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Morelli A, Filippi S, Comeglio P, Sarchielli E, Chavalmane AK, Vignozzi L, Fibbi B, Silvestrini E, Sandner P, Gacci M, Carini M, Vannelli GB, Maggi M. Acute Vardenafil Administration Improves Bladder Oxygenation in Spontaneously Hypertensive Rats. J Sex Med 2010; 7:107-20. [DOI: 10.1111/j.1743-6109.2009.01558.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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103
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Aldridge N, Kim HW, Motamedi A, Rajasekaran M. Chronic partial bladder outlet obstruction does not impair erectile function in male rats. BJU Int 2009; 106:572-7. [DOI: 10.1111/j.1464-410x.2009.09105.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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104
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Demir O, Ozdemir I, Bozkurt O, Aslan G, Esen AA. The effect of alpha-blocker therapy on erectile functions in patients with lower urinary tract symptoms due to benign prostate hyperplasia. Asian J Androl 2009; 11:716-22. [PMID: 19823178 DOI: 10.1038/aja.2009.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In this study we aimed to evaluate the impact of doxazosin treatment on erectile functions in patients with lower urinary tract symptoms (LUTS) and having erectile dysfunction (ED) at baseline. Fifty-three patients with LUTS (IPSS score > 7) whose maximum flow rate (Q(max)) < 15 mL s(-1) and PSA < 4 ng dL(-1) were enrolled in the study. Patients received doxazosin 4 mg once daily for 6 weeks. Subjective efficacy was assessed by IPSS, IPSS-Quality of Life (IPSS-QoL) for LUTS and efficacy was assessed by International Index of Erectile Function (IIEF) for erectile functions at baseline and sixth weeks. The objective efficacy was assessed by Q(max). The patients were classified according to their self reported erectile status: group I had ED and group II did not have ED. At the endpoint, doxazosin significantly improved the total IPSS score (-7.7 +/- 6.1, P = 0.006), IPSS-QoL score (-1.5 +/- 1.5, P = 0.024) and Q(max) (3.2 +/- 4.6 mL s(-1), P = 0.002) over baseline. Mean decrease in IPSS and IPSS-QoL scores after the treatment period were 6.9 +/- 6.4 (P < 0.001) and 0.95 +/- 1.80 (P < 0.05) in group I, whereas 8.2 +/- 5.8 (P < 0.001) and 1.9 +/- 1.1 in group II (P < 0.001), respectively. Mean changes of Q(max) values were 2.3 +/- 3.3 mL s(-1) in group I (P < 0.05) and 3.7 +/- 5.3 mL s(-1) in group II (P < 0.001). The improvement of IIEF-EF scores after the treatment period was only significant for group I. The efficacy of alpha-blocker therapy for LUTS was better by means of symptomatic relief for patients who did not have ED when compared with patients who had ED at baseline. However, slight improvement in erectile functions with alpha-blocker therapy was only seen in LUTS patients with ED.
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Affiliation(s)
- Omer Demir
- Dokuz Eylul University Medical School, Department of Urology, Inciralti, Izmir 35340, Turkey.
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105
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Place of overactive bladder in male lower urinary tract symptoms. World J Urol 2009; 27:723-8. [PMID: 19705127 DOI: 10.1007/s00345-009-0470-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 08/11/2009] [Indexed: 01/29/2023] Open
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Abstract
To review the current literature regarding the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), and the role of phosphodiesterase-5 (PDE5) inhibitors for the treatment of LUTS. Review of recently published (1990-2009) data regarding epidemiologic and pathophysiologic mechanisms are involved in LUTS-ED, focusing on PDE5 inhibitors particularly evidenced from level 1 clinical trials. Search terms included phosphodiesterase inhibitors, nitric oxide, autonomic hyperactivity, Rho-kinase, atherosclerosis, LUTS, benign prostatic hypertrophy, and ED. Results of several epidemiologic studies show a possible causal relationship between LUTS and ED. Four possible mechanisms have been proposed to explain this association. Multiple large clinical trials have shown a benefit in LUTS after PDE5-inhibitors treatment. PDE5 inhibitors show promise as a future treatment for LUTS, either in conjunction with existing therapies or as a primary treatment.
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Affiliation(s)
- S Mouli
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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107
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Marklund-Bau H, Edéll-Gustafsson U, Spångberg A. A Swedish version of a quality of life questionnaire for partners of men with symptoms suggestive of benign prostatic obstruction. ACTA ACUST UNITED AC 2009; 42:126-31. [DOI: 10.1080/00365590701725698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Helén Marklund-Bau
- Department of Biomedicine and Surgery, University Hospital, Linköping, Sweden
- Department of Medicine and Care, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Ulla Edéll-Gustafsson
- Department of Medicine and Care, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Spångberg
- Department of Biomedicine and Surgery, University Hospital, Linköping, Sweden
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108
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Hellstrom WJ, Giuliano F, Rosen RC. Ejaculatory Dysfunction and Its Association With Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia and BPH Treatment. Urology 2009; 74:15-21. [DOI: 10.1016/j.urology.2008.06.048] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 06/09/2008] [Accepted: 06/25/2008] [Indexed: 11/24/2022]
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109
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Measurement of benign prostatic hyperplasia treatment effects on male sexual function. Int J Impot Res 2009; 21:267-74. [PMID: 19536125 DOI: 10.1038/ijir.2009.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Benign prostatic hyperplasia (BPH) is the leading cause of lower urinary tract symptoms among the aging male population. Epidemiological, pathophysiological and clinical studies indicate that many of these men also suffer from declining sexual function, especially those undergoing treatment for their BPH-related urinary symptoms. Although urinary symptoms and quality of life may improve with BPH therapy, the resulting effects on sexual function vary by medical, surgical and minimally invasive approaches and have not been consistently reported. As comprehensive, validated instruments to measure male sexual function are now available for routine use in the clinical setting, urologists and primary care providers caring for patients with BPH have the opportunity to monitor both urinary and sexual function before, during and after BPH therapy. Herein, we describe the relationship between BPH and its treatments on male sexual function, the role of new measures for sexual functioning and opportunities for future work to improve the care of men suffering from both maladies.
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110
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Lee SH, Kim JC, Lee JY, Kim JH, Oh CY, Lee SW, Yoo SJ, Chung BH. Effects of components of metabolic syndrome on sexual function in Korean BPH/LUTS patients. J Sex Med 2009; 6:2292-8. [PMID: 19493291 DOI: 10.1111/j.1743-6109.2009.01325.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION There are limited data concerning the association between components of metabolic syndrome and sexual function in men aged 40 years and older in Korean benign prostatic hyperplasia (BPH) patients. AIM To examine the effects of metabolic markers on sexual function in Korean BPH patients and to evaluate obesity as a causal factor for the development of BPH and sexual dysfunction in a large population of Korean men. METHODS This is a multicenter, cross-sectional, prospective study conducted at four centers in Korea. A total 602 men with LUTS secondary to BPH were included. BPH/LUTS cases were men with international prostate symptom scores (IPSS) >or=8 points and prostate volume >or=20 cc by transrectal ultrasound of the prostate. Height, weight, and waist circumference were measured. Trained interviewers using the structured Male Sexual Health Questionnaire (MSHQ) and International Index of Erectile Function (IIEF-15) collected information on sexual function. MAIN OUTCOME MEASURES Sexual function using IIEF-15 and MSHQ was assessed according to presence of diabetes mellitus (DM) or hypertension, waist circumference and BMI. RESULTS BPH patients with DM or hypertension had significantly lower sexual function, and satisfaction scores on the MSHQ were significantly lower in BPH patients with hypertension. In the central obesity group, prostate volume was significantly greater compared to the normal waist group (P = 0.01). Moreover, in Korean BPH/LUTS patients, central obesity was significantly related to sexual function. BPH/LUTS represented by IPSS was significantly correlated with prostate volume and MSHQ and IIEF-15 scores. In addition, severe LUTS was significantly related to all domains of the MSHQ. CONCLUSIONS This study provides evidence that in the Korean population, sexual function is more closely associated to central obesity than general obesity. The relationship of comorbidities such as diabetes, hypertension, and sexual dysfunction determined by the MSHQ correlated with that determined by the IIEF-15.
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Affiliation(s)
- Seung Hwan Lee
- Department of Urology, Yonsei University Health System, Seoul, Korea
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111
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Foresta C, Caretta N, Corona G, Fabbri A, Francavilla S, Jannini E, Maggi M, Bettocchi C, Lenzi A. Clinical and metabolic evaluation of subjects with erectile dysfunction: a review with a proposal flowchart. ACTA ACUST UNITED AC 2009; 32:198-211. [DOI: 10.1111/j.1365-2605.2008.00932.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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112
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Wong SYS, Leung JC, Woo J. A prospective study on the association between lower urinary tract symptoms (LUTS) and erectile dysfunction: results from a large study in elderly Chinese in Southern China. J Sex Med 2009; 6:2024-31. [PMID: 19453871 DOI: 10.1111/j.1743-6109.2009.01295.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although many cross-sectional studies have been conducted on the association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), no studies were prospective in Asia. Aim. The relationship between LUTS and ED is examined using a prospective cohort of 2000 Chinese men. METHODS Baseline and 4-year data from a large prospective cohort study of 2000 Chinese elderly men were analyzed. A total of 1,736 subjects were included in the current analysis after excluding those with history of bladder or prostate cancer, or urological surgery, and those who used alpha blockers or anti-androgen. MAIN OUTCOME MEASURES LUTS were measured at baseline by the International Prostatic Symptom Score and ED was measured using one question on impotence at the end of 4 years. RESULTS A dose-response relationship was observed for the relationship between baseline severity of LUTS and severity of ED at follow-up with those who had more severe LUTS at baseline with an increased odds of having more severe ED (odd ratio [OR] = 1.86, confidence interval [CI]: 1.16-2.97 for mild LUTS at baseline; OR = 2.95, CI: 1.81-4.81 for moderate LUTS at baseline; and OR = 3.82, CI: 2.00-7.27 for severe LUTS at baseline). Other baseline factors that were statistically significantly associated with ED included body mass index (OR = 1.13, CI: 1.01-1.26), hypertension (OR = 1.30, CI: 1.02-1.65) and diabetes (OR = 1.44, CI: 1.07-1.93). CONCLUSION The presence of LUTS is associated with ED with more severe LUTS being associated with higher degree of ED in men.
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Affiliation(s)
- Samuel Y S Wong
- Department of Community and Family Medicine, School of Public Health, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
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113
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Abstract
The epidemiology of benign prostatic hyperplasia (BPH) is complex and not fully understood. The androgenic hormones testosterones and dihydrotestosterone play at least a permissive and important role. Growth factors and other hormones including estrogens may also play a role. BPH is a truely hyperplastic process resulting in growth of glandular-epithelial and stromal/muscle tissue in the prostate, leading to often measurable growth taking on different shapes and configurations which may impact symptoms and secondary outcomes. It is important to recognize that BPH is a histological conditions, which is one but not the only cause of lower urinary tract symptoms, and may or may not be associated with prostate enlargement and bladder outlet obstruction. Recognizing the different entities and determining their presence in individual patients may help with therapeutic decision making.
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114
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Hatzimouratidis K. Phosphodiesterase type 5 inhibitors: a viable treatment option for lower urinary tract symptoms? Expert Opin Investig Drugs 2009; 18:245-54. [DOI: 10.1517/13543780902725139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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115
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Oger S, Behr-Roussel D, Gorny D, Lecoz O, Lebret T, Denoux Y, Faix A, Leriche A, Wayman C, Alexandre L, Giuliano F. Combination of Doxazosin and Sildenafil Exerts an Additive Relaxing Effect Compared with Each Compound Alone on Human Cavernosal and Prostatic Tissue. J Sex Med 2009; 6:836-47. [DOI: 10.1111/j.1743-6109.2008.01138.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Demir O, Akgul K, Akar Z, Cakmak O, Ozdemir I, Bolukbasi A, Can E, Gumus BH. Association between severity of lower urinary tract symptoms, erectile dysfunction and metabolic syndrome. Aging Male 2009; 12:29-34. [PMID: 19326294 DOI: 10.1080/13685530902777425] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The purpose of this study was to investigate the association between severity of lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and metabolic syndrome. METHODS Our study population included a consecutive series of 190 patients with LUTS (International Prostate Symptom Score-IPSS >7) with or without manifestations of the metabolic syndrome. The diagnoses of diabetes mellitus and hypertension were obtained from the patient's medical history. Data on blood pressure, waist measure, body height and weight were collected and body mass index were calculated. Patients were assessed based on the International Index of Erectile Function (IIEF) for ED and IPSS and IPSS-Quality of Life for LUTS. Blood samples were drawn from fasting patients to determine, fasting blood glucose (FBG), triglycerides, HDL-cholesterol and serum total testosterone levels. RESULTS In severe LUTS patient group, IIEF erectile function domain scores were significantly lower than moderate LUTS patient group (p < 0.05). Multiple logistic regression analysis confirmed that presence of ED was the most predictor of severe LUTS. The prevalence of metabolic syndrome was higher in patients with severe LUTS (26%vs. 46%, p = 0.009). The severe form of the LUTS was significantly correlated with waist circumference >102 cm (p < 0.05), blood pressure > or =130/85 mmHg (p < 0.05) and FBG >110 mg/dl (p < 0.01). CONCLUSION Obesity, high plasma level of FBG and hypertension constitute risk factors for the development of severe LUTS. Metabolic syndrome may play a key role in the pathogenesis in both ED and LUTS. Presence of ED is the most predictor of severe LUTS.
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Affiliation(s)
- Omer Demir
- Department of Urology, Dokuz Eylul University, School of Medicine, Inciralti, Izmir, Turkey.
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117
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Roumeguère T, Zouaoui Boudjeltia K, Hauzeur C, Schulman C, Vanhaeverbeek M, Wespes E. Is there a rationale for the chronic use of phosphodiesterase-5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia? BJU Int 2009; 104:511-7. [PMID: 19239452 DOI: 10.1111/j.1464-410x.2009.08418.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To critically review the physiological roles of phosphodiesterase-5 (PDE5), to explain and support the putative impact and clinical significance of PDE5 inhibitors (PDE5-Is) in the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), both highly prevalent in men aged > or =50 years, as PDE5-Is are very effective as a first-line therapy for ED, and attractive for further physiological functional investigations. METHODS We searched Medline for peer-reviewed articles in English, from 1991 to 2008, to provide a critical contemporary review of PDE5 pertaining to the potential interest of findings supporting a role for PDE5-Is in LUTS due to BPH. The selection of papers was based on the relevance of subject matter. A critical analysis of available fundamental and clinical data is reported. RESULTS Several studies assessed the role of the nitric oxide/cGMP signalling pathway in the regulation of the prostate tone, with the support of clinical observations. PDE5-Is can also represent a potential mode of action allowing the targeting of transcriptional activity implicated in the regulation of the progression of the inflammatory process involved in BPH. PDE5-Is can inhibit human stromal cell proliferation of the prostate mediated by cGMP accumulation. New targeting hypotheses of pathophysiological processes are also reported. CONCLUSIONS There is evidence that LUTS and ED are strongly linked. This analysis of the regulatory basis of PDE5 biology could indicate several directions of investigation. However, it is necessary to devise well-designed large prospective studies that would produce significant data before this approach becomes a standard of care.
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Affiliation(s)
- Thierry Roumeguère
- Laboratory of Experimental Medicine, CHU Charleroi, ULB, Montigny -le -Tilleul, Belgium.
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118
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Rosen RC, Wei JT, Althof SE, Seftel AD, Miner M, Perelman MA. Association of sexual dysfunction with lower urinary tract symptoms of BPH and BPH medical therapies: results from the BPH Registry. Urology 2009; 73:562-6. [PMID: 19167031 DOI: 10.1016/j.urology.2008.05.034] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 04/23/2008] [Accepted: 05/03/2008] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The severity of lower urinary tract symptoms (LUTS) has correlated with erectile dysfunction (ED) and ejaculatory dysfunction (EjD) in large-scale epidemiologic studies. ED and EjD are also side effects of some medical therapies for LUTS suggestive of benign prostatic hyperplasia (LUTS/BPH). These relationships were examined in a physician office-based population of men enrolled in the BPH Registry. METHODS Enrolled men with LUTS/BPH who completed the International Prostate Symptom Score (IPSS), IPSS bother question, 5-item International Index of Erectile Function, and the 3 ejaculatory function items of the Male Sexual Health Questionnaire-EjD short form at baseline were eligible. The relationship between sexual dysfunction and LUTS/BPH and BPH medical therapies were examined using multivariate analyses. RESULTS Of 6924 men enrolled, 5042 (mean age 65 years) completed all 4 baseline assessments. Of 3084 sexually active men, age, total IPSS, IPSS bother score, hypertension, diabetes, and black race/ethnicity were independent predictors of both ED and EjD (all P < .05). For the subset of 1362 men receiving BPH medical therapy, a significant association (P < .0001) was demonstrated for ED and EjD with specific BPH medical therapies. The alpha(1A)-subtype nonsuperselective quinazoline alpha(1)-blockers alfuzosin, doxazosin, and terazosin appeared to be associated with better ejaculatory function than were the alpha(1A)-subtype superselective sulfonamide alpha(1)-blocker tamsulosin, 5alpha-reductase inhibitors, and alpha(1)-blocker plus 5alpha-reductase inhibitor combination therapy. CONCLUSIONS These results have provided additional evidence of the link between LUTS/BPH and sexual dysfunction in aging men and support clinical trial results indicating different rates of sexual side effects for BPH medical therapies.
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Affiliation(s)
- Raymond C Rosen
- New England Research Institutes, Watertown, Massachusetts 02472, USA.
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119
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Tsao CW, Cha TL, Lee SS, Tang SH, Wu ST, Tsui KH, Sun GH. Association between lower urinary tract symptoms and sexual dysfunction in Taiwanese men. Andrologia 2008; 40:387-91. [DOI: 10.1111/j.1439-0272.2008.00876.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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120
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Park JK, Köhler TS, McVary KT. Lower urinary tract symptoms, benign prostatic hyperplasia, and sexual dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2008. [DOI: 10.1007/s11884-008-0034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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121
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Gur S, Sikka SC, Chandra S, Koka PS, Agrawal KC, Kadowitz PJ, Hellstrom WJ. Alfuzosin attenuates erectile dysfunction in rats with partial bladder outlet obstruction. BJU Int 2008; 102:1651-7. [DOI: 10.1111/j.1464-410x.2008.07914.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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123
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YONO MAKOTO, YAMAMOTO YASUHIRO, IMANISHI AYA, YOSHIDA MASAKI, UEDA SHOICHI, LATIFPOUR JAMSHID. Differential Effects of Prazosin and Naftopidil on Pelvic Blood Flow and Nitric Oxide Synthase Levels in Spontaneously Hypertensive Rats. J Recept Signal Transduct Res 2008; 28:403-12. [DOI: 10.1080/10799890802176626] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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124
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Association Between Lower Urinary Tract Symptoms and Serum Levels of Sex Hormones in Men. Urology 2008; 72:552-5. [DOI: 10.1016/j.urology.2008.04.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2007] [Revised: 01/18/2008] [Accepted: 04/09/2008] [Indexed: 11/24/2022]
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125
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Jaspersen-Gastelum J, Rodríguez JA, Espinosa de los Monteros FJ, Beas-Sandoval L, Guzmán-Esquivel J, Calvo DD, Gutiérrez T. Prostatic profile, premature ejaculation, erectile function and andropause in an at-risk Mexican population. Int Urol Nephrol 2008; 41:303-12. [DOI: 10.1007/s11255-008-9417-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Accepted: 06/09/2008] [Indexed: 11/30/2022]
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126
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Estudio prospectivo para valorar el impacto del sildenafilo 50 mg/día durante 28 días en pacientes con disfunción eréctil y sintomatologíasecundaria a hiperplasia benigna de próstata. Rev Int Androl 2008. [DOI: 10.1016/s1698-031x(08)75675-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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127
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The evolving relationship of erectile dysfunction and lower urinary tract symptoms. CURRENT SEXUAL HEALTH REPORTS 2008. [DOI: 10.1007/s11930-008-0003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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128
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McVary K, Foley KA, Long SR, Sander S, Curtice TG, Shah H. Identifying patients with benign prostatic hyperplasia through a diagnosis of, or treatment for, erectile dysfunction. Curr Med Res Opin 2008; 24:775-84. [PMID: 18237458 DOI: 10.1185/030079908x260916] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) associated with benign prostate hyperplasia (BPH) are highly correlated. This study examined rates of screening, diagnosis, and treatment of BPH/LUTS among men seeking care for ED. RESEARCH DESIGN AND METHODS This was a retrospective US claims data analysis (1999-2004) evaluating men > or = 40 years old with a new diagnosis of or prescription medication for ED. Multivariate analyses were used to examine times to screening, diagnosis, and treatment. RESULTS 81 659 men with ED were identified (mean age 57 years). The baseline prevalence of recorded BPH was 1.5%. During the follow-up period (mean 2.2 years), 7.6% had documented BPH. Time to screening was shorter among patients seeing urologists (121.1 days) compared with those seeing primary-care physicians (282.2 days). Controlling for demographic and clinical characteristics, patients who saw a urologist were more likely to be screened (OR: 2.4, p < 0.0001), diagnosed with BPH (OR: 1.8, p < 0.0001), and treated (OR: 1.3, p < 0.0001), relative to patients seeing other providers. Men aged 75 and over were 43% less likely to be screened (p < 0.0001), but 5.4 times more likely to be diagnosed with BPH (p < 0.0001) and 5.3 times more likely to be treated (p < 0.0001) compared with men aged 40-49. CONCLUSIONS Screening for BPH appears less likely for men with ED who do not see a urologist. When screening does occur, it takes much longer with non-specialty providers. Patient age and provider specialty are key factors associated with screening, diagnosis, and treatment of BPH among men with ED.
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Affiliation(s)
- Kevin McVary
- Department of Urology, Feinberg School of Medicine, Northwestern University School of Medicine, Chicago, IL 60611, USA.
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Oger S, Behr-Roussel D, Gorny D, Charles Tremeaux J, Combes M, Alexandre L, Giuliano F. Combination of alfuzosin and tadalafil exerts in vitro an additive relaxant effect on human corpus cavernosum. J Sex Med 2008; 5:935-945. [PMID: 18221277 DOI: 10.1111/j.1743-6109.2007.00754.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Phosphodiesterase type 5 (PDE5) inhibitors, such as tadalafil, are a first-line treatment for erectile dysfunction (ED). Nevertheless, some patients do not respond to this treatment. Clinical data suggest that the addition of alpha1-adrenoceptor blocker, such as alfuzosin, commonly prescribed for lower urinary tract symptoms suggestive of benign prostatic hyperplasia, may be of benefit. Aim. Evaluation of the effect of alfuzosin, tadalafil or the combination of both on human corpus cavernosum. METHODS Human cavernosal tissues were obtained from 10 patients undergoing penile surgery. Strips contractility was studied in organ baths. Concentration-response curves to tadalafil were generated on norepinephrine (NE, 1-10 microM)-precontracted strips in the presence of alfuzosin or vehicle. Frequency-response curves (FRC) to electrical field stimulation (EFS, 0-64 Hz, 3 ms, 10 seconds, 300 mA) were generated in the presence of vehicle, alfuzosin, tadalafil, or both drugs combined. EFS (20 Hz, 1 ms, 10 seconds, 300 mM)-induced nitrergic relaxation on NE-precontracted strips was studied in the presence of vehicle, alfuzosin, tadalafil, or both drugs combined. MAIN OUTCOME MEASURES Functional measurement of cavernosal smooth muscle relaxation in the presence of tadalafil and alfuzosin. RESULTS The relaxation induced by tadalafil (10(-10) to 10(-5) M) on precontracted strips was enhanced by alfuzosin at both 10(-8) and 10(-7) M. The combination of alfuzosin (3.10(-8) M) and tadalafil (10(-7) M) was more efficient to inhibit FRC-induced contractions than each compound alone. The combination of tadalafil (10(-6) M) and alfuzosin (10(-8) M) increased the relaxation induced by EFS and its effect was greater than tadalafil alone. In addition, the combination of tadalafil (10(-6) M) and alfuzosin (10(-7) M) prolonged EFS-induced relaxation to a greater extent than each compound alone. CONCLUSIONS In vitro, the combination of alfuzosin and tadalafil is more efficient than each compound alone to relax adrenergic tone or to enhance nitrergic relaxation of the human corpus cavernosum. Such a combination deserves further investigation in placebo-controlled studies to evaluate its benefit in ED patients who are not sufficiently improved by PDE5 inhibitors.
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Affiliation(s)
| | | | | | | | | | | | - François Giuliano
- Raymond Poincaré Hospital-Department of Physical Medicine and Rehabilitation, Garches, France.
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130
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Hatzimouratidis K. Sildenafil in the treatment of erectile dysfunction: an overview of the clinical evidence. Clin Interv Aging 2008; 1:403-14. [PMID: 18046917 PMCID: PMC2699643 DOI: 10.2147/ciia.2006.1.4.403] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Erectile dysfunction (ED) is a highly prevalent disease associated with aging as well as with several risk factors including hypertension, heart disease, obesity, dyslipidemia, diabetes, hypogonadism, drugs-related, and pelvic surgery. Many of these factors are components of the metabolic syndrome, a multiplex risk factor for cardiovascular disease (CVD). ED shares common risk factors with CVD. Endothelial dysfunction seems to be the early underlying pathophysiology across both conditions. The efficacy, tolerability and cardiovascular safety of sildenafil has been evaluated in numerous large, randomized, double-blind, placebo-controlled clinical studies in the broad population of men with ED including men with several co-morbid conditions. Sildenafil is effective in several specific patient populations including the difficult-to-treat subpopulations such as diabetes mellitus and after radical prostatectomy. It is associated with rapid onset of action – within 14 minutes for some men – and an extended duration of action for up to 12 hours. Sildenafil improves quality of life and satisfaction for treated men and is well tolerated with a favorable safety profile. New data suggest that sildenafil has beneficial effects in several chronic conditions. It has been approved for the treatment of idiopathic pulmonary hypertension. Numerous articles have suggested that it improves endothelial function and a possible role on premature ejaculation or treatment of lower urinary tract symptoms has been suggested.
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Affiliation(s)
- Konstantinos Hatzimouratidis
- 2nd Department of Urology, Papageorgiou General Hospital, and Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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131
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Gur S, Kadowitz PJ, Hellstrom WJG. Guide to Drug Therapy for Lower Urinary Tract Symptoms in Patients with Benign Prostatic Obstruction. Drugs 2008; 68:209-29. [DOI: 10.2165/00003495-200868020-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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132
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Affiliation(s)
- Kevin T McVary
- Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, USA.
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133
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Brookes ST, Link CL, Donovan JL, McKinlay JB. Relationship between lower urinary tract symptoms and erectile dysfunction: results from the Boston Area Community Health Survey. J Urol 2007; 179:250-5; discussion 255. [PMID: 18001787 DOI: 10.1016/j.juro.2007.08.167] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Indexed: 01/19/2023]
Abstract
PURPOSE We explored the association of lower urinary tract symptoms and erectile dysfunction in a racially and ethnically diverse random sample of men. MATERIALS AND METHODS The Boston Area Community Health Survey used a stratified, 2-stage cluster sample to recruit 2,301 men representative of Boston. Data were obtained on symptoms suggestive of a number of urogynecologic conditions, comorbidities, and lifestyle and psychosocial factors. RESULTS The percent of men reporting moderate/severe lower urinary tract symptoms, as measured by the American Urological Association symptom index, ranged from 8% in those 30 to 39 years old to 26% in those 70 to 79 years old. The prevalence of erectile dysfunction was high and it increased dramatically with age with 10% of 30 to 39-year-old and 59% of 70 to 79-year-old men reporting mild-moderate/moderate/severe symptoms. A strong association was observed between the American Urological Association symptom index and erectile dysfunction after adjusting for age. However, after adjusting for other symptoms and comorbidities evidence of this association became weak. Much stronger associations were seen with incontinence, which is not included in the American Urological Association symptom index, and symptoms suggestive of prostatitis. When considering the American Urological Association symptom index symptoms separately, only nocturia increased the severity of erectile dysfunction. Stratified analyses demonstrated similar associations across race/ethnicity groups. CONCLUSIONS Lower urinary tract symptoms and erectile dysfunction are common conditions in older men in the community. This study provides evidence to suggest that the previously observed association between erectile dysfunction and lower urinary tract symptoms may be primarily due to nocturia, incontinence and symptoms suggestive of prostatitis.
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Affiliation(s)
- Sara T Brookes
- Department of Social Medicine, University of Bristol, Bristol, United Kingdom.
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134
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Chitale S, Collins R, Hull S, Smith E, Irving S. Is the Current Practice Providing an Integrated Approach to the Management of LUTS and ED in Primary Care? An Audit and Literature Review. J Sex Med 2007; 4:1713-25. [PMID: 17908234 DOI: 10.1111/j.1743-6109.2007.00598.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are highly prevalent in aging men. A common pathophysiology is hypothesized to explain causal link. However, prevalence of ED in patients with LUTS remains underdiagnosed, as we believe general practitioners (GPs) do not inquire about ED in men presenting with LUTS. AIM Our goal to find out if LUTS and ED were dealt with in an integrated fashion in primary care. METHODS One hundred consecutive patients with LUTS attending the prostate assessment clinic anonymously completed a locally developed, qualitatively validated questionnaire and sexual health inventory for men. MAIN OUTCOME MEASURES (i) Prevalence of concomitant ED in men presenting with LUTS; (ii) proportion of GPs enquiring about ED; (iii) patients with LUTS + ED who were offered treatment in primary care; and (iv) patients who sought treatment on review in secondary care. RESULTS The age of patients was 39-86 years. Fifty-four percent admitted to ED: 66% >/=60 years, and 28% </=60 years had ED. Mean international prostate symptom score in both LUTS +/- ED groups was 16. There was a direct correlation between severity of LUTS and ED. Only 13/54 (24%) admitted ED to their GP. Of the patients, 15.4% received treatment, but 90.9% untreated patients were interested in therapy. Seventy-one percent stated definite reasons for inability to discuss their ED. GPs inquired about ED in only 9.2%. Overall, 66.6% wanted their ED addressed. CONCLUSIONS Fifty-four percent of the patients with LUTS also admitted to ED. Patients with more severe LUTS had more severe ED. More than 75% of patients did not report coexistent ED. GPs inquired about ED in only <10% of patients and offered no therapy to more than 80%. Sixty-seven percent of LUTS patients were interested in receiving treatment for ED when offered. A more integrated approach is desired to address the prevalence of ED in patients presenting with LUTS in order to offer them a comprehensive management in primary care.
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Affiliation(s)
- Sudhanshu Chitale
- Norfolk and Norwich University Hospital NHS Trust--Urology, Norwich, UK.
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135
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Paick JS, Um JM, Kim SW, Ku JH. Influence of High-Power Potassium-Titanyl-Phosphate Photoselective Vaporization of the Prostate on Erectile Function: A Short-Term Follow-Up Study. J Sex Med 2007; 4:1701-7. [PMID: 17672845 DOI: 10.1111/j.1743-6109.2007.00574.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Erectile function after high-power potassium-titanyl-phosphate (KTP) photoselective laser vaporization of the prostate has not been investigated systemically. AIM The aim of this study was to evaluate the impact of high-power KTP photoselective laser vaporization of the prostate on erectile function in men with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia. METHODS A total of 45 patients with mean age of 68.3 years (range 56-86) were included in the primary analysis. At baseline and at 6-month postoperative visit, the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual urine (PVR) volume were evaluated. MAIN OUTCOME MEASURES The primary efficacy outcome was changes in the "erectile function" domain and other sexual functions. The secondary outcome was changes in LUTS. RESULTS Six months after surgery, data of the IPSS, Qmax, and PVR volume improved (P < 0.05). All IIEF domains also improved 6 months after surgery (P < 0.05). "Erectile function" domain increased from a baseline of 11.3 +/- 1.8 to 14.7 +/- 1.7 (P = 0.015). Overall, the IIEF total sum increased from a baseline mean of 27.4 +/- 3.8 to 34.9 +/- 3.7 after KTP photoselective vaporization of the prostate (P = 0.010). CONCLUSIONS The present results suggest that 6 months after high-power KTP laser vaporization, sexual functions including erectile function improved. However, as with any new technique, a longer follow-up and a larger cohort are needed further to validate these findings.
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Affiliation(s)
- Jae-Seung Paick
- Department of Urology, Seoul National University Hospital, Jongno Ku, Seoul, Korea
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136
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Reply by Authors. J Urol 2007. [DOI: 10.1016/j.juro.2007.05.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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137
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Brading AF, Heaton JPW, Hashitani H. A survey of commonalities relevant to function and dysfunction in pelvic and sexual organs. Int J Impot Res 2007; 20:1-16. [PMID: 17717525 DOI: 10.1038/sj.ijir.3901568] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Micturition, defecation and sexual function are all programmed through spinal reflexes that are under descending control from higher centres. Interaction between these reflexes can clearly be perceived, and evidence is accumulating the dysfunction in one reflex is often associated with dysfunction in another. In this article, we describe some of the basic properties and neural control of the smooth muscles mediating the reflexes, reviewing the common features that underlie these reflex functions, and what changes may be responsible for dysfunction. We propose that autonomic control within the pelvis predisposes pelvic and sexual organs to crosstalk, with the consequence that diseases and conditions of the pelvis are subject to convergence on a functional level. It should be expected that disturbance of the function of one system will inevitably impact adjacent systems.
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Affiliation(s)
- A F Brading
- Oxford Continence Group, University Department of Pharmacology, Oxford, UK.
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138
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Ponholzer A, Madersbacher S. Lower urinary tract symptoms and erectile dysfunction; links for diagnosis, management and treatment. Int J Impot Res 2007; 19:544-50. [PMID: 17611608 DOI: 10.1038/sj.ijir.3901578] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent large-scale epidemiological studies have documented a strong association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). This observation has two important scientific and clinical aspects: (i) to reveal the pathomechanism linking LUTS and ED and (ii) to consider this fact in the individual approach for diagnosis and management of these two disorders. The following hypotheses are under investigation to explain the relation between LUTS and ED: (i) an increased Rho-kinase activation, (ii) an alpha-adrenergic receptor imbalance, (iii) a decrease of NOS/NO in the endothelium, (iv) atherosclerosis affecting the small pelvis and (v) an autonomic hyperactivity, each affecting simultaneously bladder, prostate and penis. According to a recent randomized trial, sildenafil has a positive effect on LUTS yet not on uroflowmetry in men with LUTS and ED. Although further trials are mandatory, phosphodiesterase-5 inhibitors might play a role in the management of LUTS in the future. alpha-Blockers have no relevant effect on erectile function, tamsulosin leads to retrograde ejaculation in up to 10%. 5alpha-Reductase inhibitors are associated with ED, loss of libido and reduction of ejaculate volume in up to 10%. Transurethral and open prostatectomy induce retrograde ejaculation in up to 90% of patients while their impact on erectile function is still controversially discussed. Minimal invasive treatment options (laser prostatectomy, transurethral microwave thermotherapy) have a lower rate of retrograde ejaculation in the range of 20-70%. LUTS and ED are strongly linked although the exact mechanism is poorly understood. Men seeking for help for LUTS/benign prostatic hyperplasia should be assessed for different aspects of sexual dysfunction and informed regarding the impact of medication and surgery on sexual health.
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Affiliation(s)
- A Ponholzer
- Department of Urology and Andrology, Donauspital, Vienna, Austria
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139
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Sighinolfi MC, Micali S, De Stefani S, Mofferdin A, Ferrari N, Giacometti M, Bianchi G. Bacille Calmette-Guérin intravesical instillation and erectile function: is there a concern? Andrologia 2007; 39:51-4. [PMID: 17430423 DOI: 10.1111/j.1439-0272.2007.00762.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of our study was to evaluate the effect of bacille Calmette-Guérin (BCG) therapy on erectile function in a cohort of male patients affected by non-muscle invasive bladder cancer. Thirty male patients undergoing BCG treatment for non-muscle invasive bladder cancer were enrolled in the study. Their mean age was 60.4 years. None of the patients had risk factors for erectile dysfunction (ED). All subjects underwent a BCG standard schedule therapy (once weekly instillation for 6 weeks). International Index of Erectile Function (IIEF-5) and International Prostate Symptom score (I-PSS) were addressed to the patients during the treatment schedule (at fourth or fifth instillation) and 1 month after the last instillation. The mean IIEF-5 score was 17.6 +/- 6.7 during therapy and 21.7 +/- 2.92 a month after the last instillation (P=0.008). Baseline ED and the association with lower urinary tract symptoms are variables significantly connected with post-treatment results (P=0.016 and 0.00 respectively) whereas the age seems not to be related to ED (P=0.256). No major side effects were recorded. It is concluded that BCG treatment is effective for prophylaxis of non-muscle invasive bladder cancer; however, it may induce a high incidence of ED. Although this effect is transient and reversible, erectile failure is another source of psychological distress that adversely affects the quality of life of men undergoing BCG treatment.
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Affiliation(s)
- M C Sighinolfi
- Department of Urology, University of Modena, Modena, Italy.
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140
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Reggio E, de Bessa J, Junqueira RG, Timm O, Sette MJ, Sansana V, Gomes CM. Correlation between lower urinary tract symptoms and erectile dysfunction in men presenting for prostate cancer screening. Int J Impot Res 2007; 19:492-5. [PMID: 17554395 DOI: 10.1038/sj.ijir.3901557] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are age-related conditions that may have a profound impact on the quality of life. The relationship between LUTS and ED is not completely understood. In this study, we assessed this relationship in men over 45 years of age during a prostate cancer screening program. LUTS and ED were evaluated in 1267 men aged 45-75 years (mean 58.2+/-8.2 years). Patients completed the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5 (IIEF-5). The association between LUTS and ED was analyzed and the influence of age in the results was tested. We also evaluated the influence of the intensity of LUTS in the ED severity. A total of 514 (40.6%) patients were considered symptomatic of LUTS (24.8% with mild, 11.8% with moderate and 4% with severe LUTS). ED was present in 758 (59.9%) men and was considered mild in 25.0%, moderate in 18.3% and severe in 16.7%. The IIEF-5 score had a negative correlation with both the IPSS score (r=-0.33, P<0.001) and age (r=-0.31 and P<0.001). Age was positively associated with the IPSS score (r=0.14 and P<0.001). A significant correlation was observed between LUTS and ED, with 57.6% of the men with LUTS presenting ED as opposed to 29.7% of the asymptomatic population (odds ratio=3.32; 95% CI =2.57-4.29, P<0.001). Age-adjusted univariate analysis revealed a significant and independent influence of LUTS on the incidence of ED (odds ratio=2.72; 95% CI=2.08-3.57, P<0.001). IIEF scores varied significantly according to the severity of the urinary symptoms. Our findings in a prostate cancer screening population confirm that LUTS is an age-independent predictor of ED. Furthermore, they demonstrate that not only the presence of LUTS increases the likelihood of developing ED, but the severity of LUTS is associated with the intensity of ED.
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Affiliation(s)
- E Reggio
- Department of Urologia, Uroclínica de Joinville, Atiradores, Joinville, Brazil.
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141
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Yono M, Yamamoto Y, Yoshida M, Ueda S, Latifpour J. Effects of doxazosin on blood flow and mRNA expression of nitric oxide synthase in the spontaneously hypertensive rat genitourinary tract. Life Sci 2007; 81:218-22. [PMID: 17574276 PMCID: PMC2077832 DOI: 10.1016/j.lfs.2007.05.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2006] [Revised: 04/13/2007] [Accepted: 05/07/2007] [Indexed: 12/01/2022]
Abstract
Hypertension may impact pelvic arterial blood flow resulting in reduction of nitric oxide synthase (NOS) levels. Although doxazosin, an alpha(1)-adrenoceptor antagonist, has been shown to improve erectile dysfunction as well as benign prostatic hyperplasia (BPH) and hypertension, it is not clear whether these improvements using doxazosin are primarily due to direct actions on the prostate, urinary bladder and penis, possibly via inhibition of vascular alpha(1)-adrenoceptors, or other sites of actions. Therefore, we investigated effects of doxazosin to the spontaneously hypertensive rat (SHR) on blood flow and NOS levels in the genitourinary tract. Four groups of rats were assessed: group 1, SHRs treated with doxazosin (30 mg/kg/day) for 4 weeks; group 2, SHRs treated with nifedipine (30 mg/kg/day) for 4 weeks; group 3, untreated SHRs; and group 4, untreated Wistar-Kyoto (WKY) rats. Blood flow to the ventral prostate, dorsolateral prostate, urinary bladder and penis was determined using a fluorescent microsphere infusion technique. Expression levels of nNOS and eNOS mRNAs were quantified by real-time RT-PCR using SYBR Green I. Blood flow to the ventral prostate, dorsolateral prostate, urinary bladder and penis was significantly lower in untreated SHRs than WKY rats. Treatment with doxazosin increased blood flow to each tissue studied in SHRs. RT-PCR data indicated that untreated SHRs had lower mRNA expression levels of nNOS in the bladder and penis and eNOS in the penis than WKY rats and that administration of doxazosin to the SHR caused an increase in expression levels of these genes, i.e., up-regulation of nNOS in the bladder and penis and eNOS in the penis. However, nifedipine had no significant effects on blood flow and NOS levels in the SHR genitourinary tract. Our data demonstrate that doxazosin treatment causes differential alterations in blood flow and NOS levels in the SHR genitourinary tract. These findings may provide insight into the beneficial effects of alpha(1)-adrenoceptor antagonists, on prostate, bladder and penile function, when used to treat symptoms of BPH and elevated blood pressure.
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Affiliation(s)
- Makoto Yono
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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142
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McVary KT, Roehrborn CG, Kaminetsky JC, Auerbach SM, Wachs B, Young JM, Esler A, Sides GD, Denes BS. Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 2007; 177:1401-7. [PMID: 17382741 DOI: 10.1016/j.juro.2006.11.037] [Citation(s) in RCA: 286] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Indexed: 12/29/2022]
Abstract
PURPOSE We assessed the efficacy and safety of tadalafil dosed once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS Following a 4-week, single-blind, placebo run-in 281 men were randomly assigned (1:1) to 5 mg tadalafil for 6 weeks, followed by dose escalation to 20 mg for 6 weeks or 12 weeks of placebo. RESULTS Tadalafil significantly improved the mean change from baseline in International Prostate Symptom Score at 6 weeks (5 mg tadalafil -2.8 vs placebo -1.2) and at 12 weeks (5/20 mg tadalafil -3.8 vs placebo -1.7). Larger changes were observed with inclusion of the placebo run-in at 12 weeks (5/20 mg tadalafil -7.1 vs placebo -4.5). Significant improvements were also seen in the International Prostate Symptom Score irritative and obstructive domains, the International Prostate Symptom Score quality of life index, a question about urinary symptom improvement and the Benign Prostatic Hyperplasia Impact Index (significant at 12 weeks) vs placebo. International Prostate Symptom Score and International Index of Erectile Function erectile function domain scores significantly improved in the 56% of men with lower urinary tract symptoms/benign prostatic hyperplasia who were sexually active and had erectile dysfunction. Changes in uroflowmetry parameters were similar in the placebo and tadalafil groups. Commonly reported (2% or greater) treatment emergent adverse events were "erection increased," dyspepsia, back pain, headache, nasopharyngitis and upper respiratory tract infection (each 5.1% or less). No change in post-void residual volume was seen with tadalafil treatment. CONCLUSIONS Tadalafil once daily was well tolerated and demonstrated clinically meaningful and statistically significant symptomatic improvement for lower urinary tract symptoms/benign prostatic hyperplasia. Tadalafil also improved erectile function in men with lower urinary tract symptoms and erectile dysfunction.
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Affiliation(s)
- Kevin T McVary
- Department of Urology, Northwestern University Medical School, Chicago, Illinois 60611, USA.
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143
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Fitzgerald MP, Link CL, Litman HJ, Travison TG, McKinlay JB. Beyond the lower urinary tract: the association of urologic and sexual symptoms with common illnesses. Eur Urol 2007; 52:407-15. [PMID: 17382458 PMCID: PMC2396456 DOI: 10.1016/j.eururo.2007.03.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 03/06/2007] [Indexed: 01/23/2023]
Abstract
OBJECTIVE In addition to being prevalent and bothersome, urologic and sexual symptoms may be related to chronic medical illnesses. We investigate the relationship between ten urologic and sexual symptoms and four major illnesses (type II diabetes, cardiac disease, hypertension, and depression). METHODS We analyzed data from the Boston Area Community Health (BACH) survey, a community-based epidemiologic study of urologic symptoms and risk factors. BACH used a two-stage stratified cluster sampling design to recruit 5,506 adults aged 30-79 (2301 men, 3205 women; 1770 black, 1877 Hispanic, and 1859 white). RESULTS In bivariate analyses, most urologic and sexual symptoms were associated with type II diabetes, cardiac disease, hypertension, and depression. However, in multivariate models adjusting for all four illnesses, gender, race/ethnicity, age, alcohol intake, smoking, physical activity, and body mass index there were fewer significant associations. We found that all urologic symptoms were significantly related to at least one illness, with depression increasing the odds of all urologic and sexual symptoms studied. CONCLUSIONS Urinary tract specialists should consider factors outside the urinary tract that may be contributing to urologic symptoms. It remains unknown whether treatment of medical and psychological illnesses can result in meaningful improvement in urologic symptoms, or conversely, whether urinary tract symptoms can provide valuable insight into an individual's overall health status.
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Affiliation(s)
| | - Carol L. Link
- New England Research Institutes, Watertown, MA 02472
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144
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Waldkirch ES, Uckert S, Langnäse K, Richter K, Jonas U, Wolf G, Andersson KE, Stief CG, Hedlund P. Immunohistochemical distribution of cyclic GMP-dependent protein kinase-1 in human prostate tissue. Eur Urol 2007; 52:495-501. [PMID: 17329019 DOI: 10.1016/j.eururo.2007.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 02/05/2007] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Phosphodiesterase 5 (PDE5) inhibitors improve smooth muscle relaxation and therefore are considered for pharmacotherapy of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Cyclic guanosine monophosphate (cGMP)-dependent protein kinase-1 (cGKI) has been identified as one of the downstream targets for cGMP. The aim of the present study was to evaluate, by means of immunohistochemistry and Western blot analysis, the expression and localization of cGKI isoforms in relation to smooth muscle alpha-actin and cGMP in the human prostate. METHODS Cryostat sections of tissue segments excised from the transition zone of human prostates from 11 patients (aged 54-68 yr) were incubated with primary antibodies directed against smooth muscle alpha-actin, cGMP, cGKI, cGKIalpha, and cGKIbeta. Visualization of double-labelled immunofluorescent staining was achieved by laser microscopy. Western blot analysis was performed to confirm the expression of cGKI isoforms. RESULTS Immunoreactivities specific for cGKI, cGKIalpha, and cGKIbeta were observed in the smooth musculature of the transition zone. Double-staining revealed the colocalization of smooth muscle alpha-actin, cGMP, and cGKI isoforms in smooth muscle cells of the fibromuscular stroma. The expression of cGKI isoforms was confirmed by Western blot analysis. CONCLUSIONS Our results confirm the presence of cGKI isoforms alpha and beta in the transition zone of human prostate tissue. In addition, the colocalization of alpha-actin, cGMP, and cGKI isoforms provides further evidence for a significant role of the nitric oxide/cGMP pathway in the regulation of smooth muscle contractility in human prostate tissue and therefore could provide additional targets for pharmacotherapy of BPH and LUTS.
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Hatzimouratidis K. Re: Assessment of the Impact of Sildenafil Citrate on Lower Urinary Tract Symptoms in Men with Erectile Dysfunction. Eur Urol 2007; 51:278. [PMID: 17373047 DOI: 10.1016/j.eururo.2006.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Konstantinos Hatzimouratidis
- 2nd Department of Urology, Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Greece.
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Mas M, Ramón Gutiérrez P. Inhibidores de la fosfodiesterasa 5 y tracto urogenital. Rev Int Androl 2007. [DOI: 10.1016/s1698-031x(07)74036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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147
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Current World Literature. Curr Opin Urol 2007; 17:77-81. [PMID: 17143115 DOI: 10.1097/mou.0b013e328012cbca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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148
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Heaton JPW. Lower urinary tract disease: what are we trying to treat and in whom? Br J Pharmacol 2006; 147 Suppl 2:S2-13. [PMID: 16465181 PMCID: PMC1751489 DOI: 10.1038/sj.bjp.0706620] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The diseases of the lower urinary tract are traditionally divided into abnormalities of storage and abnormalities of emptying. The targets for therapy were the organs most responsible for influencing storage and emptying. Modern understanding places the symptomatic status of the patient as the overriding criterion for treatment. It also accommodates a broader understanding of multiple and overlapping systems. Symptoms of voiding dysfunction have been clearly shown to be associated with symptoms of other genitourinary disease, for example, erectile dysfunction (ED). Treatment of voiding dysfunction has also been shown to have effects (adverse or beneficial) in these other domains. Thus, the symptoms of lower urinary tract disease (LUTD) that have to be considered now as targets relevant to these therapies include ED, ejaculatory dysfunction, sexual desire, sexual pain disorders and female sexual dysfunction. The anatomic, neural and endocrine systems that support these symptomatic functions and dysfunctions span the range from the urogenital smooth muscle to the hypothalamus, the bladder sensory output to the micturition centre and growth factors to androgens. Potentially important targets also include vascular and spinal structures, sex hormones and nitric oxide as well as the obvious genes, enzymes and receptors. The epidemiological studies prove the convergence of LUTD when viewed through the lens of the current patient-related outcomes and problem constructs. This convergence serves as a clear guidance to include wide ranging outcome instruments in all future studies with compounds being investigated for the treatment of LUTD. Out of these will come evidence of expected and unexpected collateral effects. The convergence should open the possibility to a different business model for developing therapeutic concepts. The blockbuster drug for a monolithic indication may be supplemented by agents with single or multiple pathway activity with smaller parallel targets. Using an approach based on patient reported outcomes to therapeutic targets not only widens the range of conditions, but also the patient types who can be considered as having LUTD.
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Affiliation(s)
- Jeremy P W Heaton
- Queen's University, 76 Stuart Street, Kingston, Ontario, Canada K7L 2V7.
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Mariappan P, Chong WL. Prevalence and correlations of lower urinary tract symptoms, erectile dysfunction and incontinence in men from a multiethnic Asian population: results of a regional population-based survey and comparison with industrialized nations. BJU Int 2006; 98:1264-8. [PMID: 17034498 DOI: 10.1111/j.1464-410x.2006.06525.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine, in a population-based survey, the prevalence of lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and incontinence in community-dwelling men in multiethnic Malaysia, as currently available Western demographic data might not be applicable in the Asian population. SUBJECTS AND METHODS A cross-sectional population-based survey was carried out in the State of Penang, Malaysia, with a target population of men aged > or = 40 years. Using a multistage study design, random systematic sampling was used to represent the target population, who were weighted based on ethnicity and rural-urban ratios so as to represent the general population distribution. Trained field-workers conducted direct interviews and administered the American Urological Association Symptom Index (AUA-SI), the International Index of Erectile Function (IIEF-5) questionnaire and questions on incontinence based on the International Continence Society 2002 definition. RESULTS In all, 418 men aged > or = 40 years were interviewed, of whom 353 completed the AUA-SI questionnaire (84.5% response rate). The prevalence of mild, moderate and severe LUTS was 80.6%, 6% and 0.3%, respectively. The prevalent symptoms were frequency and nocturia. There was moderate and severe ED in 45.9% of men, whereas incontinence was reported by 8.2%. The AUA-SI correlated strongly with age (R = 0.291, P < 0.001), IIEF-5 (R = - 0.265, P < 0.001) and diabetes mellitus. CONCLUSION The prevalence and severity of LUTS, ED and incontinence increased with age in this multiethnic Asian population, in which ED correlated strongly with LUTS. Compared to the Western population, the prevalence of LUTS was significantly lower, while the prevalence of ED and incontinence were comparable.
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150
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Abstract
BACKGROUND AND SCOPE Lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH), and sexual dysfunction such as erectile dysfunction (ED), are highly prevalent in men over the age of 50. LUTS and ED have a negative impact on sexual function and when comorbid, result in reduced quality of life. The goal of this article is to discuss the relationship between ED and LUTS, describe the diagnostic workup of these disorders, explore the current treatment options, and examine how treatments may affect this population. Medline (1980-2006), Cochrane reviews, and the American Urological Association 2006 General Meeting abstracts were searched for relevant clinical trials and reviews with the terms: benign prostatic hyperplasia, lower urinary tract symptoms, erectile dysfunction, sexual dysfunction, alpha-adrenergic receptor antagonists, alpha-blockers, 5alpha-reductase inhibitors, phosphodiesterase type-5 inhibitors, transurethral resection of the prostate, transurethral microwave thermotherapy, transurethral needle ablation, adverse events, alfuzosin, doxazosin, tamsulosin, terazosin, dutasteride, finasteride, sildenafil, tadalafil, vardenafil. However, because of the volume of literature, this article is not a systematic review. FINDINGS Although age is an independent risk factor for both LUTS and ED, studies report that LUTS is also an independent risk factor for ED. Treatments for LUTS include pharmacologic, minimally invasive, and surgical therapies. Among pharmacologic options, alpha1-adrenergic receptor (alpha1-AR) antagonists provide effective treatment with a low risk of sexual side-effects; some of these drugs have been reported to improve sexual function. The treatment of LUTS may improve ED. Phosphodiesterase type 5 inhibitors (PDE-5s) are considered first-line therapy for ED. Comorbid LUTS and ED are treated with an alpha1-AR antagonist and a PDE-5; however, this combination must be used with caution because of vasodilatory adverse events associated with both classes of drugs. CONCLUSIONS Optimal management includes screening to identify patients with comorbid LUTS and ED, and the use of treatments that minimize both vasodilatory and sexual side-effects.
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Affiliation(s)
- Jed Kaminetsky
- Department of Urology, New York University School of Medicine, New York, NY 10016, USA.
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