Introdução: A disfunção erétil (DE) é definida como a incapacidade de alcançar ou manter a ereção do pênis para um desempenho sexual satisfatório, contribuindo significativamente para a baixa qualidade de vida e morbidade psicossocial masculina. A endotelina-1 (ET-1), um potente peptídeo vasoconstritor que promove contração lenta e sustentada em células de músculo liso vascular, possui grande importância na fisiopatologia da DE. Diversos estudos mostram que o aumento da expressão de mediadores inflamatórios está intimamente ligado ao desenvolvimento da DE. O inflamassoma é um complexo multiprotéico do sistema imune inato que atua através da ativação da caspase-1 e resulta na maturação de citocinas pró- inflamatórias, tais como interleucina- IL (IL-l?). O receptor NLRP3 faz parte do inflamassoma e sua ativação leva a clivagem de caspase-1 e consequente secreção de IL-1?. A ET-1, também possui papel importante na inflamação crônica vascular, mediando a liberação de citocinas pró-inflamatórias. No entanto, ainda é desconhecido se a ação pró- inflamatória da ET-1 em células de músculo liso é mediada pela ativação da via do inflamassoma. Hipótese: A ET-1 ativa o NLRP3 em células do músculo liso do corpo cavernoso (CMLCC), promovendo alterações na reatividade do corpo cavernoso (CC). Objetivo: Avaliar o papel da endotelina-1 na ativação do NLRP3 em CMLCC de camundongos. Métodos: CMLCC de camundongos C578BL/6 (WT) e NLRP3-/- foram cultivadas em meio de cultura DMEM acrescido de soro fetal bovino (SFB), 10%, foram pré- incubadas com endotelina-1 nas concentrações de 10-9, 10-8 e 10-7 M, em presença de LPS ou veículo. Avaliamos o efeito da deleção do NLRP3 sobre a reatividade do CC (contratilidade e relaxamento mediante estímulos por campo elétrico e/ou farmacológico). Após, avaliamos o efeito da ET-1 na ativação do NLRP3, nas alterações sobre a reatividade do CC de camundongos WT, e se estas persistiriam nos camundongos NLRP3-/- e caspase1/11-/- . Resultados: As células apresentaram-se fluorescentes para marcação para ?-actina e não para Von Willebrand, caracterizando assim que não houve contaminação com células endoteliais. A incubação com a ET-1 10-7 M por 24 h na presença de LPS ou veículo aumentou a atividade da caspase-1 em CMLCC de camundongos WT e este efeito não ocorreu nas CMLCC de camundongos NLRP3-/-. Não se observou diferença com relação à massa corporal ou massa dos órgãos entre os animais WT e NLRP3-/-. O CC de animais NLRP3-/- apresenta prejuízo para o relaxamento mediado por nitroprussiato de sódio (NPS) quando comparado com as tiras de CC de camundongos WT. A incubação com ET-1 10-7 M por 4 horas promove aumento na contração para fenilefrina (PE) e prejuízo no relaxamento induzido por nitroprussiato de sódio (NPS), e o mesmo efeito não é observado nas tiras de CC de camundongos NLRP3-/- e caspase1/11-/-. Conclusão: O NLRP3 contribui para o aumento na contração e prejuízo no relaxamento produzido pela ET-1 em CC de camundongos, possivelmente através da ativação da caspase-1 / Introduction: Erectile dysfunction (ED) is defined as the inability to achieve or maintain penile erection to perform sexual intercourse, it contributes significantly to the low quality of life and male psychosocial morbidity. Endothelin-1 (ET-1), a potent vasoconstrictor peptide that promotes slow and sustained contraction of vascular smooth muscle cells, has great importance in the pathophysiology of ED. Several studies show that increased expression of inflammatory mediators is closely linked to the development of ED. The inflammasome is a multiproteic complex of the innate immune system that acts through activation of caspase-1, which leads to maturation of pro-inflammatory cytokines such as interleukin-1 beta (IL-l?). The activation of NLRP3 receptor, part of the inflammasome, leads to caspase-1 cleavage and subsequent secretion of IL-1?. ET-1 also plays an important role in chronic vascular inflammation by mediating the release of pro-inflammatory cytokines. However, it is still unknown whether pro-inflammatory actions of ET-1 on smooth muscle cells is mediated by the activation of the inflammasome. Hypothesis: ET-1 activates NLRP3 in smooth muscle cells of the corpora cavernosa (SMCCC), promoting changes in corpus cavernosum (CC) reactivity. Objective: To evaluate the role of endothelin-1 in the activation of the NLRP3 in SMCCC of mice. Methods: SMCCC of C57BL/6 (WT) and NLRP3-/- mice were grown in DMEM culture medium supplemented with bovine fetal serum (FBS) 10%, pre-incubated with endothelin-1 at concentrations of 10-9, 10- 8 and 10-7M, in the presence of LPS or vehicle. We evaluated the effect of the NLRP3 deletion on the reactivity of the CC (contractility and relaxation by electric field and/or pharmacological stimulation). After that, we evaluated the ET-1 effect on activation NLRP3, changes on the reactivity of the CC of WT, and if these alterations would persist NLRP3-/- and caspase1/11-/- mice. Results: The cells presented fluorescent labeling to ?-actin, but not for Von Willebrand factor, characterizing absence of endothelial cells contamination. The incubation with 10-7 M ET-1 for 24 h in the presence of LPS or vehicle increased caspase-1 activity in SMCCC from WT, but not from NLRP3-/- mice. No difference was observed in body mass or weight of the organs between WT and NLRP3-/- animals. The CC from NLRP3-/- animals displayed impaired relaxation mediated by sodium nitroprusside (SNP) when compared to WT CC. The incubation with ET-1 10-7 M for 4 hours promoted an increase in the contraction to phenylephrine (PE) and reduced relaxation induced by sodium nitroprusside (SNP). The same effect was not observed in CC strips from NLRP3-/- and caspase1/11-/- mice. Conclusion: NLRP3 contributes to the increase in contraction and impaired relaxation produced by ET-1 in mice CC, possibly by activation of caspase-1

Bakgrund: Det är känt att erektil dysfunktion, eller impotens, orsakas av förstorad prostata, depression och diabetes. Den typ av erektil dysfunktion som orsakas av diabetes har en mer komplicerad utveckling än övriga orsaker.Syfte: Syftet med denna litteraturöversikt var att belysa sexuellt aktiva mäns erfarenheter av erektil dysfunktion till följd av diabetes mellitus typ 2. Metod: Metoden som valdes var en litteraturöversikt med kvalitativa och kvantitativa artiklar. Datamaterialet bestod av tio kvantitativa och två kvalitativa artiklar. Resultat: Två kategorier identifierades såsom Livet påverkas samt Förståelse för situationen med underkategorier. Konklusion: Det råder kunskapsbrist i fråga om varför män drabbas av erektil dysfunktion. Många män anser inte att det finns någon fungerande behandling. Om kontroll av den erektila funktionen ingick i årskontrollen av diabetes tillsammans med en välgrundad information samt adekvat behandling skulle de drabbade männen och deras partner få bättre insikt och medvetande om problemet. Detta skulle leda till mindre oro, bättre sexuell och mental hälsa samt en bättre relation. / Background: It is commonly known that erectile dysfunction, popularly known as impotence, is caused by several factors including enlarged prostate, depression and diabetes. The erectile dysfunction caused by diabetes has a more difficult progress than other causes.Aim: The aim of this study was to illustrate sexually active men’s experiences of erectile dysfunction caused by diabetes mellitus type 2. Method: The chosen method was a literature review based of qualitative and quantitative articles. Ten quantitative and two qualitative articles were analysed. Results: Two categories were identified, Affects on life and Understanding the situation with subcategories. Conclusions: There is lack of knowledge about why men suffer from erectile dysfunction. Several of the men do not believe there is a treatment for their problem. If erection status was a part of the annual diabetes check-ups as well as valid information and adequate treatment the men and their partner would have better knowledge and awareness about the condition. This would also result in less anxiety, better sexual and mental health and a better relation.

Syfte: Syftet var att beskriva hur män upplever att de påverkats av miktionsproblem och erektil dysfunktion efter radikal prostatektomi. Metod: Examensarbetet utfördes som en litteraturöversikt med tio vetenskapliga studier. Resultat: Upplevelsen av förlorad kontroll vid miktionsproblem var det som främst påverkade männen samt medförde att det sociala livet blev lidande. Männen beskrev hur de var tvungna att planera inför olika sociala tillställningar, vilket upplevdes som stressande och ångestfyllt. Det framkom också att männen oroade sig för urinläckage, stark odör och upplevde möten med oförstående människor som frustrerande. Erektil dysfunktion var den vanligaste komplikationen efter behandling, men miktionsproblem var det som orsakade mest besvär. Det upplevdes som att männen förlorat sin självständighet. Det framkom även att erektil dysfunktion upplevdes av vissa män som den komplikation som gav störst besvär. Erektil dysfunktion påverkade männen och var mycket svårt att hantera. Det var svårt att finna en acceptans för att den erektila dysfunktion kunde vara bestående. Många av männen beskrev att en viktig del i deras liv förlorats, en del av deras maskulinitet. De kände sig ofullständiga och det fanns en rädsla för att förlora sin partner. Slutsats: Studier visar att erektil dysfunktion och miktionsproblem i samband med radikal prostatektomi ger upphov till stress, oro, ångest samt en känsla av ofullständighet.

Να διερευνηθεί η επίδρασης μίας τροποποιημένης τεχνικής ριζικής προστατεκτομής, με διατήρηση της ουρήθρας μέχρι το επίπεδο του σπερματικού λοφιδίου, στα μετεγχειρητικά ογκολογικά και λειτουργικά αποτελέσματα. Ασθενείς και μέθοδοι: Στην προοπτική αυτή μελέτη, 360 ασθενείς που υποβλήθηκαν σε ανοικτή οπισθοηβική ριζική προστατεκτομή από τον Ιανουάριο του 2008 μέχρι τον Απρίλιο του 2012 χωρίστηκαν σε δύο ομάδες. Στους ασθενείς της ομάδας Α πραγματοποιήθηκε η κλασσική ριζική προστατεκτομή ενώ οι ασθενείς της ομάδας Β υποβλήθηκαν στην τροποποιημένη χειρουργική επέμβαση. Τα ογκολογικά αποτελέσματα αξιολογήθηκαν με την παρακολούθηση του PSA και τον έλεγχο βιοχημικής υποτροπής καθώς και με την ύπαρξη θετικών χειρουργικών ορίων. Η μετεγχειρητική ακράτεια εκτιμήθηκε με τον αριθμό πανών/ημέρα καθώς και με τη συμπλήρωση των ερωτηματολογίων ICIQ-SF και IIQ-SF. Η μετεγχειρητική στυτική δυσλειτουργία εκτιμήθηκε με τη συμπλήρωση των ερωτηματολογίων IIEF και SEAR. Επίσης καταγράφηκε και αναλύθηκε η επίδραση της χειρουργικής τροποποίησης στην εμφάνιση μετεγχειρητικών συμπτωμάτων αποθήκευσης των ούρων. Αποτελέσματα: Ογδόντα πέντε ασθενείς εξαιρέθηκαν από τη μελέτη. Από τους 244 ασθενείς που πληρώσουν τα κριτήρια εισόδου, στην ομάδα Α και Β συμπεριλήφθηκαν 115 (47,1%) και 129 (52,9%) ασθενείς, αντίστοιχα. Δεν παρατηρήθηκαν στατιστικά σημαντικές διαφορές στα ποσοστά εμφάνισης θετικών χειρουργικών ορίων (p=0,562) και βιοχημικής υποτροπής (p=0,321). Παρατηρήθηκαν σημαντικά υψηλότερα ποσοστά ακράτειας (p=0,026), επιτακτικότητας (p<0,001) και νυκτουρίας (p<0,001) στους ασθενείς της ομάδας Α στον 1ο μήνα μετεγχειρητικά. Επίσης, υπήρξε στατιστικά σημαντική διαφορά στον αριθμό πανών/ημέρα υπέρ της ομάδας Β στον 1ο (p=0,037), 3ο (p=0,003) και 6ο (p=0,032) μήνα μετά το χειρουργείο. Η διαφορά αυτή, ωστόσο, εξαλείφθηκε στους 12 μήνες μετεγχειρητικά. Παρόμοια αποτελέσματα παρατηρήθηκαν με τις βαθμολογίες των ερωτηματολογίων ICIQ-SF και IIQ-SF, αναδεικνύοντας βελτιωμένα αποτελέσματα στους ασθενείς της ομάδας Β για τους πρώτους 6 μήνες. Δεν παρατηρήθηκαν διαφορές στα ποσοστά εμφάνισης μετεγχειρητικής στυτικής δυσλειτουργίας καθώς και στις βαθμολογίες των ερωτηματολογίων IIEF και SEAR. Συμπεράσματα: Η τροποποιημένη χειρουργική τεχνική με διατήρηση της ουρήθρας μέχρι το επίπεδο του σπερματικού λοφιδίου αποτελεί μία νέα τροποποίηση της κλασσικής τεχνικής, η οποία μπορεί να μειώσει το χρόνο ανάκτησης της εγκράτειας των ούρων σε ασθενείς που υποβάλλονται σε ριζική προστατεκτομή, χωρίς να μειώνει το ογκολογικό αποτέλεσμα και την πρόγνωση της νόσου. / To investigate the effect of a modified surgical technique of open retropubic radical prostatectomy, with preservation of maximal urethral length to the level of verumontanum, in postoperative oncological and functional outcomes. Patients and methods: In this study, 360 patients who underwent open retropubic radical prostatectomy from January 2008 until April 2012 were divided into two groups. Patients of group A underwent the classical procedure of radical prostatectomy as it has been described by Walsh and Donker, while patients of group B underwent the modified technique. The oncological outcomes were evaluated by monitoring PSA value for biochemical failure and by recording the incidence of positive surgical margins. Postoperative incontinence was evaluated by the number of pads/day and through ICIQ-SF and IIQ-SF questionnaires. Postoperative erectile dysfunction was assessed by completing IIEF and SEAR questionnaires. We also recorded and analyzed the effect of the surgical modification in postoperative irritative urinary symptoms. Results: Eighty five patients were excluded from the study. Of the 244 patients who fulfill the inclusion criteria, 115 (47.1%) and 129 (52.9%) patients were included in group A and B, respectively. There was no statistically significant difference in the incidence rates of positive surgical margins (p=0.562) and biochemical recurrence (p=0.321) between the groups. There were significantly higher rates of incontinence (p=0.026), urgency (p<0.001) and nocturia (p<0.001) in patients of group A within the first postoperative month. There was also statistically significant difference in the number of pads/day in favor of group B in 1st (p=0.037), 3rd (p=0.003) and 6th (p=0.032) month after the operation. However, this difference disappeared at 12 months postoperatively. Similar results were observed in the scores of ICIQ-SF and IIQ-SF questionnaires, demonstrating improved outcomes in patients of group B within the first 6 months. There were no differences in the incidence rates of postoperative erectile dysfunction and in the scores of IIEF and SEAR questionnaires, as well. Conclusions: We proposed a modified surgical technique with preservation of maximal urethral length until the anatomical landmark of verumontanum. This technique may reduce the time continence recovery in patients undergoing radical prostatectomy, without compromising the oncological outcome and disease prognosis.

Mokslinis konsultantas: doc. dr. Vidmantas Alekna (Vilniaus universiteto Eksperimentinės ir klinikinės medicinos institutas, biomedicinos mokslai, medicina – 07 B). Darbo tikslas: ištirti Vilniaus mieste gyvenančių senyvo amžiaus vyrų šlapimo nelaikymo ir erekcijos sutrikimų ypatumus bei gyvenimo kokybę. Tyrimo objektas ir metodai. Tiriamųjų grupė sudaryta sluoksninės imties metodu. Apklausti 788 asmenys, gyvenantys Vilniaus m. bendruomenėje ir 168 vyrai – globos įstaigose. Respondentai buvo tiriami interviu metodu, naudojant specifinius ir bendrus klausimynus. Statistinė duomenų analizė atlikta „SPSS 12.0 for Windows“. Pagrindinės išvados. Šlapimo nelaikymo dažnumas tarp Vilniaus m. bendruomenėje gyvenančių 55 metų amžiaus ir vyresnių vyrų yra 17,8 proc., o tarp globos įstaigose gyvenančių vyrų – 38,1 proc. Su amžiumi šlapimo nelaikymo dažnumas didėja. Šlapimo nelaikymo riziką didina gerybinė prostatos hiperplazija, patirtas insultas, depresija, pažinimo sutrikimas, Parkinsono liga, obstipacija ir kai kurių vaistų vartojimas. Erekcijos sutrikimai nustatyti 79,2 proc. šlapimo nelaikančių 55 metų amžiaus ir vyresnių vyrų ir 36,7 proc. sveikų vyrų, gyvenančių Vilniaus m. bendruomenėje. Esant šlapimo nelaikymui yra blogesnės šios gyvenimo kokybės sritys: fizinė sveikata, psichologinė būsena, socialiniai santykiai ir aplinka. Po 2 metų gyvenimo kokybė pablogėjo fizinės sveikatos bei socialinių santykių srityse. / Scientific adviser: Assoc. Prof. Dr. Vidmantas Alekna (Institute of Experimental and Clinical Medicine at Vilnius University, Biomedical sciences, Medicine - 07 B). The aim: To estimate the frequency of urinary incontinence (UI) in men residing in Vilnius city community and nursing institutions, to assess risk factors for UI, to determine the frequency of erectile dysfunction in men with UI, and to analyse their quality of life. Object and methods: 788 elderly men residing in Vilnius city community and 168 - in nursing institutions were interviewed. The respondents were interviewed with the specific and general questionnaires for UI and quality of life. Statistical data analysis was performed by applying SPSS 12.0 for Windows. Conclusions: Frequency of UI among the men living in Vilnius city community amounts to 17.8% and 38.1% - in nursing institutions. The benign prostatic hyperplasia, stroke, senile cognition disorder, Parkinson’s disease, depression, constipation and use of the some medications increase the risk of UI among elderly men. Erectile dysfunction was diagnosed in 79.2% of the men with UI aged 55 and over and in 36.7% of the healthy men of the same age. In men with UI the physical health, psychological state, social relations and the environment domains of quality of life were disturbed. After two years the quality of life of the men with UI became lower in the areas of physical health and social relations.

Scientific adviser: Assoc. Prof. Dr. Vidmantas Alekna (Institute of Experimental and Clinical Medicine at Vilnius University, Biomedical sciences, Medicine - 07 B). The aim: To estimate the frequency of urinary incontinence (UI) in men residing in Vilnius city community and nursing institutions, to assess risk factors for UI, to determine the frequency of erectile dysfunction in men with UI, and to analyse their quality of life. Object and methods: 788 elderly men residing in Vilnius city community and 168 - in nursing institutions were interviewed. The respondents were interviewed with the specific and general questionnaires for UI and quality of life. Statistical data analysis was performed by applying SPSS 12.0 for Windows. Conclusions: Frequency of UI among the men living in Vilnius city community amounts to 17.8% and 38.1% - in nursing institutions. The benign prostatic hyperplasia, stroke, senile cognition disorder, Parkinson’s disease, depression, constipation and use of the some medications increase the risk of UI among elderly men. Erectile dysfunction was diagnosed in 79.2% of the men with UI aged 55 and over and in 36.7% of the healthy men of the same age. In men with UI the physical health, psychological state, social relations and the environment domains of quality of life were disturbed. After two years the quality of life of the men with UI became lower in the areas of physical health and social relations. / Mokslinis konsultantas: doc. dr. Vidmantas Alekna (Vilniaus universiteto Eksperimentinės ir klinikinės medicinos institutas, biomedicinos mokslai, medicina – 07 B). Darbo tikslas: ištirti Vilniaus mieste gyvenančių senyvo amžiaus vyrų šlapimo nelaikymo ir erekcijos sutrikimų ypatumus bei gyvenimo kokybę. Tyrimo objektas ir metodai. Tiriamųjų grupė sudaryta sluoksninės imties metodu. Apklausti 788 asmenys, gyvenantys Vilniaus m. bendruomenėje ir 168 vyrai – globos įstaigose. Respondentai buvo tiriami interviu metodu, naudojant specifinius ir bendrus klausimynus. Statistinė duomenų analizė atlikta „SPSS 12.0 for Windows“. Pagrindinės išvados. Šlapimo nelaikymo dažnumas tarp Vilniaus m. bendruomenėje gyvenančių 55 metų amžiaus ir vyresnių vyrų yra 17,8 proc., o tarp globos įstaigose gyvenančių vyrų – 38,1 proc. Su amžiumi šlapimo nelaikymo dažnumas didėja. Šlapimo nelaikymo riziką didina gerybinė prostatos hiperplazija, patirtas insultas, depresija, pažinimo sutrikimas, Parkinsono liga, obstipacija ir kai kurių vaistų vartojimas. Erekcijos sutrikimai nustatyti 79,2 proc. šlapimo nelaikančių 55 metų amžiaus ir vyresnių vyrų ir 36,7 proc. sveikų vyrų, gyvenančių Vilniaus m. bendruomenėje. Esant šlapimo nelaikymui yra blogesnės šios gyvenimo kokybės sritys: fizinė sveikata, psichologinė būsena, socialiniai santykiai ir aplinka. Po 2 metų gyvenimo kokybė pablogėjo fizinės sveikatos bei socialinių santykių srityse.

Erectile dysfunction and cardiovascular disease share etiologies, and commonly coexist. One unifying concept is that the arterial insufficiency in hypertension is also the primary basis for blunted sexual responses. The objective of these studies was to characterize the age-related changes in the structure and function of the pudendal artery (the main resistance vessel) in young and old normotensive and hypertensive animals in relation to erectile function. In addition, we assessed the impact of antihypertensive treatments and lifestyle modifications, such as exercise and/or caloric restriction, on erectile responses and the structure and function of the pudendal artery. In 30 week old hypertensive rats or following re-challenges at 50 and 70 weeks, antihypertensive treatment (enalapril or hydralazine) did not prevent the age-related decline in erectile function. Experiments involving cross-over kidney transplantations between treated and untreated young hypertensive rats revealed that changes in penile vasculature and not the level of arterial pressure were important for normalizing erectile responses. In addition, intervention with exercise and caloric restriction showed that these treatments substantially improved erectile responses in normotensive and hypertensive rats. The pudendal artery in young normotensive rats was found to have a thick medial layer but a relatively small lumen. With age, the pudendal lumen didn’t change, but all components of the medial layer were markedly increased. Of interest, the smooth muscle cells within the pudendal medial layer became more disorganized with aging, although iii contractions were similar. In contrast, endothelium-dependent relaxation decreased with age. Young hypertensive rats also had an increased wall thickness, but not lumen diameter or extracellular matrix. Antihypertensive therapy significantly decreased the pudendal wall thickness. In aging hypertensive rats, the pudendal artery walls were even thicker, lumen decreased and extracellular matrix greatly enhanced compared to younger rats. In addition, there were numerous regions of intimal thickening associated with marked disruptions of the internal elastic lamina. Moreover, pudendal smooth muscle cells bordering the intima and in the neointima were round in shape, and electron microscopy confirmed their synthetic state. Taken together, these findings provide key evidence of the importance of the structure and function of the pudendal artery in facilitating erectile responses. / Thesis (Ph.D, Pharmacology & Toxicology) -- Queen's University, 2009-05-19 12:55:30.469

The aims of this study were to determine the effects of smoking on the incidence and prognosis of erectile dysfunction (ED) and that of ED on smoking behavior, and to find out whether smoking either directly or through vascular diseases causes ED. The target population comprised of all men born in 1924, 1934 or 1944 and residing in the city of Tampere or 11 adjacent municipalities in Finland. Questionnaires were mailed to 3,143 men in 1994, to 2,864 in 1999 and to 2,510 men in 2004. The response rates were 70%, 75% and 75% respectively. ED was assessed using two questions on subjects’ erectile capacity. Logistic and Poisson regression models were used in the multivariable analyses. Current smoking was associated with ED (Adjusted prevalence odds ratio (POR) = 1.7, 95% CI 1.2-2.4), but not with ex smoking. The incidence of ED non-significantly increased (incidence density ratio (IDR)=1.4) and that of ED recovery reduced (IDR=0.7) with current smoking. A dose-response relationship was found between smoking and ED. Although the relative risks estimates were not statistically significant, probably due to small numbers. Only heavy smokers were significantly at higher risk of ED. Compared with non-smokers, confounder-adjusted IDR was 1.6 (95% CI 1.0-2.6) for men who smoked 21 cigarettes or more daily. Both quitting (IDR=1.7) and starting smoking (IDR=1.9) were rare and higher in men with ED. However, the IDRs estimates were not statistically significant. Current smokers at baseline (1994) who developed vascular disease during 1994-1999 were three times (Confounder-adjusted IDR=3.1, 95% CI 1.3-7.5) at higher risk of ED during 1999-2004 compared with never or ex smokers who did not develop vascular diseases. On the other hand, current smokers who did not develop vascular diseases were not at higher risk of ED (IDR=1.0). There were two bi-directional relations between smoking and ED. Smoking caused ED though vascular diseases and ED caused smoking. The recovery from ED was less in smokers than in non-smokers, and current smokers with ED were more likely to stop smoking compared with men free from ED. / <p>ISBN 91-7997-124-5</p>

Enhanced external counterpulsation (EECP) is a noninvasive treatment modality which can increase arterial blood flow in peripheral and coronary arterial disease. Several studies have demonstrated an increase in the flow of the internal iliacal artery and in carotid and renal perfusion during EECP treatment. We investigated the effect of EECP in patients with erectile dysfunction (ED). Thirteen patients were treated with EECP for 20 days, 1 h per day. Patients reported a significant improvement of penile rigidity after completion of the EECP treatment and a significant improvement of penile peak systolic flow was measured by Doppler sonography. No adverse effects were observed. In conclusion, EECP seems to be an effective treatment modality in patients with ED. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Sammanfattning Bakgrund: Orsakerna till att prostatacancer uppstår är i dagsläget inte fastställt, men ärftlighet har visat sig ha en betydelse. Prostatacancer är den vanligaste typen av cancer i världen bland män, där patienterna drabbas av såväl fysiska som psykiska besvär vilket har en påverkan på individernas sexuella hälsa. Syfte: Syftet var att beskriva patienters upplevelser av sexuell hälsa vid prostatacancer.  Metod: En litteraturöversikt baserad på artiklar med kvalitativa data användes. Resultat: Resultatet redovisade tre huvudkategorier som ger en insyn i individernas upplevelse av sexuell hälsa: Att förlora en del av sin identitet, Upplevd påverkan på relationer samt Att kunna anpassa sin livssituation. Det var främst den försämrade förmågan till erektion som påverkade individernas identitet, deras relationer och skapade ett behov av anpassning till den nya situationen. Slutsats: Patienter som lever med prostatacancer upplever en försämrad sexuell hälsa till följd av sin sjukdom. Det resulterar i konsekvenser där patienterna drabbas fysiskt, psykiskt, och socialt, vilket leder till svåra utmaningar för individerna. Litteraturöversikten kan bidra till att ge vårdpersonal en ökad insikt i hur patienterna upplever sin situation, vilket kan resultera i att patienterna får en bättre och mer individanpassad vård. / Summary Background: The causes why the prostate cancer occurring are currently not determined, but heredity has been shown to be of importance. Prostate cancer is the most common type of cancer in the world among men, where the patients suffer from physical and mental illness which affect the sexual health of individuals. Purpose: The purpose was to describe patients' experiences of sexual health in prostate cancer. Method: A literature review based on qualitative data was used. Result: The result presented three main categories that provide an insight into the individual's perception of sexual health: Losing a part of one's identity, Experienced effect on relationships, and Being able to adjust one's life. It was primarily the impaired ability of erection that affected the individual’s identity, their relationships and created a need for adaption to the new situation. Conclusion: Patients living with prostate cancer experience impaired sexual health due to their illness. This results in consequences where patients suffer physically, mentally, and socially, leading to difficult challenges for the individuals. This literature review can provide healthcare professionals with an increased insight into how patients experience their situation, which can result in patients getting a better and more individualized care.