The most common urological diseases in younger males are inflammatory diseases of small pelvis, as prostatitis, orchiepididymitis, urethritis and others. Their course significantly bothers the patient himself as well as his closest ones, encumbers account in Health Insurance Company and doesn't add any peace to the patient's attending physician either. Patient with chronic inflammatory disease comes to the outpatient's office 4-times more often than patient with BPH or prostate cancer. Part of clinical diagnosis in patients with inflammatory disease of small pelvis is infertility of unknown ethiology in up to 37% and erectile dysfunction in 12%. Uropathogenic flora (gram-negative or gram-positive microorganisms) is successfully proved as ethiologic agent only in small part of patients. Thorough laboratory diagnostics can discover inducer in major part of diseases, after all. Great majority of them belongs to the group of STIs (sexually transmitted infections). Besides that, even the above mentioned “uropathogens” can be included among STIs. The most common of these are Chlamydia infections, which form, with annual incidence over 90 million cases, a real worldwide problem. Yet, they do not reach the incidence of the most frequent STI, which is the HPV infection. For STI is characteristic polysymptomatic or asymptomatic course, and this is oftentimes in both sexual partners. During anti-microbial therapy of “banal” problems multi-resistance develops. Significant is a rapid increase of virus and Chlamydia infections that are curable however only with difficulties. Part of those unambiguously relates to the development of tumour diseases (HPV, HSV, and also Chlamydiosis). Tubular infertility of females is almost in 100% based on Chlamydia infection. The work presents view to the complex diagnostics of STIs and inflammatory diseases of small pelvis, findings of microbiological testing and examination of ejaculate. On the results of therapy of some of STIs we substantiate complicacy of treatment and inconsistency or total absence of therapeutic guidelines. It looks like that there could be possibly active prevention established by vaccination at least in one of the diseases. But how the virus shall act and what can we expect from the state economics (national vaccination) – these are the questions for the future. The main emphasis therefore has to be put on primary prevention.
Pro-active approach to the diagnostics of prostate cancer leads not only to the stages shift, but primarily to the recognition of the diseases in younger-age categories. Unique biological behaviour of the prostate cancer is different from other solid tumours. Natural course of the disease (long doubling time and slow progression) enables the patient with hormonally dependant tumour long-term stabilization of the disease and survival. Every therapy of prostate cancer (surgical-, radiation- and drug therapies) shall significantly influence sexual life of the patients and thereby also the quality of their life. Material a methods: We present a group of 36 males with average age of 63.2 years <48;67> with locally advanced or generalised disease. Before commencement of the therapy all these men lived sexual life. Hormonal suppression had been incited with LH RH analogues or anti-androgens, in 29 men from the group in the form of intermittent androgenic suppression, others were receiving continual therapy. We were evaluating Life Quality Assessment Questionnaires and IIEF score (International Index of Erectile Function), therapeutic response and its duration. Results: Before commencement of the therapy we had diagnosed erectile dysfunction in 21 pts (59%) patients, ejaculation disorder in 50% and painful ejaculation in 11 pts (30%) of patients. Progress of the sexual dysfunction depended on the kind of pharmaceutical used. LH RH analogues lead to the quick loss of libido and development of impotence in majority of patients. Administration of steroid anti-androgens is not followed by development of sexual dysfunction, despite decrease of testosterone levels. We have observed libido decrease only in 25% of patients. Erectile dysfunction worsened in patients with already developed dysfunction. Non-steroid anti-androgens induced sexual dysfunction in 30% of patients. Intermittent androgenic suppression reduces incidence of symptoms associated with lack of androgens; in the cycle without therapy comes to the increase of testosterone levels and improvement of sexual life. Conclusion: Sexual dysfunction (SD) is accompanied with prostate diseases. Depending on the level of symptoms of lower urinary tract also the SD level gets worse. Moreover, in prostate cancer we influence development of SD also by selection of therapeutic regimen and anti-tumour pharmacotherapy. During selection of therapeutic strategy we should take into consideration not only safety of oncological therapy but also the patient’s sexuality and preferences.
