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mellitus and depression in men with erectile dysfunction. J Urol . 2004;171:2341-2345. 5. Solomon H, Man JW, Jackson G. Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart . 2003;89:251-253. 6. Feldman HA, Johannes CB, Derby CA, et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med . 2000;30:328-338. 7. Fung MM, Bettencourt R, Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo study

1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RG, MC Kinley JB. Impotence and its medical and psychosocial relates: results of the Massachusetts Male Ageing Study. J Urol 151: 54-61, 1994. 2. Kapoor D, Malkin CJ, Channer KS, Jones TH. Androgens, insulin resistance and vascular disease in man. Clin Endocrinol (Oxf) 63: 239-250, 2005. 3. Kempler P. Erectile dysfunction. In: Neuropathies. Kempler P (ed). Springer Scientific Publisher, Budapest, pp. 123-128, 2002. 4. Dhindsa S, Prabhakar S, Sethi M, Bandyopadhyay A, Chaudhuri A, Dandona P. Frequent occurrence

References 1. Hatzimouratidis K, Burnett AL, Hatzichristou D, McCullough AR, Montorsi F, Mulhall JP. Phosphodiesterase type 5 inhibitors in postprostatectomy erectile dysfunction: a critical analysis of the basic science rationale and clinical application. Eur Urol. 2009;55(2):334-47. 2. Dimitrov P, Panchev P, Simeonov P, Vasilev V, Georgiev M, Yanev K. Prostate carcinoma - staging and possibilities for operative treatment. Medical science. 2008;2:51-5. 3. Walsh PC. Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent

References 1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA.1993;270(1):83-90. 2. Gong B, Ma M, Xie W, Yang X, Huang Y, Sun T et al. Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. Int Urol Nephrol. 2017;49(10):1731-40. doi: 10.1007/s11255-017-1644-5. 3. Izdebski Z. Seksualność Polakow na początku XXI wieku. Studium badawcze. Krakow: Wyd. UJ; 2012:287-92. 4. Szurgociński A. Zaburzenia erekcji w Polsce. Grodzisk Mazowiecki: Vedi Clinic;2016

References [1] WebMD. (2012). Atherosclerosis and erectile dysfunction . www.webmd.com/erectile-dysfunction/ atherosclerosis-and-erectile-dysfunction. [2] Arnett, D.K., Evans, G.W., Riley, W.A. (1994). Arterial stiffness: A new cardiovascular risk factor? American Journal of Epidemiology , 140 (8), 669-682. [3] Klocke, R., Cockcroft, J.R., Taylor, G.J., Hall, I.R., Blake, D.R. (2003). Arterial stiffness and central blood pressure, as determined by pulse wave analysis, in rheumatoid arthritis. Annals of the Rheumatic Diseases , 62 (5), 414-418. [4] Reaz, M

Roentgenol 1989; 153 : 1141-47. Shafik A, Shafik I, El SO, Shafik AA. On the pathogenesis of penile venous leakage: role of the tunica albuginea. BMC Urol 2007; 7 : 14. Peskircioglu L, Tekin I, Boyvat F, Karabulut A, Ozkardes H. Embolization of the deep dorsal vein for the treatment of erectile impotence due to veno-occlusive dysfunction. J Urol 2000; 163 : 472-5. Miwa Y, Shioyama R, Itou Y, Kanamaru H, Okada K. Pelvic venoablation with ethanol for the treatment of erectile dysfunction due to veno-occlusive dysfunction. Urology 2001; 58 : 76-9. Moncada I

Summary

During the last few years, prostate cancer is more frequently diagnosed in young patients. This lays emphasis on the necessity to preoperatively evaluate the sexual function in patients undergoing bilateral nerve sparing radical retropubic prostatectomy (BNSRRP). The aim of our study was to make an objective evaluation of the basic sexual function in patients with clinically localized prostate cancer and candidates for BNSRRP, using internationally validated questionnaires. We also tried to find a correlation between these questionnaires and the individual assessment of candidates, on one hand, and between comorbidities of the patients and degree of erectile dysfunction (ED), on the other hand. From January 2014 to March 2017, at the urology clinic of University Hospital – Pleven, 64 patients opted BNSRRP and reported to have preserved erectile function (EF), wishing to maintain this function after surgery. The patients’ histories and comorbidities were recorded on the day of hospitalization. The subjective assessment of the patients’ potency was compared with International Index of Erectile Function (IIEF). According to the EF domain of the IIEF, baseline EF was assessed in 28 patients. Twelve patients had mild ED, 9 patients had mild to moderate ED, seven patients had moderate, and eight had severe ED. The results showed that a significant number of patients with clinically localized prostate cancer who were candidates for BNSRRP reported to be fully potent but actually had impaired EF preoperatively. There was also a pronounced correlation between concomitant diseases and EF.

Identification of Counterfeit Medicines for Erectile Dysfunction from an Illegal Supply Chain

The appearance of counterfeit medicines in supply chains is a global public health problem that may seriously affect patients. Counterfeit drugs do not meet quality standards and do not declare their real composition and/or source for the purposes of fraud. They may be generic or innovative, they may contain genuine constituents in a fake packaging, or wrong ingredients, or inactive ingredients, or an incorrect quantity of the active substance. In Croatia, no cases of counterfeit medicines have been detected so far, but the Agency for Medicinal Products and Medical Devices has received 34 samples of medicines and other products for testing from Zagreb City Police. The samples included medicines for erectile dysfunction: sildenafil, tadalafil, and vardenafil. Twenty-three samples of tablets without marketing authorisation in Croatia were tested with high-performance liquid chromatography (HPLC) for the declared sildenafil and tadalafil content. Samples labelled 1 (batch T/33), 3 (batch T/33), 5 (batch 4), 6 (batch M0016J), 10 (batch T-070235), 12 (batch T-070544), 15 (batch 314833201), 16 (batch 832718474), and 17 (batch 504830028) containing sildenafil and samples labelled 20 (batch 070356), 21 (batch 05668), and 22 (batch T 378 5) containing tadalafil did not contain the active substance within the acceptable 95 % to 105 % margin of deviation from the declared content. While most samples cannot be described as fake with a reasonable amount of certainty, there is still a suspicion of counterfeit. A correct conclusion can be drawn only with the assistance of the manufacturers and by conducting additional laboratory tests.

ABBREVIATIONS BPH - Benign prostatic hyperplasia cAMP - Cyclic adenosine 3’,5’ monophosphate cGMP - Cyclic guanosine 3’,5’ monophosphate ED - Erectile dysfunction FAP-1 - Fas associated phosphatase-1 FLIP - FLICE -like inhibitory protein GAF - Allosteric cGMP binding sites iNOS - Inducible NO synthase MnSOD - Manganese superoxide dismutase mRNA - Messenger RNA NO - Nitric oxide NSRP - Nerve-sparing radical prostatectomy PCSC - Prostatic cancer stem cells PDE - Phosphodiesterase PDE5Is - Phosphodiesterase-5 inhibitors PKA - Protein

, Carmack AJK, Cava A, Goodman KW. Treatment of infertility in men with spinal cord injury: medical progress and ethical considerations. Top Spinal Cord Inj Rehabil. 2008; 13: 120-33. 10.1310/sci1304-120 4. Burns AS, Rivas DA, Ditunno JF. The management of neurogenic bladder and sexual dysfunction after spinal cord injury. Spine. 2001; 26:S129. 10.1097/00007632-200112151-00022 5. Deforge D, Blackmer J, Garritty C, Yazdi F, Cronin V, Barrowman N, et al. Male erectile dysfunction following spinal cord injury: a systematic review. Spinal Cord. 2005; 44:465-73. 10.1038/sj