Erectile Dysfunction and Cardiac Patient

Erektilna je disfunkcija (ED) nesposobnost postizanja i/ili održavanja erekcije dovoljno čvrste za zadovoljavajući spolni odnos. Posebno mjesto u dijagnostici i liječenju zauzimaju bolesnici sa srčanim tegobama. ED je „marker“ u otkrivanju srčanih bolesnika, a javlja se prosječno 3 – 5 godina prije prvih srčanih tegoba. Liječenje ED-a danas je uspješno te je većina bolesnika zadovoljna svojim spolnim životom. Ipak, treba biti oprezan prilikom propisivanja simptomatske terapije kod srčanih bolesnika te uvijek uključiti i kardiologa u procjeni srčane 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 1999–2003, 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

Poboljšanje spolne i reprodukcijske funkcije u muškaraca s oštećenjem kralježnične 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 individual’s 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 članka je analizirati spolne i reprodukcijske funkcije u muškaraca s oštećenjem kralježnične moždine (OKM). Mnoge spolne i reprodukcijske funkcije u ovih bolesnika mogu biti oštećene uključujući vlastitu podcjenjenost, nedostatak spolnog zadovoljstva, erekcijsku i ejakulacijsku disfunkciju te nepravilnosti spermiograma koje karakteriziraju slabija pokretljivost i vijabilnost. Zahvaljujući napretku u fizikalnoj medicini i rehabilitaciji pomiče se glavna usmjerenost na omogućavanje preživljenja takvih bolesnika prema osiguranju kvalitete života, poboljšanju spolne disfunkcije i kasnije reprodukcije. Erekcijska disfunkcija može se liječiti primjenom inhibitora fosfodiesteraze-5, intrakavernoznih injekcija, vakumskih uređaja i proteza za penis. U većine muškaraca s anejakulacijom sjeme se može dobiti postupkom medicinski pomognute ejakulacije primjenom vibracijske stimulacije penisa, elektroejakulacije, masaže prostate ili kirurških zahvata. Premda većina muškaraca s OKM ne uspijeva postići trudnoću na prirodan način, stvaranje potomstva ipak je moguće uvođenjem specijalističkog medicinskog liječenja. Primjenom raznih medicinskih, tehničkih i kirurških tehnika za dobivanje spermija u kombinaciji s metodama za pomognutu oplodnju postignute su zavidne stope trudnoća slično kao u subfertilnih osoba bez tjelesnih oštećenja. Ipak, potrebna su daljnja istraživanja za poboljšanje kvalitete sjemena i metoda za pomognutu ejakulaciju u bolesnika s OKM

Sakralna neuromodulacija u liječenju bolesnika s prekomjerno aktivnim mokraćnim 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, učinkovita i minimalno invazivna napredna terapija koja uključuje električnu stimulaciju korijena sakralnog živca s ciljem podešavanja aktivnosti neuralnih putova. Indikacije za SNM uključuju simptome prekomjerno aktivnog mokraćnog mjehura (PAMM), inkontinenciju mokraće, zadržavanje mokraće, urgenciju i učestalost, kao i fekalnu inkontinenciju. U Europi i Kanadi dodatno je postavljena indikacija za kroničnu opstipaciju. Mehanizam djelovanja još uvijek nije u cijelosti razjašnjen te potpuno razumijevanje tek treba utvrditi. Smatra se da SNM modulira neuronske krugove središnjih i perifernih živčanih putova čime utječe na aktivnost u mozgu, kao i na neuronsku aktivnost usmjerenu na mjehur. Drugi mogući značajan učinak na poremećenu aktivnost mokraćnog mjehura je inhibicijom aferentnih putova mjehura stimulativnim djelovanjem na pudendni živac. Tijekom posljednja dva desetljeća s više od 300.000 liječenih bolesnika SNM se sve češće rabi za ublažavanje refraktornih simptoma PAMM-a, kao i za liječenje zadržavanja mokraće 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 budućnosti

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

Liječenje 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 liječenja bolesnika u završnom stadiju kronične bubrežne bolesti. Učestalost kronične bubrežne bolesti u svijetu iznosi 13,4%. Karcinom prostate je drugi najčešći karcinom u muškaraca u svijetu. Liječenje lokaliziranog karcinoma prostate je izazovno zbog imunosupresivne terapije i lokalizacije grafta u zdjelici. Visoke stope preživljenja grafta i primatelja rezultirale su sve većom učestalošću karcinoma prostate u ovih bolesnika. Učinjena je retrospektivna analiza muških bolesnika u kojih je učinjena transplantacija bubrega u našem centru između 2002. i 2022. godine, a kojima je dijagnosticiran i liječen karcinom prostate. Analizirali smo incidenciju, metode liječenja i praćenje bolesnika s karcinomom prostate u ovoj populaciji. Ukupno je transplantirano 1079 muških bolesnika. Karcinom prostate dijagnosticiran je u 12 bolesnika (8 nakon i 4 prije transplantacije). Incidencija karcinoma prostate iznosila je 1,11%. Radikalna prostatektomija učinjena je u 11 bolesnika, a jedan bolesnik je liječen radikalnom radioterapijom. Stabilna funkcija presatka prati se u 11 bolesnika, a u jednog bolesnika je učinjena 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 praćenju bez recidiva. Radikalna prostatektomija je sigurna metoda liječenja lokaliziranog karcinoma prostate u bolesnika s transplantacijom bubrega koja ne narušava funkciju i preživljenje grafta