Ikääntyvän miehen seksuaalisuus ja sen häiriöt

Ikääntyvän miehen seksuaalinen toimintakyky heikkenee mutta vähemmän kuin on oletettu. Myös seksuaalinen halu säilyy pitkään. Tavallisimmat häiriöt ovat erektiokyvyn heikkeneminen ja ejakulaation häiriöt. Virtsaamisoireilla ja seksuaalitoimintojen häiriöillä on vahva yhteys toisiinsa. Osa miehistä saa apua niihin häiriöihin samalla, kun hoidetaan eturauhasen liikakasvun aiheuttamia virtsaamisoireita. Erektiohäiriö voi olla ensimmäinen oire sydän- ja verisuonitaudista, minkä vuoksi sen riskitekijöiden kartoittaminen ja tarvittaessa myös hoitaminen ovat tärkeitä. Ejakulaatiohäiriön syynä saattavat olla myös lääkkeet, kuten selektiivisesti serotoniinin takaisinottoa estävät masennuslääkkeet tai eturauhasen liikakasvun hoitoon käytetyt lääkkeet, etenkin alfasalpaaja tamsulosiini. Jos iäkäs mies haluaa seksuaalihäiriöönsä hoitoa, hänelle tulee tarjota yksilöllisesti parhaiten sopivaa hoitomuotoa. English summary: Sexuality and sexual disorders of aging man Functional ability of an aging man decreases less than presumed, and sexual desire remains for long. The most common disturbances include lessened ability for erection and ejaculatory disturbances. Some men will be helped for their sexual disturbances in connection with the treatment of urinary symptoms caused by benign prostatic hyperplasia. Erectile dysfunction may be the initial symptom of cardiovascular disease. Erectile dysfunction may also be caused by medication used by the patient. If an aged man wants therapy for his sexual disorder, he should be individually provided with the most appropriate treatment form

Ikääntyvän miehen seksuaalisuus ja sen häiriöt

Ikääntyvän miehen seksuaalinen toimintakyky heikkenee mutta vähemmän kuin on oletettu. Myös seksuaalinen halu säilyy pitkään. Tavallisimmat häiriöt ovat erektiokyvyn heikkeneminen ja ejakulaation häiriöt. Virtsaamisoireilla ja seksuaalitoimintojen häiriöillä on vahva yhteys toisiinsa. Osa miehistä saa apua niihin häiriöihin samalla, kun hoidetaan eturauhasen liikakasvun aiheuttamia virtsaamisoireita. Erektiohäiriö voi olla ensimmäinen oire sydän- ja verisuonitaudista, minkä vuoksi sen riskitekijöiden kartoittaminen ja tarvittaessa myös hoitaminen ovat tärkeitä. Ejakulaatiohäiriön syynä saattavat olla myös lääkkeet, kuten selektiivisesti serotoniinin takaisinottoa estävät masennuslääkkeet tai eturauhasen liikakasvun hoitoon käytetyt lääkkeet, etenkin alfasalpaaja tamsulosiini. Jos iäkäs mies haluaa seksuaalihäiriöönsä hoitoa, hänelle tulee tarjota yksilöllisesti parhaiten sopivaa hoitomuotoa. English summary: Sexuality and sexual disorders of aging man Functional ability of an aging man decreases less than presumed, and sexual desire remains for long. The most common disturbances include lessened ability for erection and ejaculatory disturbances. Some men will be helped for their sexual disturbances in connection with the treatment of urinary symptoms caused by benign prostatic hyperplasia. Erectile dysfunction may be the initial symptom of cardiovascular disease. Erectile dysfunction may also be caused by medication used by the patient. If an aged man wants therapy for his sexual disorder, he should be individually provided with the most appropriate treatment form

Hyperuricemia Is Not an Independent Predictor of Erectile Dysfunction

Introduction: Erectile dysfunction (ED) is strongly associated with physiological and metabolic disturbances, and hyperuricemia has been proposed to predict the onset of ED.Aim: To investigate if hyperuricemia is an independent predictor for ED when all relevant confounding factors are taken into account.Methods: This is a cross-sectional study of men aged between 45 and 70 years. The population was well characterized for established cardiovascular risk factors, metabolic syndrome, as well as kidney function, depression, and socioeconomic factors. Analysis was limited to 254 men with complete data and also serum uric acid (SUA) measurements were available. This included 150 men with and 104 without ED. The presence and severity of ED was evaluated using International Index of Erectile Function-5 questionnaire. Risk of ED by SUA level was calculated using univariate and multivariable-adjusted logistic regression. Effect modification by participant characteristics were evaluated in subgroup analyses.Main outcome measures: The main outcome measures of this study are prevalence and severity of erectile dysfunction.Results: Patients with ED (59% of the study population) were older than men without ED (59 vs 54 years) and had lower serum testosterone (14.3, 95% CI 11.3-17.3 vs 15.1 nmol/l, 95% CI 12.1-18.8, respectively). Regarding all other variables, the groups were comparable. No significant difference was found for SUA by ED. SUA was not associated with ED risk in univariate or multivariable analysis (multivariable-adjusted OR 1.14, 95% CI 0.59-2.19, P = .7) for SUA level higher than median compared with median or lesser (OR 1.00, 95% CI 0.997-1.006, P = .7 for continuous variable). No subgroup analysis modified the association. After multivariable adjustment age, education level and depression were statistically significant predictors of ED.Conclusions: Elevated SUA was not found to be an independent risk factor for ED. Metabolic syndrome, glomerular filtration rate, or cardiovascular risk factors did not modify this result. ED cannot be predicted based on the level of SUA. A Tuokko, T Murtola, P Korhonen, et al. Hyperuricemia Is Not an Independent Predictor of Erectile Dysfunction.</p

Acute kidney injury following hip fracture

BACKGROUND: Hip fracture causes disability and excess mortality in the aging population. Acute kidney injury (AKI), is known to diminish survival of critically ill and trauma patients. AKI is also a common perioperative complication among surgical patients. We examined the effect of AKI on the survival of hip fracture patients in a Finnish hip fracture population and the risk factors for AKI in a prospective study.METHODS: The study cohort constituted of 486 consecutive low-energy trauma hip fracture patients referred to Satakunta Central Hospital (Pori, Finland) and Turku University Hospital (Turku, Finland). The patients underwent standard diagnostics and treatment in the emergency department (ER) and were operated according to the local treatment protocol. Serum creatinine (sCr) was analyzed daily pre- and post-operatively during the hospital stay. Patients were divided into groups; AKI and non-AKI based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria.RESULTS: The incidence of AKI in the study cohort was 8.4% (40/475). Eleven patients were excluded due to missing sCr data. The baseline characteristics of AKI and non-AKI groups differed significantly concerning baseline sCr but were otherwise similar. At 90-day follow-up, the overall mortality was 14.4%. Patients with AKI had a significantly higher mortality (35.0%) than those with no AKI (12.7%) (p < 0.001). Dementia, preoperative sCr and any stage of AKI were independent predictors for mortality. Dementia and preoperative sCr were independently associated with post-operative AKI.CONCLUSION: In this study AKI was a significant factor associated with a 3 -fold mortality during the first three months after surgery for low-energy trauma hip fracture.</p

Survival and mortality of elderly men with localized prostate cancer managed with primary androgen deprivation therapy or by primary observation

Background Androgen deprivation therapy (ADT) remains a primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment. Methods Men aged >= 70 years (n = 16,534) diagnosed with localized PCa from 1985 to 2014 and managed either with primary observation or ADT in the absence of curative treatment were included. The cases were identified from the population-based Finnish Cancer Registry. We estimated the standardized mortality ratios (SMR) for overall mortality by treatment group. We determined the relative risk (RR) of PCa-specific mortality (PCSM) and other-cause mortality between the two treatment groups. Survival was determined using the life table method. Two age groups (70-79 years and >= 80 years) and three calendar time cohorts (1985-1994, 1995-2004, and 2005-2014) were compared following adjustment of propensity score matching between the treatment groups with four covariates (age, year of diagnosis, educational level, and hospital district). Follow-up continued until death or until December 31, 2015. Results Patients in the observation group had lower overall SMRs than those in the ADT group in both age cohorts over the entire study period. PCSM was higher in men aged 70-79 years undergoing primary ADT compared to those managed by observation only (RR: 1.70, 95% confidence interval [CI]: 1.29-2.23 [1985-1994]; RR 1.55, 95% CI: 1.35-1.84 [1995-2004]; and RR 2.71, 95% CI: 2.08-3.53 [2005-2014]); p = 0.005 for periodic trend. A similar trend over time was also observed in men aged > 80 years; (p for age-period interaction = 0.237). Overall survival was also higher among men in their 70's managed by observation compared to those undergoing ADT. Conclusions Primary ADT within four months period from diagnosis is not associated with improved long-term overall survival or decreased PCSM compared to primary conservative management for men with localized PCa. However, this observational study's conclusions should be weighted with confounding factors related to cancer aggressiveness and comorbidities.Peer reviewe

Lonkkamurtumien leikkausmenetelmien komplikaatiot alkoholin väärinkäyttäjillä

English abstrac

Survival and mortality of elderly men with localized prostate cancer managed with primary androgen deprivation therapy or by primary observation

Background Androgen deprivation therapy (ADT) remains a primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment. Methods Men aged >= 70 years (n = 16,534) diagnosed with localized PCa from 1985 to 2014 and managed either with primary observation or ADT in the absence of curative treatment were included. The cases were identified from the population-based Finnish Cancer Registry. We estimated the standardized mortality ratios (SMR) for overall mortality by treatment group. We determined the relative risk (RR) of PCa-specific mortality (PCSM) and other-cause mortality between the two treatment groups. Survival was determined using the life table method. Two age groups (70-79 years and >= 80 years) and three calendar time cohorts (1985-1994, 1995-2004, and 2005-2014) were compared following adjustment of propensity score matching between the treatment groups with four covariates (age, year of diagnosis, educational level, and hospital district). Follow-up continued until death or until December 31, 2015. Results Patients in the observation group had lower overall SMRs than those in the ADT group in both age cohorts over the entire study period. PCSM was higher in men aged 70-79 years undergoing primary ADT compared to those managed by observation only (RR: 1.70, 95% confidence interval [CI]: 1.29-2.23 [1985-1994]; RR 1.55, 95% CI: 1.35-1.84 [1995-2004]; and RR 2.71, 95% CI: 2.08-3.53 [2005-2014]); p = 0.005 for periodic trend. A similar trend over time was also observed in men aged > 80 years; (p for age-period interaction = 0.237). Overall survival was also higher among men in their 70's managed by observation compared to those undergoing ADT. Conclusions Primary ADT within four months period from diagnosis is not associated with improved long-term overall survival or decreased PCSM compared to primary conservative management for men with localized PCa. However, this observational study's conclusions should be weighted with confounding factors related to cancer aggressiveness and comorbidities.Peer reviewe

Perceived quality of surgical care in association with patient-related factors and correlation to reported postoperative complications in Finland: a cross-sectional study

Objective To study if patient-related factors are associated with patient-evaluated quality of care in surgery. To examine if there is an association with postoperative complications and patient-evaluated low quality of care. Design A correlation cross-sectional study, in addition, a phone call interview at 30 days postoperatively to examine complications. Setting The data on patients admitted for non-cardiac general and orthopaedic surgery at a central hospital in Southwestern Finland were collected in two phases during an 8-month period. Participants 436 consecutive consenting and eligible in-ward non-cardiac general surgery and orthopaedic surgery adult patients. Ambulatory, paediatric and memory disorder patients were excluded. 378 patients completed the questionnaire (Good Nursing Care Scale for Patients (GNCS-P)). Methods Perceived quality of care was examined by the GNCS-P questionnaire. Patient-related factors were obtained from electronic patient records and questionnaire. A telephone interview related to postdischarge complications was conducted 30 days after discharge. Main outcome measures Patient evaluation of quality of care at discharge, its association with patient-related factors and patient-reported postdischarge complications. Results The overall quality was evaluated high or very high by the patients. The lowest overall quality of care rate was assessed by surgical patients living alone (p=0.0088) and patients who evaluated their state of health moderate or poor (p=0.0047). Surgical patients reporting postoperative complications after discharge evaluated lower overall quality of care (p=0.0105) than patients with no complications. Conclusion Patient demographic factors do not seem to influence the perceptions of the quality of care. Instead, subjective state of health and living conditions (living alone) may have an influence on the patient experience of quality of care. The perceived quality of care in healthcare staff technical and communication skills may have an association with reported postoperative complications.</div

”Nyt on kovat piipussa” – miesten kokemuksia penissyöpään sairastumisesta

Penissyöpä on harvinainen ja varsin tuntematon sairaus, jonka pääsääntöinen hoitomuoto on kirurginen hoito. Tutkimuksen tarkoituksena oli kuvata miesten kokemuksia penissyöpään sairastumisesta, mitä Suomessa ei ole aikaisemmin tutkittu. Aineisto kerättiin vuonna 2019 yksilöhaastatteluilla ja kirjallisilla vastauksilla penissyöpään sairastuneilta, kirurgisesti hoidetuilta miehiltä (n=14). Aineisto analysoitiin aineistolähtöisellä sisällönanalyysillä. Miesten voimavaroja sairaudesta selviytymisessä heikensivät ajatuksia kuormittavat tunteet, vakavan sairauden aiheuttama pelko, miehuuden menettämisen tunne, yksinjäämisen kokemus, huoli läheisten jaksamisesta sekä taloudelliset huolet. Miesten voimavaroja puolestaan tuki omien selviytymiskeinojen rakentuminen, puhumisen taito, läheisten tuki, usko tulevaisuuteen sekä sairauden hyväksyminen osana elämää. Hoidetuksi tulemisen tunnetta heikensi epäluottamusterveydenhuollon ammattilaisiin, tiedonpuute hoidon vaikutuksista sekä organisaatiokeskeinen toiminta. Hoidetuksi tulemisen tunnetta vahvisti turvallisuudentunne hoitoprosessista, rehellinen informaatio, osallisuus päätöksenteossa sekä merkityksellinen kohtaaminen

Visual Analogue Scale (VAS) in the Evaluation of Functional Outcomes After Three-dimensional Laparoscopic Prostatectomy

OBJECTIVE: To assess suitability of visual analog scale (VAS) in the evaluation of functional outcomes after 3D laparoscopic prostatectomy (3D LRP) METHODS: Two hundred men underwent 3D LRP for localised prostate cancer at Seinäjoki Central Hospital in Finland between December 2013 and September 2018. In October 2019, an EPIC-26 survey along with VAS scales enquiring urinary (VAS-incontinence) and sexual (VAS-sexual) symptoms was mailed to the patients, and the correlations between these 2 methods were evaluated. In the EPIC-26 survey, scores for incontinence-(EPIC-26 UI) and sexual (EPIC-26-sexual) domains were calculated using the University of Michigan scoring system. In the VAS questionnaires, patient put a mark on the 10 cm long horizontal line in place, which described his experience of continence and potency. The Spearman rank correlation coefficient was used to evaluate the correlation between methods. RESULTS: The median scores were as follows: EPIC-26-UI, 79.25 (14.5-100); EPIC-26-sexual, 36.17 (0.0-100); VAS-incontinence, 8.8 cm (1.4-10.0); and VAS-sexual, 3.2 cm (0.0-10). The correlation coefficient between EPIC-26 UI and VAS-incontinence was 0.722 (95% confidence interval [CI], 0.63-0.79; p <.0001) and 0.883 (95% CI, 0.84-0.91; p <.0001) between EPIC-26-sexual and VAS-sexual. CONCLUSION: Our study shows a strong correlation between VAS and EPIC-26 urinary incontinence and sexual domains. In daily clinical practice VAS-scale may serve as a simple tool to evaluate the key functional outcomes of radical prostatectomy.publishedVersionPeer reviewe