Utjecaj liječenja simptoma donjeg mokraćnog sustava uzrokovanih dobroćudnim povećanjem prostate na erektilnu funkciju

Background: Benign prostatic enlargement is the most common benign disease in men. The main cause for the emergence of benign prostatic enlargement is sexual hormone testosterone. Under the influence of enzyme 5-alpha reductase testosterone turns into active dihydrotestosterone, which is then combined with receptors and causes the growth of the prostate. Benign prostatic enlargement can cause the lower urinary tract symptoms. One of the treatment options of lower urinary tract symptoms due to benign prostatic enlargement is the treatment with medicaments – inhibitors 5-alpha reductase. Like any other medicament, this one can also have unpleasant side effects, between others reduced erectile function and reduced libido. Methods: We used the International Index of Erectile Function (IIEF-5), Quality of Erection Questionnaire (QEQ), and demographic data. Results: Men with benign prostatic enlargement have problems with keeping an erection even before starting the therapy with medicaments. After the therapy with inhibitors 5-alpha reductase the results of the research show that on the erectile function scale, there are no significant differences between the first and second measurement, but on the erectile dysfunction scale expected differences occur – the functionality decreases. We also noticed that the independent variables of age and employment status have influence on the result of medicament treatment in the way that older participants in the study have more issues with erectile function than younger ones. Secondly, the men in retirement have more problem than employed men. There were no noticeable connections between the level of completed education and the profession of the participants. Conclusions: The results of the research were expected, according to the previously consulted literature, where the side effects of treatment with medicaments inhibitors 5-alpha reductase were already mentioned. The effects that the treatment has on erectile function are that the function deteriorates, that is why it is important that we seek doctor assistance immediately after it occurs. The disease mainly manifests itself in older generation of men and it has a negative effect on erectile function already at the very beginning. Before starting the treatment the patients would need to be informed about the side effects of the medicament treatment and they should be presented other possibilities of treatment without side effects for erectile function.Uvod: Dobroćudno povećanje prostate je najčešća dobroćudna bolest u muškaraca. Glavni uzročnik pojave dobroćudnog povećanja prostate je muški spolni hormon testosteron. Pod utjecajem enzima 5-alfa reduktaze testosteron se pretvara u aktivni dihidrotestosteron, koji se tada kombinira s receptorima i uzrokuje rast prostate. Dobroćudno povećanje prostate može uzrokovati simptome u donjem mokraćnom sustavu. Jedna od mogućnosti liječenja simptoma donjeg dijela mokraćnog sustava uslijed dobroćudnog povećanja prostate je liječenje lijekovima - inhibitorima 5-alfa reduktaze. Kao i bilo koji drugi lijek, i ovaj može imati neugodne nuspojave, između ostalih smanjenu erektilnu funkciju i smanjeni libido. Metode: Koristili smo međunarodni indeks erektilne funkcije (IIEF-5), upitnik o kvaliteti erekcije (QEQ) i demografske podatke. Rezultati: Muškarci s benignim povećanjem prostate imaju problema s održavanjem erekcije, čak i prije nego što započnu terapiju lijekovima. Nakon terapije inhibitorom 5-alfa reduktaze rezultati istraživanja pokazuju da na ljestvici erektilne funkcije nema značajnih razlika između prvog i drugog mjerenja, ali na ljestvici erektilne disfunkcije dolazi do očekivanih razlika - funkcionalnost opada. Također smo primijetili da nezavisne varijable dobi i zaposlenja imaju utjecaj na rezultat liječenja lijekovima na način da stariji sudionici u istraživanju imaju više problema s erektilnom funkcijom od mlađih muškaraca. Zatim, muškarci u mirovini imaju više problema nego muškarci koji su zaposleni. Nisu bile uočljive veze između završene razine obrazovanja i profesije sudionika. Zaključci: Rezultati istraživanja bili su očekivani, prema prethodno konzultiranoj literaturi, gdje su već spomenute nuspojave liječenja inhibitorima 5-alfa reduktaze. Učinak koji tretman ima na erektilnu funkciju je pogoršanje funkcije, zato je važno potražiti pomoć liječnika odmah nakon što se pojavi. Bolest se uglavnom očituje kod starije generacije muškaraca i negativno utječe na erektilnu funkciju već u samom početku. Prije početka liječenja, pacijente bi trebalo informirati o nuspojavama liječenja lijekovima i treba im predstaviti druge mogućnosti liječenja bez nuspojava za erektilnu funkciju

A case of penile fracture with complete urethral disruption during sexual intercourse: a case report

Penile fracture is a rare condition. Primarily it is a rupture of the corpus cavernosum that occurs when the penis is erect. The rupture can also affect the corpus spongiosum and the urethra. We report a case of a 37 year old man who presented with acute penile pain, penile swelling and the inability to pass urine after a blunt trauma during sexual intercourse. In emergency surgery we found bilateral partial rupture of the corpus cavernosum with complete urethral and corpus spongiosum disruption. In the one year follow up the patient presented with normal erectile and voiding function. Emergency surgical repair in penile fracture can preserve erectile and voiding function

COMPARISON OF EFFICACY AND TOLERABILITY OF TWO SELECTIVE M3 RECEPTOR ANTAGONISTS SOLIFENACIN AND DARIFENACIN IN WOMEN WITH OVERACTIVE BLADDER – THE SOLIDAR STUDY

Background. To assess clinical efficacy and tolerance of solifenacin and darifenacin in women with OAB with urgency as primary end point. To estimate the impact of anticholinergic drugs on quality of life of patients and to assess treatment outcome (objective and subjective improvement). Methods. Multicentric, prospective, randomized, head to head, open label pilot study in 100 women with OAB. Patients were randomly assigned into two groups, 50 of them received solifenacine and the remaining 50 patients darifenacin. Study duration was 3 months, patients came to the office 1 and 3 months after inclusion in the study and they always filled out voiding diaries, urgency perception questionnaires as well as the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaires (IIQ). At the end of the study all patients estimated the success of treatment on the basis of VAS scale. Results. Only 77 patients were enrolled into study. Their average age was 54.8 years, and their BMI amounted to 27.6 kg/m2. The average duration of OAB symptoms and urge urinary incontinence was 86.0 and 46.5 months, respectively. 40 patients received solifenacin and remaining 37 patients darifenacin. Before treatment patients from both groups did not differ statistically significant in any of observed variables. 16 patients did not finish the study (8 solifenacin, 8 darifenacin), mainly due to side effects (8 patients). After 3 months of treatment we observed a significant improvement in severity, frequency and botherness of urgency in all patients, significantly improved were also other OAB symptoms (Table 1). Objective improvement after 1 months was greater in patients with solifenacin (p = 0.033), these patients also experienced significantly less irritative symptoms (p = 0.034). There was no difference in subjective improvement score between both drugs. Quality of life was better after three months in both groups of patients and there was no significant difference between both drugs with this regard (p = 0.174). However, we observed a significantly higher objective improvement score (3.8 vs. 3.2, p = 0.047) as well as the subjective improvement VAS score (74.4 vs. 54.1, p = 0.010) in solifenacin group. Patients receiving solifenacin used significantly less pads after three montha (Figure 1). Common side effect with both drugs was dry mouth (32 % of patients). In Figure 2 we are presenting the prevalence of different difficulties and side effects in the beginning of the study and after 3-month treatment. After 3-month treatment 65.6 % of patients received the same dose of solifenacin (37.9 % in darifenacin group), higher dose received 44.8 % patiens with darifenacin (12.5 % in solifenacin group). Conclusions. Both anticholinergics significantly improved urgency as well as other OAB symptoms and thus significantly improved the quality of life of patients. These observations are, however, in accordance with literature.1 Common side effect was dry mouth which developed or worsen in one third of patients. Objective and subjective treatment outcome were higher in patients receiving solifenacin, the reason for later probably being 3.5-times higher solifenacin concentration in urine as compared to darifenacin.2, 3 We feel that a greater study population is needed to confirm our preliminary results. Literatura 1. Nabi G, Cody JD, Ellis G, Herbison P, Hay-Smith J. Anticholinergic drugs versus placebo for overactiv

Rak prostate

Prenovljena različica knjižice Rak prostate je obsežen in odlično zasnovan ter strukturiran priročnik o raku prostate, namenjen bolnikom z rakom prostate, njihovim svojcem pa tudi širši laični javnosti. Priročnik vsebinsko precej poljudno in razumljivo bralcu najprej predstavi žlezo prostato ter njena pomen in vlogo v telesu, nato pa ga izčrpno seznani z vsemi vidiki raka prostate, od mogočih dejavnikov tveganja do znakov začetne in napredovale bolezni, vsemi elementi diagnostike, vrstami zdravljenja in v končni fazi tudi lajšanjem neželenih učinkov zdravljenja in tudi znaki napredovale neobvladane bolezni. Pomembna odlika knjižice Rak prostate je, da bralca ne samo dobro seznani z boleznijo, ampak ga tudi natančno pouči o strokovnih merilih, na katerih temeljijo odločitve zdravnikov pri izbiri raznih metod zdravljenja. Posebno obsežen del besedila je namenjen prepoznavanju in obvladovanju neželenih učinkov metod lokalnega in sistemskega zdravljenja, kar bo bolnikom in njihovim svojcem gotovo zelo olajšalo pot zdravljenja