Erectile dysfunction is common in the patient with cardiovascular disease. It is an important component of the quality of life and it also confers an independent risk for future cardiovascular events. The usual 3-year time period between the onset of erectile dysfunction symptoms and a cardiovascular event offers an opportunity for risk mitigation. Thus, sexual function should be incorporated into cardiovascular disease risk assessment for all men. A comprehensive approach to cardiovascular risk reduction (comprising of both lifestyle changes and pharmacological treatment) improves overall vascular health, including sexual function. Proper sexual counselling improves the quality of life and increases adherence to medication. This review explores the critical connection between erectile dysfunction and cardiovascular disease and evaluates how this relationship may influence clinical practice. Algorithms for the management of patient with erectile dysfunction according to the risk for sexual activity and future cardiovascular events are proposed.

Erectile dysfunction in the cardiovascular patient

We review our experience with Melanotan II, a non-selective melanocortin receptor agonist, in human subjects with erectile dysfunction (ED). Melanotan II was administered to 20 men with psychogenic and organic ED using a double-blind placebo-controlled crossover design. Penile rigidity was monitored for 6 h using RigiScan. Level of sexual desire and side effects were reported with a questionnaire.In the absence of sexual stimulation, Melanotan II led to penile erection in 17 of 20 men. Subjects experienced a mean of 41 min Rigiscan tip rigidity>80%. Increased sexual desire was reported after 13/19 (68%) doses of Melanotan II vs 4/21 (19%) of placebo (P<0.01). Nausea and yawning were frequently reported side effects due to Melanotan II; at a dose of 0.025 mg/kg, 12.9% of subjects had severe nausea. We conclude that Melanotan II is a potent initiator of penile erection in men with erectile dysfunction. Our findings warrant further investigation of melanocortin agonists and antagonists on penile erection.

Melanocortin receptor agonists, penile erection, and sexual motivation

Microablative fractional CO2-laser therapy and the genitourinary syndrome of menopause: An observational study.

Objectives: To assess the effect of microablative fractional CO2 laser (MFCO2-Laser) therapy on the vaginal microenvironment of postmenopausal women.Methods: Three laser therapies at monthly intervals were applied in postmenopausal women with moderate to severe symptoms of genitourinary syndrome of menopause, pH of vaginal fluid >4.5 and superficial epithelial cells on vaginal smear <5%. Vaginal fluid pH values, fresh wet mount microscopy, Gram stain and aerobic and anaerobic cultures were evaluated at baseline and 1 month after each subsequent therapy. Nugent score and Hay-Ison criteria were used to evaluate vaginal flora.Results: Fifty-three women (mean age 57.2 ± 5.4 years) participated and completed this study. MFCO2-Laser therapy increased Lactobacillus (p < 0.001) and normal flora (p < 0.001) after the completion of the therapeutic protocol, which decreased vaginal pH from a mean of 5.5 ± 0.8 (initial value) to 4.7 ± 0.5 (p < 0.001). The prevalence of Lactobacillus changed from 30% initially...

The effect of microablative fractional CO2 laser on vaginal flora of postmenopausal women.

The need for safety represents one of the fundamental human needs. Coming to a new and unfamiliar environment (healthcare institution), as well as worries about diagnostic and therapy procedures may result in fear and the feeling of insecurity in patients. Patients expect to be treated in the best possible manner and that their condition will improve, as well as that procedures implemented within their treatment will not lead to deterioration of their condition. An equally wide choice and preferential treatment within healthcare activities is today expected the same as from any other service. Thus, a great attention has recently been paid to achieving, maintaining, measuring and improving healthcare quality. Investing in patient safety and quality improvement is economically efficient for a healthcare subject, as well as for the wider community as a whole. It is necessary to develop a system that will ensure the implementation of nursing care in compliance with accepted standards, systematic collection and analysis of data on undesired events, error-based learning and setting up standards according to which it will be possible to measure the safety and quality of nursing care. As nurses spend a significant part of their working hours in direct contact with patients and frequently act as coordinators of the patients’ overall healthcare treatment, they must tend to quality and improvement of their services and the safety of patients they provide care for. Providing nursing care lead by a well-thought integration of the best available scientific insights and clinical experience allows for critical assessment of research data, guidelines and other sources of information in order to identify the problem correctly and apply the best interventions. The improvement and development of healthcare quality (patient safety) requires knowledge, selection and application of specific methods and tools adapted to the possibilities of individual healthcare institutions. Better care improves the overall treatment quality, which contributes to safe treatment oriented towards achieving positive healthcare outcomes, which results in the reduction of costs for individuals, family, employers and the society.

https://repozitorij.mef.unizg.hr/islandora/object/mef:304/datastream/PDF/download

Sveučilište u zagrebu medicinski fakultet sveučilišni diplomski studij sestrinstva

This paper briefly describes the POP–Q system, by comparison with other staging systems, analyzing its main features and the concept behind it

Pelvic Organ Prolapse Quantification System (POP-Q) - a new era in pelvic prolapse staging.

During the last decades, erectile dysfunction was considered a direct consequence of aging and, although of a great concern for the affected patient, little was available to evaluate and treat this problem. If aging could not be invoked in all cases, than the psychogenic etiology was the only explanation. Over the coming years, a better understanding of the physiology involved in the penile process of tumescence and detumescence has allowed for better approach of each disease asociated with erectile dysfunction so that adequate treatment modalities can be applied to the pacient. As we all know, every pacient is a particular case. The development of modern PDE–5 inhibiters, along with other more or less invasive therapies, puts a new light on the medical approach of ED.

Diagnosis and treatment of erectile dysfunction--a practical update.

There are still many things to be found out about interstitial cystitis/painful bladder syndrome (IC/PBS) because the pathological processes underlying the condition are not yet elucidated, biological markers of the condition are not yet available, and the type and severity of symptoms can vary, so, clearly defining the condition is not yet possible. For example, it is not clearly understood whether IC/PBS represents a systemic disease, if it is localized in the bladder, or if it was initially localized in the bladder and it later evolved into a systemic disease. This condition is best managed by using a multidisciplinary approach. Management requires a good integration and knowledge of all pelvic organ systems and other systems including musculoskeletal, neurologic, and psychiatric systems.

From interstitial cystitis to chronic pelvic pain.

BPH remains one of the most common disease that the urologist has to manage. The last decade brought numerous new techniques, aiming to improve the minimally invasive approach to BPH, but none had, for the moment, changed the place of TURP as the gold standard treatment for medium sized prostates.

Based on a large personal experience, the authors present a study in which TURP is used for prostates over 80ml, the cutoff point set by the guidelines of the European Association of Urology. The rationale for this study is that many situations require minimally invasive treatment, based on the express request of the patient, other conditions that makes open surgery very difficult or impossible, or the need for a quick discharge in an overcrowded service. The aim of the study was to prove that TURP is safe and effective even in larger prostates. The technique used is basically the classic one, with minor tactical alterations in some cases. Some cases required a two-stage approach, but offered good functional results after the first stage. The results proved that, with a good technique, a skilled urologist might achieve the same results by using TURP or open surgery for large sized prostates.

TURP for BPH. How large is too large

Introduction. The standard treatment for upper urinary tract urothelial cell carcinoma (UUT-UCCs) is radical nephroureterectomy with bladder cuff excision. The endoscopic treatment was introduced with promising results in selected cases. The purpose of this study was the retrospective analysis of the factors that can influence the prognosis of the patients with UUT-UCCs who underwent endoscopic treatment.

Patients and method. We identified 187 patients who where diagnosed and treated for UUT-UCCs, between 1998 – 2011, in the Urology Department of “Sf. Ioan” Clinical Emergency Hospital, Bucharest. The endoscopic treatment was used in 65 cases. The indications for endoscopic treatment were imperative (41 cases) or elective (24 cases). The retrograde approach (rigid or flexible) was used in 47 cases, while the anterograde approach was preferred in 18 cases. Tumor ablation was performed using electroresection or Nd:YAG laser. The mean follow-up period was 60 months (range between 6 and 120 months). The follow-up protocol included computed tomography or intravenous urography, urinary cytology (selected cases), cystoscopy and ureteroscopy. The recurrence rates were reviewed by retrospective analysis. 

Results. During follow-up 31 patients (47.6%) presented upper urinary tract recurrence. In 20 cases (30.7%) bladder recurrence was present. The median time from diagnosis to first recurrence was of 12.6 months. 18 patients (27.69%) underwent subsequent nephroureterectomy. The survival rates without recurrence at 1, 3 and 5 years were 61% (40 patients), 55.3% (36 patients) and 52.3% (34 patients). The most significant prognostic factors were: history of bladder tumour, tumour location and size, tumour stage and grade. The recurrence rate for pyelocaliceal tumours was 53.84% (21 out of 39 cases) and only 45.45% (10 out of 26 cases) for ureteral tumours. The recurrence rate for low-grade tumours was 36,36% (16 out of 44 cases) and 71.42% (15 out of 21 cases) for high-grade tumours. The tumours over 1.5 cm were associated with a higher recurrence rate compared with tumours below 1.5 cm (64.2 versus 43.13%). 

Conclusions. Endoscopic management of UUT-UCCs offers the advantage of preserving of renal function. Laser treatment of malignant urothelial lesions in the upper urinary tract should be reserved for a selected patient. The most important prognostic factors for UUT-UCCs evolution are tumours location, size and mostly tumour grade. The patients’ compliance is very important for detecting recurrences. 

Abbreviations UUT-UCCs - Upper urinary tract urothelial cell carcinomas

C. Persu

Papers

Pelvic Organ Prolapse Quantification System (POP-Q) - a new era in pelvic prolapse staging.

Diagnosis and treatment of erectile dysfunction--a practical update.

From interstitial cystitis to chronic pelvic pain.

TURP for BPH. How large is too large

Prognostic factors in laser treatment of upper urinary tract urothelial tumours