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Kralježnična moždina predstavlja najjednostavnije građen dio središnjeg živčanog sustava zauzimajući oblik lagano spljoštenog cilindra sa samim smještajem u kanalu kralježnice gdje seže od zatiljnog otvora do drugog slabinskog kralješka. S obzirom na svoju lokalizaciju u tijelu i osjetljivost prilikom ozljeda, često biva ozlijeđenom prilikom raznih padova i nesreća. Ozljede kralježnične moždine najčešće se pojavljuju kod mlađih ljudi, češće u muškaraca ispod 40. godine života, tipično kao rezultat prometne nesreće, padova, sportskih ozljeda ili nasilja. Ovisno o intenzitetu ozljede, dolazi do narušavanja fizičkog, emocionalnog, psihičkog kao i društvenog statusa pojedinca. Ozlijeđena kralježnična moždina predstavlja kompleksno stanje ovisno o razini i intenzitetu nastale traume, a dijelimo ih na traumatske i ne traumatske ozljede. Osim što narušava pacijentove fizičke mogućnosti kretanja i osjeta u ekstremitetima, također uzrokuje impotencijske i inkontinencijske tegobe. Makar seksualno zdravlje predstavlja bitan faktor u pacijentovu svakodnevnom životu, i dalje biva nekvalitetno istraženo i obrađeno od strane brojnih kliničara. Najčešći seksualni problemi koji se pojavljuju kod ozljeda kralježnične moždine su nemogućnost postizanja erekcije kod muškaraca, nemogućnost lubrikacije vagine u žena te neosjetljivost spolnih organa kod obje skupine. Najčešći nedostatak u rješavanju problema seksualnog zdravlja predstavlja manjak formalnih bolničkih i usluga seksualne rehabilitacije u zajednici. Postoje brojni programi za liječenje crijeva i mjehura nakon ozljede leđne moždine, no programi u području seksualnog zdravlja su u znatnom nedostatku. Postoji rupa u znanju koja se odnosi na potencijalnu stalnu ulogu i odgovornosti pružatelja primarne zdravstvene zaštite, uključujući obiteljske liječnike i medicinske sestre, u rješavanju pitanja seksualnog zdravlja kod žena i muškaraca sa ozljedom kralježnične moždine. Ključno je da pružatelji primarne zdravstvene zaštite budu upoznati s resursima i specijalnim uslugama dostupnim u njihovim zajednicama za rješavanje specifičnih pitanja seksualnog zdravlja i plodnosti kod žena i muškaraca s traumatskim ozljedama leđne moždine kako bi ih mogli uputiti na odgovarajući način. U moguće resurse možemo ubrojiti specijalizirane programe rehabilitacije seksualnog zdravlja, medicinske sestre za seksualno zdravlje, seksualne terapeute, fizioterapeute, savjetnike, radne terapeute, urologe, liječnike fizikalne medicine i rehabilitacije te stručnjake za plodnost. The spinal cord is the most simply built part of the central nervous system, taking the form of a slightly flattened cylinder with its own accommodation in the spinal canal where it reaches from the occipital opening to the second lumbar vertebra. Due to its localization in the body and sensitivity to injuries, it is often injured during various falls and accidents. Spinal cord injuries most often occur in younger people, more often in men under the age of 40, typically as a result of traffic accidents, falls, sports injuries or violence. Depending on the intensity of the injury, the physical, emotional, psychological and social status of the individual is impaired. An injured spinal cord is a complex condition depending on the level and intensity of the resulting trauma, and we divide them into traumatic and non-traumatic injuries. In addition to impairing the patient's physical ability to move and feel in the extremities, it also causes problems with impotence and incontinence. Although sexual health is an important factor in the patient's daily life, it is still poorly researched and treated by many clinicians. The most common sexual problems that occur with spinal cord injuries are the inability to achieve an erection in men, the inability to lubricate the vagina in women, and the insensitivity of the sexual organs in both groups. The most common deficiency in solving sexual health problems is the lack of formal hospital and sexual rehabilitation services in the community. There are numerous programs for the treatment of bowel and bladder after spinal cord injury, but programs in the field of sexual health are significantly lacking. There is a gap in knowledge regarding the potential ongoing role and responsibilities of primary care providers, including family physicians and nurses, in addressing sexual health issues in women and men with spinal cord injury. It is critical that primary care providers are aware of the resources and specialty services available in their communities to address the specific sexual health and fertility issues of women and men with traumatic spinal cord injuries so that they can make appropriate referrals. Possible resources include specialized sexual health rehabilitation programs, sexual health nurses, sex therapists, physical therapists, counselors, occupational therapists, urologists, physical medicine and rehabilitation physicians, and fertility specialists.

Peyronieva bolest je progresivni poremećaj vezivnog tkiva penisa koji je karakteriziran stvaranjem kolagenskih plakova na TA penisa. Rezultat je deformacija i bol penisa, a često se javlja zajedno s erektilnom disfunkcijom. Iako su brojni čimbenici rizika povazani s razvojem Peyronieve bolesti i dalje su potrebna dodatna istraživanja za bolje razumijevanje ove bolesti. Simptomi Peyronieve bolesti mogu ograničiti spolni odnos i nametnuti ozbiljno fizičko i psihičko opterećenje u bolesnika. Stoga je potrebno dobiti njegovo povjerenje te naglasiti dobroćudnu narav bolesti kako bi se olakšalo postavljanje inicijalne dijagnoze i stekla suradljivost pacijenata prilikom donošenja odluke o terapiji. Tijek bolesti uključuje ranu akutnu fazu koja može trajati 1 do 18 mjeseci i kasniju stabilnu fazu. U ranoj fazi pacijenti mogu osjetiti bol u penisu dok se razvija plak. Tijekom kronične faze, plak postaje organiziraniji, zakrivljenost penisa se stabilizira, a bol obično popušta. Peyronieva bolest često prolazi nedijagnosticirano, a i u točno dijagnosticiranih pacijenata trenutno ne postoji terapija koja je pokazala značajnu učinkovitost. Nekirurške opcije često se koriste s promjenjivim rezultatima. Kirurško liječenje je rezervirano za bolesnike sa stabilnim stanjem bolesti, erektilnom disfunkcijom i deformitetom penisa koji narušava seksualnu funkciju., Peyronie’s disease is a progressive fibrotic disorder of penile connective tissue characterized by the formation of collagen plaques on the tunica albuginea of the penis. The result is penile deformity and pain, which are often accompanied with erectile dysfunction. Although a numerous risk factors are associated with the development of Peyronie's disease, further research is still needed to better understand this disease. Peyronie's disease can limit sexual intercourse and impose a serious physical and mental burden on the patient. Therefore, it is necessary to gain the patient's trust and emphasize the benign nature of the disease to facilitate initial diagnosis and patient’s compliance in determining appropriate therapy. We can distinguish two phases of the disease: an early acute phase that can last one to 18 months and a later chronic phase. In acute phase, patients may experience penile pain as the plaque develops. During the chronic phase, the plaque becomes more organized, the curvature of the penis stabilizes and the pain usually subsides. Peyronie's disease often goes undiagnosed and even in accurately diagnosed patients, there is still no effective therapy. Non-surgical options are often used with variable results. Surgical treatment is reserved for those patients with stable disease, erectile dysfunction and penile deformity that impairs sexual function.

Najčešći razlog posjeta muškarca urologu su simptomi donjeg urinarnog trakta čiji je najčešći uzrok benigna hiperplazija prostate koja u dobi od 70 do 80 godina je zastupljena u 80 do 90 % muškaraca. Za pacijente koji imaju značajne smetnje koje ne odgovaraju na konzervativno liječenje na raspolaganju je velik izbor kirurških metoda, od otvorene operacije do minimalno invazivnih zahvata. Rak prostate pripada najčešćim malignim bolestima u muškaraca. Mortalitet je u usporedbi s drugim malignim bolestima nizak, jer je spororastući tumor ali starenjem populacije učestalost se povećava. Većina bolesnika umire s njim, a ne od njega. Unatoč tome, specifični i značajni tjelesni, seksualni, emocionalni i mentalni zdravstveni problemi često dovode do loše kvalitete života. Odluka o liječenju ovisi o dobi oboljelog, stadiju bolesti te pacijentovom shvaćanju i prihvaćanju rizika i koristi svakog od mogućih načina liječenja. Kirurški zahvati mogu biti radikalna, laparoskopska i robotski asistirana prostatektomija. Moguće posljedice zahvata su inkontinencija i erektilna disfunkcija. Uloga medicinske sestre od velike je važnosti. Sama pomisao da može biti inkontinentan kod pacijenta izaziva odbojnost, strah i nelagodu i zato je važno da uz sebe ima empatičnu i educiranu osobu. Rehabilitacija, kako pacijenta tako i obitelji, započinje čekajući operacijski zahvat. Sestra ga educira o važnosti vježbanja koje uključuje aerobne vježbe, trening otpora i vježbe zdjelične muskulature. Sestra mora uspostaviti odnos povjerenja, pružati emocionalnu podršku i hrabriti pacijenta da se što prije suoči s činjenicama. Planovi zdravstvene njege izrađuju se za svakog pacijenta posebno, na osnovi sustavno i cjelovito utvrđenih potreba, kako prije zahvata, tako tijekom i nakon operacije. Provođenje standardiziranih postupaka te intezivne mjere prevencije očekivanih komplikacija predstavljaju ključni korak u liječenju. Nakon zahvata sestrinska skrb je usmjerena na sprječavanje i ublažavanje komplikacija koje nastaju kao posljedica operacije kao i stanja nakon toga. Od izuzetne je važnosti znati na vrijeme prepoznati potencijalno životno ugrožavajuća stanja kao što je npr. krvarenje, obavijestiti liječnika i pravovremeno intervenirati. Zdravstvena skrb kod otpusta se nastavlja edukacijom pacijenta i obitelji o toaleti urinskog katetera, pravilnoj prehrani, o nastavku vježbanja jačanja mišića zdjelice, uključivanja u grupe za potporu, važnosti redovitih kontrola. Tijekom cijelog vremena sestra mora biti profesionalna, empatična, poticati ga da usvoji vještine samozbrinjavanja kako bi se što prije vratio u život kakav je vodio prije operacije. The most common reason for a man to visit a urologist are the symptoms of the lower urinary tract, the most common cause of which is benign prostatic hyperplasia, which is present in 80 to 90% of men between the ages of 70 and 80. For patients who have significant disorders that do not respond to conservative treatment, a wide range of surgical methods is available, from open surgery to minimally invasive procedures. Prostate cancer is one of the most common malignancies in men. Mortality is low compared to other malignancies because it is a slow-growing tumor but as the population ages, the incidence increases. Most patients die with it, not from it. Nevertheless, specific and significant physical, sexual, emotional, and mental health problems often lead to poor quality of life. The decision to treat depends on the patient's age, stage of the disease, and the patient's understanding and acceptance of the risks and benefits of each of the possible treatments. Surgical procedures can be radical, laparoscopic, and robot-assisted prostatectomy. Possible consequences of the procedure are incontinence and erectile dysfunction. The role of the nurse is of great importance. The very thought of being incontinent causes the patient repulsion, fear and discomfort and that is why it is important to have an empathetic and educated person with you. Rehabilitation, for both the patient and the family, begins with waiting for surgery. The nurse educates him about the importance of exercise that includes aerobic exercise, resistance training, and pelvic floor exercises. The nurse must establish a relationship of trust, provide emotional support, and encourage the patient to face the facts as soon as possible. Health care plans are made for each patient separately, based on systematically and comprehensively identified needs, both before the procedure and during and after surgery. The implementation of standardized procedures and intensive measures to prevent expected complications are a key step in treatment. After the procedure, nursing care is focused on preventing and alleviating the complications that arise as a result of the operation as well as the condition after it. It is extremely important to be able to identify potentially life-threatening conditions such as bleeding in time, inform the doctor and intervene in a timely manner. Discharge health care continues by educating the patient and family about the urinary catheter toilet, proper nutrition, continuing to exercise pelvic floor muscle strengthening, joining support groups, and the importance of regular checkups. At all times, the nurse must be professional, empathetic, encourage him to adopt self-care skills in order to get back to the life he led before the operation.

ilj istraživanja: U ovom istraživanju je napravljena analiza sumnji na nuspojave vezane uz lijekove s djelatnom tvari sildenafil koje su zaprimljene u Agenciji za lijekove i medicinske proizvode (HALMED) u vremenskom razdoblju od 21. ožujka 2009. do 20. travnja 2020. godine. Materijal i metode: Od Agencije za lijekove i medicinske proizvode (HALMED) zatraženi su podatci o zaprimljenim sumnjama na nuspojave za lijekove koji sadrže djelatnu tvar sildenafil prijavljene u Hrvatskoj. Od dobivenih podataka su analizirani dob i spol pacijenta, struka prijavitelja nuspojave, ozbiljnost nuspojave i nuspojave navedene prema MedDRA klasifikaciji po organskim sustavima. Rezultati: U promatranom vremenskom razdoblju prijavljeno je ukupno devetnaest sumnji na nuspojave, a od toga su petnaest slučajeva prijavile osobe muškog spola. Od ukupnog broja prijava, devet (47,37%) je okarakterizirano kao ozbiljna nuspojava. Liječnici su prijavili 47,37%, farmaceuti 31,58%, pacijenti 15,79%, a ostali zdravstveni djelatnici 5,26 % sumnji na nuspojave. Većina pacijenata pripadaju dobnoj skupini od 30 do 70 godina (73,68%). Najviše sumnji na nuspojavu, prema MedDRA klasifikaciji, odnosilo se na skupinu poremećaja živčanog sustava (18,37%), srčane poremećaje (16,33%) te opće poremećaje i reakcije na mjestu primjene (14,29%). Zaključci: Nuspojave najčešće prijavljuju liječnici za pacijente muškog spola, od čega je ozbiljnih 40%. Obzirom da je broj prijava od 2009. godine samo devetnaest, trebalo bi potaknuti zdravstvene djelatnike i pacijente na češće prijavljivanje sumnji na nuspojave lijekova., Objective: In this study an analysis was made of suspected drug-related side effects with the active substance sildenafil received at the Agency for Medicinal Products and Medical Devices (HALMED) in the period from 21 March 2009 to 20 April 2020. Patients and Methods: The Agency for Medicinal Products and Medical Devices (HALMED) was requested to provide information on suspected side effects for medicine containing the active substance sildenafil reported in Croatia. From the obtained data, the age and sex of the patient, the profession of the reporters, the severity of the adverse reaction and the adverse reactions listed according to the MedDRA classification by organ systems were analyzed. Results: In the observed time period, a total of nineteen suspected adverse reactions were reported, of which fifteen cases were reported by males. Of the total number of reports, nine (47.37 %) were characterized as serious side effects. Doctors reported 47.37%, pharmacists 31.58%, patients 15.79%, and other health professionals 5.26% of suspected side effects. Most patients belong to the age group of 30 to 70 years (73.68%). According to the MedDRA classification, the most suspected side effects were related to the group of nervous system disorders (18.37%), cardiac disorders (16.33%) and general disorders and reactions at the site of application (14.29%). Conclusion: Side effects are mostly reported by doctors for male patients, of which 40% are serious. Given that the number of reports since 2009 is only nineteen, healthcare professionals and patients should be encouraged to report suspected adverse drug reactions more frequently.

Endocrinopathies are relatively rare causes of erectile dysfunction. Cases of hyperprolactinemia and pituitary adenomas have been previously reported. We present a clinical case of a 27-year-old male with suspected infertility and recent symptoms of erectile dysfunction. Additional radiological and endocrinologic workup revealed underlying subependymoma, which was expanding in the sellar and suprasellar regions, causing pressure against the pituitary gland. The resulting endocrine disorder caused problems that were subjectively at first manifested mainly as erectile dysfunction. The case is an educative example pointing to the need of taking possible intracranial lesions in consideration when starting workup in a patient presenting with erectile dysfunction. It may be of broad clinical interest not only for endocrinologists but also for practitioners in various fields., Endokrinopatije su relativno rijetki uzroci erektilne disfunkcije. Prethodno su opisani slučajevi hiperprolaktinemije i adenoma hipofize. Mi prikazujemo klinički slučaj 27-godišnjeg muškarca sa sumnjom na neplodnost i nedavnim simptomima erektilne disfunkcije. Dodatna radiološka i endokrinološka obrada otkrila je u podlozi subependimom s ekspanzijom u selarnoj i supraselarnoj regiji, s kompresijom na hipofizu. Posljedični endokrini poremećaj uzrokovao je probleme koji su se prvobitno subjektivno manifestirali pretežno kao erektilna disfunkcija. Slučaj je edukativni primjer koji upućuje na to da je kod bolesnika koji se prezentira s erektilnom disfunkcijom pri započinjanju obrade potrebno uzeti u obzir moguće intrakranijske lezije. Slučaj bi mogao biti klinički zanimljiv ne samo za endokrinologe, nego i za praktičare iz drugih stručnih područja.

Erektilna disfunkcija je pogosta težava moških v vseh starostnih obdobjih. Kljub temu, da to stanje ne ogroža življenja prizadetih moških, pa v veliki meri vpliva na kakovost življenja, saj je spolno zdravje pomemben del splošnega zdravja posameznika. Ob težavah, ki jih imajo moški zaradi erektilne disfunkcije, so prizadete tudi njihove partnerke in na ta način trpi tudi medsebojni odnos med prizadetim moškim in njegovo partnerko, tako da ima erektilna disfunkcija tudi psihološke in socialne negativne posledice. Vseeno pa le manjši del prizadetih poišče strokovno pomoč in je tudi deležen zdravljenja svojih težav. Razlogi, zaradi katerih se moški ne odločijo za obravnavo in zdravljenje težav z erekcijo, so slabo poznani in raziskani. Dejstvo je, da so pri teh moških pogosta spremljajoča obolenja. Možno je, da le ta vplivajo na odločitev moških glede iskanja pomoči za svoje težave. Cilj te disertacije je raziskava vpliva resnosti spremljajočih obolenj na pripravljenost moških za zdravljenje erektilne disfunkcije. V raziskavo sem vključil 486 moških, ki sem jih glede na stopnjo resnosti spremljajočega obolenja razvrstil v tri skupine. V prvo skupino sem uvrstil moške z akutnimi stanji brez pridruženih obolenj, v drugo skupino moške z blažjimi kroničnimi obolenjiin v tretjo skupino moške s težjimi kroničnimi in malignimi obolenji . Preiskovance sem povabil k sodelovanju pri njihovem obisku svojega osebnega zdravnika in jih glede na razlog obiska razvrstil v naštete skupine. Z namenom, da bi pridobili čimbolj primerljive skupine bolnikov, se je vključevanje začelo v istem mesecu pri vseh sodelujočih zdravnikih splošne in družinske medicine. S tem sem se izognil vplivu sezonskih obolenj. Vsi moški, ki so pristali na sodelovanje, so izpolnili vprašalnik, v katerem so odgovorili na vprašanje o pomembnosti spolnosti v njihovem življenju in pripravljenosti za zdravljenje morebitnih težav z erekcijo. Dodatno sem jim postavil vprašanje o tem, ali bi kakšna značilnost načina zdravljenja erektilne disfunkcije kar se tiče zahtevnosti, cene in varnosti, lahko vplivala na njihovo odločitev o pripravljenosti za zdravljenje njihovih težav z erekcijo. Za statistično obdelavo prvih dveh vprašanj je bil uporabljendvostranski z-test, medtem ko je bil za ocenitev odgovorov na tretje vprašanje uporabljen Pearsonov hi-kvadrat test. Analiza dobljenih odgovorov je pokazala, da se moški s težjimi kroničnimi in malignimi obolenji manj zanimajo za spolnost in jim ta predstavlja manj pomemben del njihovega življenja v primerjavi z moškimi brez pridruženih obolenj. Odstotek pozitivnih odgovorov na vprašanje o pomembnosti spolnosti v življenju preiskovancev je bil 72,7 pri prvi in 94,3 pri slednji skupini (p=0,005). Kar se tiče pripravljenosti za zdravljenje morebitnih težav z erekcijo, so moški s težjimi kroničnimi in malignimi obolenji izrazili manjši interes za zdravljenje teh težav tako v primerjavi z moškimi brez pridruženih obolenj kot tudi v primerjavi s tistimi, ki imajo spremljajoče blažje kronične bolezni (69,7%, 88,1% in 89,3% pozitivnih odgovorov). Opisane razlike so bile statistično pomembne (p=0,03, p=0,01). Glede vpliva, ki ga imajo na pripravljenost za zdravljenje težav z erekcijo značilnosti možnega zdravljenja, nisem ugotovil statistično pomembnih razlik v nobenem od preiskovanih značilnosti, tako da pripreiskovancih na pripravljenost za zdravljenje niso vplivali niti cena, niti zahtevnost zdravljenja, niti varnost. Prisotnost težjega kroničnega ali malignega obolenja pri moških je eden izmed razlogov, da se moški ne odločijo za posvet in zdravljenje svojih težav z doseganjem ali vzdrževanjem erekcije, tej skupini moških spolnost tudi predstavlja manj pomemben del njihovega življenja v primerjavi z moškimi brez spremljajočih obolenj. Erectile dysfunction is a common condition that can affect men at any age. Although this condition doesn't represent a life threatening disease for the affected men it nevertheless significantly lowers their quality of life since the sexual health is an important part of overall wellbeing of an individual. The problems with acquiring and sustaining an adequate erection also affect their partners and can therefore also be a reason for the interrelationship problems. In this way the erectile dysfunction has a negative impact psychologically and socially. Despite all this only a small fraction of affected men seeks professional help and are treated for this condition. The reasons for this lack of interest to seek help for erectile dysfunction is poorly known or researched. The fact is that these men frequently have an underlying disease. It is possible that these underlying conditions influence men when considering getting help for their problems with erections. We have studied the possible impact of such an underlying disease on willingness to seek help for impaired erections. 486 men were included in the study and assigned to one of the three groups based on the severity of their underlying disease. First group included men with acute conditions with no underlying disease. The second group included men with mild chronic conditions, whereas men with severe chronic and malignant illnesses formed the third group. We recruited men into the study during their visit to their general practitioner and assigned them into the aforementioned groups according to the reason for their visit. The recruitment of the individuals has started in the same month at all the participating physicians thus avoiding the influence of seasonal diseases. All men were asked a question about the importance of sexual activity in their lives and about the willingness to be treated for erectile dysfunction if such arose. We additionally asked men if a specific characteristic of the treatment modality regarding the price, safety and aggressiveness could influence their decision about being treated or not. Two proportion z-test was used to analyze the answers to the first two questions while the Pearson's Chi-Squared Test was used to analyze the answers to the third question. Analysis of the answers indicated that men with severe chronic and malignant diseases show less interest in sexual activity and that this is less important to them in comparison with men with no underlying disease. The percentage of positive answers to the question about the importance of sexuality in their lives was 72,7 in first and 94,3 in the last group. As far as willingness to treat a coexisting erectile dysfunction, men with severe chronic and malignant diseases showed less interest when compared to men with mild coexisting chronic conditions or with no underlying chronic health issues (69,7%, 88,1% and 89,3% of positive answers, respectively). The mentioned differences were statistically significant. The influence of different characteristics of the treatment modalities was not proven as the differences between the answers to the third question among groups were not statistically significant. A coexistence of a severe chronic or malignant disease is one of the reasons why men don't seek help and are not treated for their inability to develop or maintain a satisfying erection.

Although phosphodiesterase 5 (PDE 5) inhibitors represent the gold standard for medical treatment of erectile dysfunction (ED), they are not curative. Over recent years, low-intensity extracorporealshock wave therapy (LI-ESWT) has been proposed as a valid non-invasive therapy approach for erectile dysfunction. The aim of our work is to assess the shortened, threeweek low-intensity extracorporeal shock wave treatment of vasculogenic erectile dysfunction. The study involved a total of 32 patients with an International Index of Erectile Function (IIEF) score between 5 and 20, and whose vasculogenic ED had been proven through Doppler ultrasound. All patients had a washout period of 1 month after previous therapy and agreed to discontinue the PDE5-I tgerapy during the follow-ap. The patients were evaluated at baseline, after 1, 3 and 6 months, with the IIEF, Doppler ultrasound and Beck Depression Inventory (BDI). All investigated parameters ( International Index of Erectile Function, Beck Depression Inventory and penile Doppler ultrasound parameters) showed statistically significant improvement just one month after the treatment, compared to pre-treatment values, in all investigated domains. The international index of erectile function passed from baseline values of 12.75 ± 4.62 to 14.87 ± 5.04 at one month after treatment (p

This study aimed to investigate whether infertility and its treatment affect couple sexuality. A systematic literature review was performed, focusing on female and male sexual dysfunctions due to infertility. The method was descriptive, using a meta-synthesis of scientific research published between 2012 and 2017 in the English language. The search for suitable studies was carried out with the research databases Medline, CINAHL, PubMed and ScienceDirect using the following keywords: infertility, sexual dysfunctions, cou-ple. It can be concluded that infertility negatively affects the sexuality of an infertile couple, which is fur-ther proven by a high percentage of sexual dysfunctions (43%-90% among women and 48%-58% among men). Couples report less satisfaction with sexuality. Since lower satisfaction and dysfunctions are closely connected with infertility and its treatment, couples might benefit from sexual therapy and support during the process of infertility treatment. Further research should focus on the evaluation of different psycholog-ical interventions that would address sexuality in couples when diagnosed and treated for infertility., Ova studija je imala za cilj istražiti utjecaj neplodnosti i njezinog liječenja na seksualnost para. Izvršena je sustavna analiza literature s naglaskom na seksualnu disfunkciju žena i muškaraca zbog neplodnosti. Metoda je bila opisna uz primjenu meta-sinteze znanstvenih istraživanja objavljenih između 2012. i 2017. godine na engleskom jeziku. Pretraživanje odgovarajućih studija provedeno je u bazama podataka Medline, CINAHL, PubMed i ScienceDirect koristeći sljedeće ključne riječi: neplodnost, seksualne disfunkcije, par. Može se zaključiti da neplodnost negativno utječe na seksualnost neplodnog para, što dodatno dokazuje visok postotak seksualnih disfunkcija (43%-90% među ženama i 48%-58% među muškarcima). Parovi iskazuju manje zadovoljstvo u seksualnom odnosu. Budući da su slabije zadovoljstvo i disfunkcije usko povezane s neplodnošću i njenim liječenjem, parovi bi mogli imati koristi od seksualne terapije i psihološke potpore tijekom procesa liječenja neplodnosti. Daljnja bi se istraživanja trebala usre-dotočiti na evaluaciju različitih psiholoških intervencija koje bi se bavile seksualnošću kod parova kad im se dijag-nosticira i liječi neplodnost.

Seksualni problemi imaju veću učestalost u starijoj životnoj dobi, ali nose manju patnju nego u mlađoj dobi. Cilj ovog rada jest utvrditi učestalost i vrstu seksualnih problema kod osoba koje su se javile u Ambulantu za seksualnu smetnje. Pretraženi su podatci Ambulante za seksualne smetnje Klinike za psihijatriju Vrapče, koja djeluje od 2014. godine. Kroz tu ambulantu prošlo je 589 pacijenata, od čega je 6,8 % bilo starije od 65 godina (40 pacijenata). Među njima bila je samo jedna žena. Većina pacijenata (57 %) imala je erektilnu disfunkciju, dok su ostali seksualni poremećaji bili rijetki. Ni jedan pacijent nije se javio zbog rodne disforije, ni zbog parafilija. Većina pacijenata s erektilnom disfunkcijom imala je organsku podlogu ovog problema. Muškarci starije životne dobi smatraju da im je erektilna disfunkcija izvor patnje te se javljaju na liječenje u ambulantu za seksualne smetnje. Potrebno je posebno obratiti pažnju na organske uzroke erektilne disfunkcije. Dio pacijenata koji se javlja zbog seksualnih smetnji zapravo imaju drugu patologiju (npr. organski sumanuti poremećaj)., Sexual problems have a higher prevalence in old age but are considered less distressing than in younger people. The aim of this study is to determine the prevalence and the type of sexual problems in people who contacted the outpatient clinic for sexual problems. Data from the outpatient clinic for sexual problems of the University Psychiatric Hospital Vrapče, founded in 2014, were analysed. 589 patients were examined in the outpatient clinic for sexual problems, and among them there were 6.8% of those aged 65 and above. There was only one woman. The majority of the patients (57%) were diagnosed with erectile dysfunction, while other sexual problems were rare. None of the patients suffered from gender dysphoria or paraphilias. The majority of the patients with erectile dysfunction had a physical factor influencing the problem. Men aged 65 and above consider erectile dysfunction distressful and seek treatment in outpatient clinic for sexual problems. It is important to pay special attention to physical factors influencing erectile dysfunction in this group. A small subgroup of patients think they have sexual problems but actually have other psychological problems (e.g. organic delusional disorder).

Cilj: Istraživanje seksualnog zdravlja u adolescenata uglavnom se temelji na rizičnom ponašanju i zdravstvenim ishodima, dok se seksualna disfunkcija u adolescenciji rijetko ispituje. Glavni cilj ovoga istraživanja bio je utvrditi učestalost erektilne disfunkcije i prerane ejakulacije među seksualno aktivnim studentima prve godine visokih škola i fakulteta te povezanost s njihovim zadovoljstvom seksualnim životom. Metode: Ukupno je 174 studenata prve godine samostalno ispunilo anonimni anketni list o medicinskim podacima, rizičnim čimbenicima ponašanja i seksualnom životu. Rezultati: Ispitivanje je pokazalo učestalost erektilne disfunkcije od 17,8% i prerane ejakulacije od 9,8%. Samo je 4,6% ispitanika potvrdilo teškoće s erekcijom. Vjerojatnost nastupa erektilne disfunkcije sedam puta je veća kod mladića koji nisu zadovoljni svojim osobnim seksualnim životom (OR 6,75; CI 2,85-15,85; p, Purpose: Research on adolescent sexual health is mainly based on risky behaviour and health outcomes, whereas sexual functioning in adolescence is poorly investigated. The main aim of the study was to determine the prevalence of erectile dysfunction and premature ejaculation among sexually active fi rst-year male college and university students, and its association with sexual life satisfaction. Methods: A total of 174 fi rst-year male college students fi lled out an anonymous, self-administered questionnaire on medical information, behavioural risk factors, and sexual life. Results: The current study showed the prevalence of erectile dysfunction and premature ejaculation of 17.8% and 9.8%, respectively. Only 4.6% of the participants acknowledged erection diffi culties. Young men dissatisfi ed with personal sexual life had a seven-fold greater probability to experience erectile dysfunction (OR 6.75; CI 2.85-15.85; p

Erectile dysfunction (ED) is a highly prevalent disorder among renal transplant recipients. Vitamin D deficiency (VDD) has been associated with several ED risk factors but only recently directly linked to ED. We conducted a study to investigate whether vitamin D serum levels were associated with the presence and severity of ED in 40 male patients that underwent deceased donor kidney transplantation (TX) from 2001 to 2013. Blood samples were collected on two seasonally distinct occasions and 25(OH)D concentration was assessed by radioimmunoassay. A 5-item version of the International Index of Erectile Function (IIEF-5) was used for ED evaluation and group stratification. We found comparable rates of ED (75%) and VDD (42.5%-62.5%) as in previously published studies. Serum levels of 25(OH)D did not differ between patients with and those without ED on both measurements (p=0.656 and p=0.914, respectively), or when comparing different ED severity groups. Duration of renal replacement therapy before TX and graft duration until analysis were longer in patients with ED (p=0.022 and p=0.05, respectively), but with the results being nonsignificant on logistic regression. In conclusion, we found no association of 25(OH)D concentration with the presence and severity of ED in renal transplant recipients. So far, there are no similar published data., Erektilna disfunkcija (ED) je poremećaj visoke učestalosti u bolesnika nakon transplantacije bubrega. Deficijencija vitamina D (VDD) je već ranije povezana s nekoliko rizičnih čimbenika za ED, ali je tek nedavno dovedena u izravnu vezu s ED. U predmetnom smo istraživanju ispitali je li serumska vrijednost vitamina D povezana s prisutnošću i jačinom izraženosti ED u 40 muških ispitanika u kojih je kadaverična transplantacija bubrega (TX) učinjena od 2001. do 2013. godine. Serumsko uzorkovanje je učinjeno u dva sezonski različita razdoblja, uz mjerenje koncentracije vitamina D radioimuno testom. Upitnik International Index of Erectile Function(IIEF-5) korišten je za stratifikaciju bolesnika s obzirom na jačinu ED. Pronašli smo usporedivu učestalost ED (75%) i VDD (42,5%-62,5%) kao u dosad objavljenim istraživanjima. Ni u jednom mjerenju nije utvrđena razlika u serumskim vrijednostima 25(OH)D između ispitanika s ED i bez nje (p=0,656 i p=0,914), kao ni među ispitanicima s različito izraženom ED. Trajanje bubrežne nadomjesne terapije (RRT) prije TX i “trajanje” transplantata do analize bilo je duže za ispitanike s ED (p=0,022 odnosno p=0,05), no samo u univarijatnoj analizi. Zaključno, nismo pronašli povezanost između serumske razine 25(OH)D i prisutnosti te jačine izraženosti ED. Prema našim spoznajama, dosad nema sličnih objavljenih rezultata za navedenu populaciju bolesnika.

U ovom se istraživanju ispitivala klinička praksa liječnika dijabetologa i dijabetoloških medicinskih sestara u vezi sa seksualnom disfunkcijom (SD) u hrvatskih bolesnika sa šećernom bolešću. Uključeno je 39 liječnika i 33 medicinske sestre, koji su anonimnim upitnikom dali podatke o svojim osobnim karakteristikama, učestalosti pitanja bolesnika sa šećernom bolešću o SD-u, vjerojatnosti da o tim smetnjama pitaju bolesnike s različitim medicinskim i nemedicinskim karakteristikama te o svojoj procjeni prepreka uključivanju SD-a u redovitu dijabetološku praksu. Dvije trećine liječnika (n = 26) i najveći dio medicinskih sestara (n = 28) o SD-u pita manje od polovine muškaraca s dijabetesom; 7,7 % dijabetologa o SD-a pita gotovo svakog bolesnika, a 15,4 % o tome ne pita gotovo nijednog bolesnika. Više od polovice medicinskih sestara (n = 17) o seksualnoj disfunkciji ne pita gotovo nijednog bolesnika. Dijabetolozi o SD-u najvjerojatnije pitaju bolesnike s trajanjem dijabetesa dužim od 10 godina te sa simptomatskim (ali ne krajnjim) komplikacijama šećerne bolesti. Također, o SD-u vjerojatnije pitaju bolesnike koje doživljavaju ugodnima u komunikaciji, kao i bolesnike koji su mlađi, urbani, oženjeni i za koje pretpostavljaju da su boljih imovinskih prilika. Glavne prepreke uključivanju SD-a u dijabetološku obradu uključuju brigu da bi to bolesnicima bilo nelagodno te nedostatak znanja i vremena za liječenje te smetnje., This paper researched the clinical practice of diabetologists and diabetes nurses regarding sexual dysfunction (SD) in Croatian patients with diabetes. It included 39 physicians and 33 nurses, who filled out an anonymous questionnaire concerning their personal characteristics, the frequency of patients inquiring about SD, the likelihood that they will ask patients with particular medical and non-medical characteristics about SD, and the barriers to including SD in regular diabetology practice. Two-thirds of physicians (n = 26) and the majority of nurses (n = 28) inquire about SD in less than half of men with diabetes; 7,7% diabetologists ask almost every patient about SD, and 15,4% of doctors and 54,8% of nurses ask almost none of the patients. Diabetologists are more likely to inquire about SD in patients who had diabetes longer than 10 years, and in those who have symptomatic (but not end-stage) chronic diabetes complications. They are more likely to ask about SD patients whom they perceive to be pleasant in communication, and patients who are younger, urban, married, and in a better material situation. The chief barriers include concern that patients may be uncomfortable with questions about sexuality, and a lack of knowledge and time to treat the SD.

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.

Erektilna se disfunkcija, prema više autora, pojavljuje u više od 50 % muškaraca, napose srednje i više dobi, koji boluju od arterijske hipertenzije. Arterijska hipertenzija, ali i neki lijekovi koji se uporabljuju u njezinu liječenju, mogu nizom patofizioloških mehanizama (ateroskleroza na krvnim žilama koje opskrbljuju tkiva odgovorna za erekciju, simpatikotonija i disregulacija vaskularnog tonusa erektilnog aparata, loša remodelacija i sniženje elastičnosti krvnih žila erektilnog aparata, promjene u strukturi kavernoznog tijela te povećanje koncentracije slobodnih radikala i peroksidacije lipida u penilnome tkivu) uzrokovati poremećaje erekcije. Nasuprot tomu, ima više istraživanja u posljednjih petnaestak godina koja dokazuju pozitivan utjecaj valsartana u poboljšanju erektilne disfunkcije, pa i orgazmične funkcije, spolne želje i zadovoljstva spolnim odnosom te u povećanju njihova broja u bolesnika koji boluju od arterijske hipertenzije. Osnovni mehanizam toga djelovanja jest inhibicija lokalnog angiotenzin- konvertirajućeg enzima, ali postoje i drugi posredni mehanizmi. Stoga se može zaključiti da valsartan, uz dobru antihipertenzivnu učinkovitost, tolerabilnost i organoprotektivni učinak, ima naglašeni proerektilni učinak te je dobar izbor u bolesnika s arterijskom hipertenzijom i erektilnom disfunkcijom, osobito ako je riječ o pretilim bolesnicima i bolesnicima sa šećernom bolešću. Istraživanjima na životinjskom modelu pokazano je da bi valsartan mogao biti i dobro terapijsko sredstvo za erektilnu disfunkciju u dijabetičara, no za potvrdu takve tvrdnje potrebna su dodatna istraživanja na humanom modelu., According to multiple authors, erectile dysfunction manifests in over half of the male population with arterial hypertension, especially in middle-aged or older men. Arterial hypertension, but also some of the medication used to treat it, can lead to erectile dysfunction through a number of pathophysiological mechanisms (atherosclerosis in the blood vessels supplying the tissue responsible for the erection, sympathicotonia and dysregulation of the vascular tonus of the erectile organ, poor remodeling and lowered elasticity of blood vessels in the erectile organ, changes in the structure of the cavernous body, and increased concentration of free radicals and lipid peroxidation in the penile tissue). On the other hand, several studies over the recent 15 years have found a positive influence of valsartan on the improvement of erectile dysfunction, as well as orgasmic function, sex drive, and intercourse satisfaction and frequency in patients with arterial hypertension. The basic mechanism that leads to these effects is inhibiting the local angiotensin converting enzyme, but other indirect mechanisms are at play as well. We can thus conclude that valsartan, in addition to good antihypertensive effectiveness, tolerability, and organoprotective effects, has a pronounced pro-erectile effect and is a good treatment choice in patients with arterial hypertension and erectile dysfunction, especially in patients with obesity and diabetes; confirming this hypothesis, however, will require further studies in a patient model.

Erektilna je disfunkcija (ED) nemogućnost postizanja i održavanja erekcije dostatne za zadovoljavajući odnošaj. Zbog starenja populacije i komorbiditeta ED postaje sve važniji zdravstveni problem, koji smanjuje kvalitetu života i narušava odnose među partnerima. Smatra se da od ED-a boluje više od polovice muškaraca u dobi od 40 do 70 godina. Danas se smatra da ED nije bolest nego jedan od najranijih simptoma endotelne disfunkcije i bolesti krvnih žila te jedan od najvažnijih prediktora razvoja teže KV bolesti. S napretkom peroralne terapije i slabim rezultatima rekonstruktivne kirurgije danas se pacijenti sve brže i ranije podvrgavaju terapiji, a komplicirana, invazivna dijagnostika provodi se samo u rijetkim slučajevima. Terapija prvog izbora u liječenju ED-a, neovisno o etiologiji, jesu inhibitori fosfodiesteraze 5. Članak prikazuje etiologiju, patogenezu, dijagnostiku i aktualne preporuke za terapiju ED-a., Erectile dysfunction (ED) has been defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Although ED is a benign disorder, it affects physical and psychosocial health and has a significant impact on the quality of life of sufferers and their partners. Recent epidemiological data have shown a high prevalence and incidence of ED worldwide and it is assumed that ED is bothering more than half of men aged 40-70 years. Today, ED is not considered a disease but one of the very early symptoms of cardiovascular disease, and it is in most cases caused by organic changes. New oral therapies have completely changed the diagnostic and therapeutic approach to ED. Phosphodiesterase-5 inhibitors are considered to be the first line treatment for all types of ED, regardless of its cause. The article presents the etiology, pathogenesis, diagnosis, and current recommendations for ED treatment.