Erectile dysfunction in railway station workers: A randomized study of different treatment approaches.

Introduction: The profession of a locomotive engineer involves stress, lack of adequate sleep and rest, and a sedentary lifestyle, all of which can contribute to the development of erectile dysfunction (ErD) as well as arterial hypertension.

Materials and methods: Consecutive patients of the railway hospital in Barnaul with arterial hypertension aged 30-60 who work as machinists or assistant locomotive drivers were enrolled. Those who have symptoms of ErD were randomized into three groups: group 1 received an endogenous nitric oxide-synthase (NOS) activator, group 2 received a combination of endogenous NOS activator and phosphodiesterase type 5 inhibitor (PDE-5i), and group 3 received no additional treatment for ErD. 20 individuals belonged to the control group without ErD. A follow-up was conducted after 2 and 4 months.

Results: A total of 85 individuals were examined (65 with symptoms of ErD). After 2 months of treatment, no significant changes in biomarkers and LDF (laser Doppler flowmetry) values were observed in groups 1 and 3. In group 2, ET-1 (endothelin-1) and hs-CRP (high-sensitivity C-reactive protein) returned to reference levels, and ischemic manifestations decreased. After 4 months, group 1 had increased mean blood flow and hs-CRP returned to reference levels. Group 2 showed improved microhemodynamics and biomarkers values. Group 2 patients had a higher IIEF and ICF total scores.

Conclusion: The combination of hypotensive drugs, PDE-5i, and NOS activator was the most effective method of treatment, improving hemodynamics and reparative properties of the endothelium by removing the substrate for thrombus formation. Treatment with an NO-synthase activator was shown to partially eliminate pathological processes in the endothelium.