR, Billups K, Mason C, et al. Impaired brachial artery endothelium-dependent and independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol. 2004 Jan 21;43(2):179-84.
17. Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13:275-86.
18. Pasquali R, Macor C, Vicennati V, et al. Effects of acute hyperinsulinemia on testosterone serum concentrations in adult obese and normal-weight men. Metabolism. 1997;46(5):526-9.
19. Haring R, Völzke H, Steveling A, et al. Low testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20–79. Eur Heart J. 2010;31:1436-7.
20. Khaw KT, Dowsett M, Folkerd E, et al. Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men. European Prospective Investigation Into Cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation. 2007 Dec 4;116(23):2694-701. doi: 10.1161/CIRCULATIONAHA.107.719005 [Published online Nov 26, 2007].
21. Rosen JC, Cappelleri J.C., Gendrano N. The International Index of Erectile Function (IIEF): a state-of-the-science review. Intern J Impot Res. 2002;14:226-44.
22. Hirshkowitz M, Karacan I, Gurakar A, Williams RL. Hypertension, Erectile Dysfunction, and Occult Sleep Apnea. Sleep. 1989;12(3):223-32.
23. Гамидов С.И., Тажетдинов О.Х., Павловичев А.А. и др. Особенности патогенеза, диагностики и лечения эректильной дисфункции у больных с гипогонадизмом. Проблемы эндокринологии. 2010;(5):33-42 [Gamidov SI, Tazhetdinov OH, Pavlovich AA, et al. Features of pathogenesis, diagnosis and treatment of erectile dysfunction in patients with hypogonadism. Probl. endocrinol. 2010;(5): 33-42 (In Russ.)].
24. Schipilliti M, Caretta N, Palego P, et al. Metabolic syndrome and erectile dysfunction: the ultrasound evaluation of cavernosal atherosclerosis. Diabetes Care. 2011;34(8):1875-7.
25. Roth A, Kalter-Leibovici O, Kerbis Y, et al. Prevalence and risk factors for erectile dysfunction in men with diabetes, hypertension, or both diseases: a community survey among 1412 Israeli men. Clin Cardiol. 2003;26(1):25-30.
26. Montorsi P, Ravagnani PM, Galli S, et al. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2005;96(26):19-23 [Epub 2005 Nov 4].
________________________________________________
2. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urology. 1994;151:54-61.
3. Laumann EO, Paik A, Rosen RC. Sexual Dysfunction in the United States: Prevalence and Predictors. J Am Med Association. 1999;281:537-44. http://dx.doi.org/10.1001/jama.281.6.537
4. Hatzimouratidis K, Giuliano F, Moncada I, et al. EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism. European Association of Urology; 2016.
5. Rosen RC, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822-30.
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Авторы
Т.А. Алексеева 1, М.А. Шария 1, С.И. Гамидов 2,3, Е.М. Елфимова 1, И.В. Старостин 1, А.Ю. Литвин 1, И.Е. Чазова 1
1 Научно-исследовательский институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. В.И. Кулакова» Минздрава России, Москва, Россия;
3 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
1 National Medical Research Center for Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia;
2 V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Moscow, Russia;
3 I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
1 Научно-исследовательский институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. В.И. Кулакова» Минздрава России, Москва, Россия;
3 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
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1 National Medical Research Center for Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia;
2 V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Moscow, Russia;
3 I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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