Goal: To identify influence of long range infra-red radiations on endothelium- dependent vasodilatation in patients with erectile
disorders.
Material and Methods: One hundred eighteen males with erectile disorders were examined. Twenty practically healthy males
comprised a control group. An endothelial function of the cavernoma arteries was determined with ultrasonic Diplography after of
application of a long range infra-red radiation.
Results: An endothelial dysfunction of the cavernous arteries
revealed with a Drug-Diplography method in the main group was
also proved at the use of the original technique. Paradoxical
vasoconstriction which was found during utilization of drug-induction
method assay was identified in some patients. A direct correlation
between these techniques was revealed and the correlation ratio
was r=0.58 (p<0.05).
Conclusion: The method developed is informative in diagnostics of endothelial dysfunction of the cavernoma arteries, and we
think that it will take a relevant place in a comprehensive examination of patients with erectile disorders.
Keywords: long range infra-red radiation; erectile dysfunction; endothelial dysfunction.
Introduction
The main diagnostic method for vasculogenic erectile
dysfunction (ED) at the percentage is diplography of the cavernous
arteries of the penis after intracavernous administration of
vasoactive drugs- pharmacodopplerography (FDG) [1]. This
method has several disadvantages-pain and fear of the patient
before injection into the penis, which can reduce the diagnostic
value of the results [2]. Some of these shortcomings are deprived
of the technique of dopplerography of the vessels of the penis after
taking 5-phosphodiesterase inhibitors [3]. However, the results
of this study are more dependent on the degree of sexual arousal
of the patient. It should be noted the high cost of such a study [4],
and the duration (in time) of the survey. Decreased abilities of the
endothelium of the arteries and sinuses of the penis to synthesize
and secrete nitric oxide (NO) lead to impaired relaxation of smooth
muscle cells of the vascular wall, which limits blood flow and
prevents the development of an erection [5,6].
Widely used in the diagnosis of endothelial dysfunction of
peripheral arteries, the method of ultrasound examination of postcompression
changes in their diameter [6]. The degree of expansion
of peripheral arteries reflects the ability of endothelial cells to
synthesize and secrete NO and its bioavailability, and, consequently,
the state of endothelial function [6]. The mechanism of post-occlusal
changes in the diameter of blood vessels is currently explained by
a sharp increase in blood flow in the arteries due to the expansion
of the distal small vessels and the mechanical effect of increased
blood flow on the vascular wall, which leads to the activation of
ion channels of endothelial cells and the accumulation of calcium
ions in them. The latter activate endothelial NO synthetase, which
is accompanied by the release of NO, which has a vasodilating effect
on the vascular wall.
R. Virag [7] applied the technique of post-occlusal changes in the
diameter of peripheral arteries to detect endothelial dysfunction in the
pool of cavernous arteries, which allows differentiating different
pathogenetic forms of ED at the stage of functional disorders.
The sensitivity and specificity of this indicator is 100 and 92%,
respectively. An improved methodology for the post-compression
test in the diagnosis of vasculogenic erectile dysfunction was
proposed by Maso EB et al. [8]. The sensitivity and specificity
of the proposed methodology are 100 and 94.5%, respectively.
However, the technique has several drawbacks-a certain technical
complexities of execution, the presence of discomfort in the area of
the cuff during compression.
It is known that hemoglobin NO complexes are photosensitive
and decompose with the release of nitric oxide. The photorelaxing
effect of infrared (IR) radiation on blood vessels is well known.
At present, a positive effect of long-range infrared radiation on
the functional properties of platelets and rheological parameters
during irradiation of blood of patients with angina pectoris in vitro
has been identified [9-11]. Infrared radiation in the terahertz range
causes an increase in the production of nitric oxide by vascular
endothelium, which is accompanied by the normalization of reduced
basal and induced vasodilating activity in animals in a state of acute
immobilization stress [12]. According to some modern authors,
when irradiating the infrared radiation of the terahertz range, not
only can the synthesis of endogenous nitric oxide and its reactivity
increase, but the duration of the existence of nitric oxide in cells can
also increase [13].
The purpose of this study is to assess the effect of long-range
infrared radiation on endothelium-dependent vasodilation in
patients with erectile dysfunction. Materials and methods. The
study included 118 men aged 32-71 years with ED, as well as 20
men (control group) aged 28-66 years without ED. All men with
ED underwent a comprehensive examination, which included the
collection of a general medical and sexological history, a survey on
the International Index of Erectile Function, a general examination,
a study of hormonal status, blood lipids and glucose, as well as
FGD using vasoactive drugs (papaverine 20-40 mg; alprostadil
5-10mkg). In addition, the study of the endothelial function of the
cavernous arteries was performed in all patients. The function
of the arterial endothelium was evaluated using ultrasonic
examination (ultrasound) of the diameter before and after the
use of long-range IR emitters (Figure 1). (ZB series registration
certificate No. UZTT 00898 - working wavelength range of useful
radiation 22.5 μm) according to our developed methodology. The
experimental nature of the test was explained to all participants
and consent was received from them to conduct it. Ultrasound of
the cavernous arteries was performed using an “HD3” device from
Philips (Holland).
In the position of the patient on the back, a linear sensor L 9-5
was placed longitudinally on the ventral surface of the penis. The
diameter of the cavernous arteries was measured as the distance
between the opposite walls of the vessel and the location of the sensor was noted with a pencil. After determining the average
diameter of the cavernous arteries of the penis, an IR emitter (ZB
series) was exposed with an exposure of 3 minutes from the ventral
side at a distance of 10-12 cm from the penis (Figure 2). After 3
minutes, an ultrasound scan was repeated to measure the diameter
of the cavernous arteries. For the calculation, the largest diameter
of the cavernous arteries was used. The percentage of increase in
the diameter of the cavernous artery (PUDKA) was adopted by us
as the main indicator for assessing the endothelial function of the
cavernous arteries. This indicator was calculated by the formula:
Figure 1: Far-range infrared emitters.
Figure 2: Methods of exposure of IR emitter to cavernous
arteries
PUDKA = 100% x (D2 - D1) / D1,
where D1 is the diameter of the cavernous artery before
exposure to an infrared emitter;
D2 - diameter of the cavernous artery after exposure to an
infrared emitter.
All studies were carried out by one specialist in ultrasound
diagnostics. The study was carried out in the morning, before the
study, patients were advised to refrain from smoking and taking
medications that affect the cardiovascular system. The average
values of this indicator were calculated for the control group and
patients with arterial and non-arterial ED. Statistical analysis
was performed using t-student criterion and Pearson correlation
coefficient. For analysis, computer software Statistica 6.0 was used;
p <0.05 was recognized as statistically significant.
Results
divided into 2 subgroups: subgroup I - non-arterial ED of 42
patients (peak systolic velocity of 30 cm / s or more); Subgroup
II - arteriogenic ED of 76 patients (peak systolic velocity less than
30 cm \ s). A comparative analysis of the average PUDA values in
patients with different forms of ED revealed that this indicator is
statistically significantly (p <0.001) less in the group of patients
with arteriogenic ED compared with the control group, as well as
in comparison with patients with other forms ED. An analysis of the
data made it possible for us to propose a threshold level of PUDA for
distinguishing organic ED from other forms of erectile disturbances,
which amounted to 30%. The sensitivity and specificity of
this indicator relative to the results of FDG in the diagnosis of
arteriogenic ED were 100% and 96%, respectively. In patients
with arteriogenic ED there was a significant correlation (r = 0.58 p
<0.05) with the results of FDG (peak systolic rate) and PUDK values.
An analysis of the results showed that the proposed method reveals
a paradoxical vasoconstriction of the cavernous arteries, which is
not determined when using FDG. When conducting the proposed
diagnostic method, in no case did we observe complications and
adverse reactions.
Discussion
The present study shows that the use of long-range IR emitters
in determining the endothelial function of the cavernous arteries
using ultrasound is a highly informative method for the diagnosis
of arteriogenic ED. The developed technique for studying the
endothelial function of the cavernous arteries has advantages
over FDG and post-occlusion test, as it is a non-invasive method
and technically simple to perform. It is known that the functional
state of penile arteries depends on the biological activity of NO.
Endothelial cells and nerve endings of non-cholinergic nonadrenergic
neurons are sources of NO in the cavernous tissue of the
penis. The synthesis of NO is carried out as a result of the action of
enzymes of endothelial and neuronal NO synthase [14,15]. In our
opinion, endothelial and neuronal NO synthases are activated by
the quantum energy of the IR emitter, which leads to the release of
NO. It is known that the quantum energy of radiation is inversely
proportional to the wavelength, and if you take this into account,
the effect on a person with radiation in the range of 8-9.8 μm (human own radiation is in the range of 9-10 μm) does not have
negative side effects, since quantum energy of such sources does
not exceed the quantum energy of the skin’s own radiation. The
radiation of ceramic infrared emitters has a specific wavelength in
the narrow spectral range. All types of emitters are characterized
in that the energy spectrum of their exposure corresponds to or
below the energy spectrum of human radiation. Emitters in these
ranges have no effect on a healthy person, since it is transparent
to them [16,17]. The paradoxical vasoconstriction detected by the
proposed method is due to the presence of oxidative stress. Longrange
infrared radiation stimulates the production of superoxide
radicals (NO; O) by blood phagocytes and tissue macrophages,
which enhances oxidative stress. This is not observed during FDG.
Endothelial dysfunction is an early stage of atherosclerosis and
is systemic in nature. Functional damage to most arterial vessels
often proceeds without clinical symptoms; therefore, the timely
detection of early stages of vascular system damage is relevant. In
our opinion, the developed method for determining the endothelial
function of the cavernous arteries is able to detect endothelial
dysfunction at the level of functional disorders, which is not always
determined with FDG.
Conclusion
Thus, our proposed method for studying the endothelial
function of the cavernous arteries after exposure to a far-infrared
emitter is highly informative in the diagnosis of arteriogenic ED,
especially in the stage of functional disorders. This method will
take its place in a comprehensive examination of patients with ED.
Conflict of interest. The author claims no conflict of interest.
Acknowledgment
To the Head of the Clinical and Diagnostic Department of the
Central Clinical Hospital No. 1 of the Main Medical Directorate
under the Office of the President of the Republic of Uzbekistan,
Doctor of Medical Sciences G. A. Rozykhojaeva.
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