25 research outputs found
Erectile Dysfunction and Cardiac Patient
Erektilna je disfunkcija (ED) nesposobnost postizanja i/ili održavanja erekcije dovoljno Ävrste za zadovoljavajuÄi spolni odnos. Posebno mjesto u dijagnostici i lijeÄenju zauzimaju bolesnici sa srÄanim tegobama. ED je āmarkerā u otkrivanju srÄanih bolesnika, a javlja se prosjeÄno 3 ā 5 godina prije prvih srÄanih tegoba. LijeÄenje ED-a danas je uspjeÅ”no te je veÄina bolesnika zadovoljna svojim spolnim životom. Ipak, treba biti oprezan prilikom propisivanja simptomatske terapije kod srÄanih bolesnika te uvijek ukljuÄiti i kardiologa u procjeni srÄane funkcije.Erectile dysfunction (ED) is the inability to achieve and/or sustain an erection suitable for sexual intercourse. Diagnosis and treatment of erectile dysfunction play a specific role in cardiac patients. ED could be seen as a marker for the diagnosis of cardiac conditions due to its onset approx. 3-5 years before the first cardiac symptoms. Nowadays ED treatment is successful and the majority of patients are satisfied with their sexual life. However, physicians need to be careful when prescribing specific symptomatic therapies to cardiac patients and always include a cardiologist in cardiac function assessment
From Azoospermia to Fertility: A Successful Case of mTESE Treatment
Infertility is diagnosed clinically in heterosexual couples who cannot achieve pregnancy after a year of having intercourse without using birth control. Statistically, every sixth couple in Croatia is infertile and 50% of infertility cases are male-originated
Socio-Demographic Characteristics and Lifestyle Habits of Pregnant Women Smokers
The aim of this study was to describe anthropometric, clinical, socio-demographic characteristics and lifestyle habits of pregnant smokers in comparison to pregnant nonsmokers. During years 1999ā2003, 1,435 pregnant smokers and 4,772 pregnant nonsmokers were interviewed after delivery with a questionnaire. They were recorded clinical, anthropometric and socio-demographic data, smoking status, labor outcome, maternal and fetal hemoglobin concentrations for each patient. The two groups were comparable in anthropometric and clinical characteristics, duration of pregnancy
and mode of delivery, except for birth weights, which were significantly lower in newborns of smokers. Maternal hemoglobin concentrations were significantly lower in smokers, but fetal hemoglobin concentrations were significantly higher in babies of smokers. The proportion of pregnant women who smoked during pregnancy was higher among urban women, among women with lower educational level and among unemployed subjects in comparison with nonsmokers. The pregnant women who smoked during pregnancy were more often caffeine and alcohol consumers. To further reduce smoking during pregnancy it is important to continue to promote smoking cessation among teenagers
PoboljÅ”anje spolne i reprodukcijske funkcije u muÅ”karaca s oÅ”teÄenjem kralježniÄne moždine
The aim of the review is to establish sexual and reproductive functions in men with spinal cord lesion (SCL). Many sexual and reproductive dysfunctions may be found in these patients including individualās low self-esteem, delay of orgasm, erectile or ejaculatory disorder and abnormalities of semen, which are characterized by lower sperm motility or viability. Owing to improvements in physical medicine and rehabilitation, the focus has been shifted from keeping patients alive towards ensuring the quality of life and improvements of sexual dysfunctions and later reproduction. Erectile dysfunction can be treated by using phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be retrieved from anejaculatory patients by medically assisted methods utilizing penile vibratory stimulation, electroejaculation, prostate massage, or surgically. Although there is low chance for pregnancy in natural way in most of SCL patients, fatherhood is possible through the introduction of assisted medical management. By use of various medical, technical and surgical procedures for sperm retrieval combined with assisted reproductive methods, high pregnancy rates have been reported comparable to those in able-bodied subfertile patients. Nevertheless, future studies are needed to improve semen quality and methods of assisted ejaculation in patients with SCL.Svrha ovoga preglednog Älanka je analizirati spolne i reprodukcijske funkcije u muÅ”karaca s oÅ”teÄenjem kralježniÄne moždine (OKM). Mnoge spolne i reprodukcijske funkcije u ovih bolesnika mogu biti oÅ”teÄene ukljuÄujuÄi vlastitu podcjenjenost, nedostatak spolnog zadovoljstva, erekcijsku i ejakulacijsku disfunkciju te nepravilnosti spermiograma koje karakteriziraju slabija pokretljivost i vijabilnost. ZahvaljujuÄi napretku u fizikalnoj medicini i rehabilitaciji pomiÄe se glavna usmjerenost na omoguÄavanje preživljenja takvih bolesnika prema osiguranju kvalitete života, poboljÅ”anju spolne disfunkcije i kasnije reprodukcije. Erekcijska disfunkcija može se lijeÄiti primjenom inhibitora fosfodiesteraze-5, intrakavernoznih injekcija, vakumskih ureÄaja i proteza za penis. U veÄine muÅ”karaca s anejakulacijom sjeme se može dobiti postupkom medicinski pomognute ejakulacije primjenom vibracijske stimulacije penisa, elektroejakulacije, masaže prostate ili kirurÅ”kih zahvata. Premda veÄina muÅ”karaca s OKM ne uspijeva postiÄi trudnoÄu na prirodan naÄin, stvaranje potomstva ipak je moguÄe uvoÄenjem specijalistiÄkog medicinskog lijeÄenja. Primjenom raznih medicinskih, tehniÄkih i kirurÅ”kih tehnika za dobivanje spermija u kombinaciji s metodama za pomognutu oplodnju postignute su zavidne stope trudnoÄa sliÄno kao u subfertilnih osoba bez tjelesnih oÅ”teÄenja. Ipak, potrebna su daljnja istraživanja za poboljÅ”anje kvalitete sjemena i metoda za pomognutu ejakulaciju u bolesnika s OKM
Sakralna neuromodulacija u lijeÄenju bolesnika s prekomjerno aktivnim mokraÄnim mjehurom - prva primjena u Hrvatskoj
Sacral neuromodulation (SNM) is a safe, efficacious, and minimally invasive advanced
therapy that involves electrical stimulation to sacral nerve root to modulate neural pathway.
Indications for SNM include symptoms of overactive bladder (OAB), urinary incontinence, urinary
retention, urgency and frequency and, regarding bowel dysfunction, fecal incontinence . In Europe and
Canada, indication is also established for chronic constipation. The mechanism of action is still not fully
elucidated and complete understanding is yet to be determined. It is proposed that SNM modulates
neural circuits in both central and peripheral pathways, thus having an impact on the brain, as well as on
the bladder-targeting neuronal activity. Another possible significant effect on irregular bladder activity
is through inhibition of the bladder afferent pathways by stimulation of the pudendal nerve. Over the
past two decades, with more than 300 000 treated patients, SNM has confirmed its efficacy to relieve
refractory OAB symptoms, as well as urinary retention or fecal incontinence. First SNM applications in
Croatia were uneventful and we are glad to offer our patients this novel therapy in the future.Sakralna neuromodulacija (SNM) je sigurna, uÄinkovita i minimalno invazivna napredna terapija koja ukljuÄuje elektriÄnu
stimulaciju korijena sakralnog živca s ciljem podeÅ”avanja aktivnosti neuralnih putova. Indikacije za SNM ukljuÄuju
simptome prekomjerno aktivnog mokraÄnog mjehura (PAMM), inkontinenciju mokraÄe, zadržavanje mokraÄe, urgenciju i
uÄestalost, kao i fekalnu inkontinenciju. U Europi i Kanadi dodatno je postavljena indikacija za kroniÄnu opstipaciju. Mehanizam
djelovanja joŔ uvijek nije u cijelosti razjaŔnjen te potpuno razumijevanje tek treba utvrditi. Smatra se da SNM modulira
neuronske krugove srediÅ”njih i perifernih živÄanih putova Äime utjeÄe na aktivnost u mozgu, kao i na neuronsku aktivnost
usmjerenu na mjehur. Drugi moguÄi znaÄajan uÄinak na poremeÄenu aktivnost mokraÄnog mjehura je inhibicijom aferentnih
putova mjehura stimulativnim djelovanjem na pudendni živac. Tijekom posljednja dva desetljeÄa s viÅ”e od 300.000 lijeÄenih
bolesnika SNM se sve ÄeÅ”Äe rabi za ublažavanje refraktornih simptoma PAMM-a, kao i za lijeÄenje zadržavanja mokraÄe te
fekalne inkontinencije. Prvi postupci postavljanja SNM-a u Hrvatskoj protekli su bez komplikacija i zadovoljastvo nam je
bolesnicima ponuditi ovu novu terapiju i u buduÄnosti
Kidney transplantation, brief history and Croatian experience
Kidney transplantation is the treatment of choice for patients with end-stage renal disease. However,
it took years and numerous attempts to achieve success, for the kidney to function well and for the patient to survive after the transplantation. Following this breakthrough made by Murray in 1954, the introduction of immunosuppressive therapy and tissue typing has significantly improved this program. Today we have new challenges in maintaining or improving a kidney transplant program, one of which is COVID-19 infection. This review presents the history and current status of kidney transplantation, emphasizing the Croatian Kidney Transplant Program
LijeÄenje karcinoma prostate u bolesnika s transplantiranim bubregom
Kidney transplantation is the treatment of choice in eligible patients with end-stage
kidney disease. Prostate cancer (PC) is the second most common cancer in men worldwide. The prevalence
of chronic kidney disease worldwide is 13.4%. The management of localized PC in these patients
is challenging due to immunosuppressive therapy and pelvic graft localization. High graft and recipient
survival rates have resulted in higher numbers of these patients in our everyday practice. A retrospective
analysis of male patients who had undergone kidney transplantation at our center between 2002 and
2022 and were diagnosed and treated for PC was performed. We analyzed the incidence, treatment
methods, and follow-up of PC patients in this population. A total of 1079 male patients were transplanted.
PC was diagnosed in 12 patients (8 after and 4 before transplantation). The incidence of PC
was 1.11%. Radical prostatectomy was performed in 11 patients, and one patient was treated with radical
radiotherapy. Eleven patients had stable graft function; 1 graftectomy was performed, unrelated to PC.
Three patients were indicated for salvage radiotherapy, one is in process for prostate-specific membrane
antigen positron emission tomography (PSMA PET CT), and 7 patients are in follow-up and without
recurrence. Radical prostatectomy is a safe treatment method for localized PC in kidney transplant recipients,
which does not impair graft function and survival.Transplantacija bubrega je metoda izbora za lijeÄenja bolesnika u zavrÅ”nom stadiju kroniÄne bubrežne bolesti. UÄestalost
kroniÄne bubrežne bolesti u svijetu iznosi 13,4%. Karcinom prostate je drugi najÄeÅ”Äi karcinom u muÅ”karaca u svijetu. LijeÄenje
lokaliziranog karcinoma prostate je izazovno zbog imunosupresivne terapije i lokalizacije grafta u zdjelici. Visoke
stope preživljenja grafta i primatelja rezultirale su sve veÄom uÄestaloÅ”Äu karcinoma prostate u ovih bolesnika. UÄinjena je
retrospektivna analiza muÅ”kih bolesnika u kojih je uÄinjena transplantacija bubrega u naÅ”em centru izmeÄu 2002. i 2022.
godine, a kojima je dijagnosticiran i lijeÄen karcinom prostate. Analizirali smo incidenciju, metode lijeÄenja i praÄenje bolesnika
s karcinomom prostate u ovoj populaciji. Ukupno je transplantirano 1079 muŔkih bolesnika. Karcinom prostate dijagnosticiran
je u 12 bolesnika (8 nakon i 4 prije transplantacije). Incidencija karcinoma prostate iznosila je 1,11%. Radikalna
prostatektomija uÄinjena je u 11 bolesnika, a jedan bolesnik je lijeÄen radikalnom radioterapijom. Stabilna funkcija presatka
prati se u 11 bolesnika, a u jednog bolesnika je uÄinjena graftektomija, nevezano za karcinom prostate. U tri bolesnika indicirana
je spasonosna radioterapija, u jednog je u tijeku prostate-specific membrane antigen positron emission tomography (PSMA
PET CT), dok je 7 bolesnika u praÄenju bez recidiva. Radikalna prostatektomija je sigurna metoda lijeÄenja lokaliziranog
karcinoma prostate u bolesnika s transplantacijom bubrega koja ne naruŔava funkciju i preživljenje grafta