Risk factors of sexual dysfunction after transurethral resection of the prostate (TURP): a 12 months follow-up

The prostatic middle lobe: clinical significance, presentation and management

The role of the prostatic middle lobe in the presentation and management of benign prostatic hyperplasia (BPH) is under-appreciated. Middle lobe enlargement is associated with intravesical prostatic protrusion (IPP), which causes a unique type of bladder outlet obstruction (BOO) via a 'ball-valve' mechanism. IPP is a reliable predictor of BOO and the strongest independent factor for failure of medical therapy necessitating conversion to surgical intervention. Men with middle lobe enlargement tend to exhibit mixed symptoms of both the storage and the voiding types, but symptomatology will vary depending on the degree of IPP present. Initial assessments such as uroflowmetry and post-void residual volumes are inadequate to detect IPP and could confound the clinical picture. Radiological evaluation of prostate morphology is key to assessment as it provides important prognostic information and can help with operative planning. Treatment strategies employed for BPH should consider the shape and morphology of prostate adenomata, specifically the presence of middle lobe enlargement and the degree of associated IPP.

Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function

CONTEXT

Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO).

OBJECTIVE

To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function.

EVIDENCE ACQUISITION

A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907).

EVIDENCE SYNTHESIS

A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006).

CONCLUSIONS

Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk.

PATIENT SUMMARY

Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function.

An Updated Meta-Analysis of the Efficacy and Safety of Prostatic Artery Embolization vs. Transurethral Resection of the Prostate in the Treatment of Benign Prostatic Hyperplasia

Background: Prostatic artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH) has been introduced into clinical practice, but conclusive evidence of efficacy and safety has been lacking.

Objective: To compare the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of prostate (TURP), we performed a meta-analysis of clinical trials.

Methods: We searched randomized controlled trials (RCTs) from Pubmed, Embase, Wanfang, and CNKI from January 2000 to December 2020 and used RevMan 5.0 to analyze the data after five RCTs were included.

Results: The reducing of prostate volume (PV) [Median mean (MD) 14.87; 95% confidence interval (CI) 7.52–22.22; P < 0.0001] and the increasing of maximum flow rate in free uroflowmetry (Qmax) (MD 3.73; 95% CI 0.19–7.27; P = 0.004) were more obvious in TURP than in PAE; however, the rate of lower sexual dysfunction [odds ratio (OR) 0.12; 95% CI 0.05–0.30; P < 0.00001] was lower in PAE compared with TURP. Meanwhile, no conspicuous difference in International Prostate Symptoms Score (IPSS) score (MD 1.42; 95% CI −0.92 to 3.75; P = 0.23), quality of life (Qol) score (MD 0.21; 95% CI −0.31 to 0.73; P = 0.43), post void residual (PVR) (MD 21.16; 95% CI −5.58 to 47.89; P = 0.12), prostate-specific antigen (PSA) (MD 0.56; 95% CI −0.15 to 1.27; P = 0.12), and complications (OR 0.90; 95% CI 0.20–4.05; P = 0.89) between PAE and TURP group was shown.

Conclusion: PAE may replace TURP as an alternative treatment for Benign prostatic hyperplasia (BPH) patients who do not want to have surgery or with operational contraindications.

The role of benign prostatic hyperplasia treatments in ejaculatory dysfunction

Ejaculatory dysfunction is not only psychologically distressing but can become a significant obstacle for men who wish to conceive. Dysfunction comes in the form of anejaculation, reduced ejaculation, retrograde ejaculation, painful ejaculation, or premature ejaculation. Most treatments for lower urinary tract symptoms related to benign prostatic hyperplasia, which commonly occurs in aging men, carry significant risks of absent, reduced, or retrograde ejaculation. This review focuses on such risks that accompany both the medical and surgical management of lower urinary tract symptoms/benign prostatic hyperplasia and how these risks impact male fertility.

Significant relationship between parameters measured by transrectal color Doppler ultrasound and sexual dysfunction in patients with BPH 12 months after TURP

BACKGROUND

A link between sexual dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) has been noticed. Transurethral resection of the prostate (TURP) remains the standard treatment for symptomatic BPH, whether TURP causes sexual dysfunction is still uncertain. In this retrospective study, we investigated the relationship between parameters measured by color Doppler ultrasound (CDU) and sexual dysfunction in patients with BPH 12 months after TURP.

METHODS

The parameters include presumed circle area ratio (PCAR), maximal horizontal area of seminal vesicles (MHA), resistive index of the prostate (RIP), and peak systolic velocity in the flaccid penis (PSV). The international prostate symptom score was used to evaluate the lower urinary tract symptoms and the five-item version of the International Index of Erectile Function was used to evaluate sexual function before and after TURP.

RESULTS

Of the 103 patients without sexual dysfunction before TURP, 11 (10.7%) had erectile dysfunction (ED) after TURP. These 11 patients had significantly lower PCAR, RIP, PSV and MHA than those without ED. The patients with retrograde ejaculation after TURP had significantly lower PCAR than those without retrograde ejaculation, and the patients with premature ejaculation after TURP had significantly lower MHA than those without premature ejaculation. Comparing the parameters between baseline and after TURP, PCAR, RIP, and MHA decreased significantly in the patients with sexual dysfunction, but no significant differences were noted in the patients without sexual dysfunction after TURP.

CONCLUSIONS

More extended TURP can lead to a higher incidence of ED and retrograde ejaculation in BPH patients without sexual dysfunction before TURP. Patients with a lower volume of seminal vesicles after TURP may have a higher incidence of premature ejaculation.

Metabolic syndrome is associated worsened erectile function in patients undergoing TURP due to benign prostatic hyperplasia

INTRODUCTION

Transurethral resection of the prostate (TURP) is the gold standard method for surgical treatment of benign prostatic hyperplasia (BPH). So, the complications of TURP is important, in which erectile dysfunction is the most important. The aim of the present study is to evaluate erectile dysfunction in patients undergoing TURP treatment for BPH and investigate the correlation between metabolic syndrome and erectile dysfunction.

MATERIALS AND METHODS

This study included 120 patients who underwent surgery for BPH at Beylikdüzü State Hospital and Okmeydani Training and Research Hospital. IIEF-5 form was administered to the patients before the surgery and six months after the surgery. The Student's t-test, Wilcoxon, and chi-square test were used in the statistical analysis.

RESULTS

The patients were investigated by IIEF-5 scoring into three groups (severe, moderate, and non-ED (erectyl disfunction)-mild). The statistical analysis of IIEF-5 form administered to 120 patients who underwent surgery did not show any significant difference before surgery and six months after surgery (p > 0.05). Metabolic syndrome and erectile dysfunction correlation were examined, and a significant correlation was obtained between metabolic syndrome and severe erectile dysfunction (p < 0.05).

CONCLUSIONS

IIEF-5 results administered before and after surgery showed no significant difference. The study showed that patients with metabolic syndrome have a higher probability of having erectile dysfunction after TURP compared to patients without metabolic syndrome. Moreover, post-surgery, patients with metabolic syndrome seemed to be affected negatively regarding erectile dysfunction compared to patients with no metabolic syndrome.

The impact of prostate-transurethral resection on erectile dysfunction in benign prostatic hyperplasia

Background: Erectile dysfunction (ED) after a prostate-transurethral resection (P-TUR) is one of the problems in the treatment of benign prostatic hyperplasia (BPH) that may affect the quality of life in middle-aged and older men. The aim of this study was to investigate the impact of P-TUR on ED in BPH patients. Methods: This study was conducted on 83 patients suffering from BPH that underwent a P-TUR. Clinically, testosterone levels, prostatic-specific antigen (PSA) levels, and prostate volume were measured before the P-TUR. Erectile function was measured prior to the P-TUR, as well as at 1 and 3 months after the P-TUR using the International Index of Erectile Function (IIEF). Suitability test of the model was done in a structural equation. Data were analyzed using the chi-square (χ 2) test by Analysis of Moment Structure (AMOS) software version 21. Results: The effects of PSA to IIEF before, 1 month after, and 3 months after P-TUR were 0.116, 0.084, and 0.097, respectively. The effects of body mass index to IIEF before, 1 month after, and 3 months after P-TUR were 0.180, 0.066, and 0.164, respectively. The effects of prostate volume to IIEF before, 1 month after, and 3 months after P-TUR were 0.049, 0.004, and 0.011, respectively. The effects of testosterone to IIEF before, 1 month after, and 3 months after P-TUR were -0.029, -0.453, and -0.415, respectively. The effects of age to IIEF before, 1 month after, and 3 months after P-TUR were -0.444, 0.921, and 0.911, respectively. Conclusion: There was a significant improvement of erectile function in patients that underwent P-TUR who previously had preoperative ED, especially 3 months after the surgery.

Investigation of prostate resected weight on postoperative sexual dysfunction following transurethral resection of prostate surgery: a population-based study

Background

Benign prostate hyperplasia, a common disease in elderly men, can be surgically treated with transurethral resection of the prostate (TURP). Postoperative sexual dysfunction is a major issue and is influenced by many factors. The present study aimed to assess whether the intraoperative resected prostate weight influences the probability of postoperative sexual dysfunction.

Methods

This population-based study included 41,574 patients from the Nation Health Insurance Research Database who had undergone TURP once between 1997 and 2013. All patients were divided into three groups according to the resected prostate weight (low, medium, and high groups). Perioperative risk factors influencing sexual function were analyzed. The chi-squared test and Fisher's exact test were used to analyze differences in demographic data. The Cox proportional hazard regression analysis was used to analyze the HRs. All statistical analyses were two-sided, and a P-value <0.05 was considered statistically significant.

Results

Of the 41,574 patients, 1,168 had postoperative sexual dysfunction after surgery. The incidence was not significantly different among the three resected prostate weight groups. Younger patients and patients with histories of chronic renal disease, ischemic heart disease, and obesity had higher prevalence of postoperative sexual dysfunction. Additionally, the onset time of sexual dysfunction was not significantly different among the three resected prostate weight groups.

Conclusion

Among patients undergoing TURP in Taiwan, the resected prostate weight does not seem to be related to the presence or onset time of postoperative sexual dysfunction.

Clinical evaluation of embolization of the superior vesical prostatic artery for treatment of benign prostatic hyperplasia: a single-center retrospective study

Introduction

Non-surgical minimally invasive treatments are greatly needed for patients with symptomatic benign prostatic hyperplasia (BPH), for whom medical treatment has failed and surgery is contraindicated. This study retrospectively evaluated the efficacy and safety of super-selective prostatic artery embolization (PAE) for BPH, relative to transurethral resection of the prostate (TURP).

Aim

To clinically evaluate the efficacy and safety of super-selective PAE for BPH, relative to TURP.

Material and methods

From February 2012 to March 2015, patients with BPH underwent selective PAE (n = 17) or TURP (control group; n = 40). Prostate volume, maximum urinary flow rate (Qmax), International Prostate Symptoms Score (IPSS), and quality of life (QoL) score were evaluated at baseline and postoperative 3, 6, and 12 months. Complications were also recorded.

Results

All the procedures were technically successfully. At postoperative 1 year, patients given PAE had significantly greater prostate volume (64.6 ±10.2 ml), IPSS (23.9 ±4.9), and QoL (4.1 ±0.7) compared with the control patients (42.0 ±7.5 ml, 13.1 ±3.5, and 2.1 ±0.7, respectively). The Qmax of the PAE group (9.5 ±3.7 ml/s) was significantly lower than that of the control (21.8 ±4.2 ml/s). The changes in parameters of the TURP patients relative to the preoperative baseline were significantly greater than those of the PAE group. No severe complications occurred.

Conclusions

Prostatic artery embolization was demonstrated as safe and effective and may be considered an alternative treatment for BPH patients, especially for those who are not candidates for or refuse surgery.

Transurethral resection of the prostate (TURP) vs GreenLight photoselective vaporization of benign prostatic hyperplasia: analysis of BPH6 outcomes after 1 year of follow-up

The surgical treatment of benign prostatic obstruction is changing over the time, thanks the increase evidence about the successful role of laser techniques in this surgery. We aimed to compare prostatic GreenLight photovaporization (PVP) to bipolar transurethral resection of the prostate (TURP) with regard to lower urinary tract symptoms (LUTS) improvement through the evaluation of BPH6. We enrolled 220 consecutive subjects affected by LUTS. We performed a propensity score matching using prostate volume, peak flow and International Prostate Symptoms Score (IPSS). A total of 110 (55 TURP and 55 PVP) were analyzed. We found after 1 year of follow-up that the rate of subjects resulting in greater BPH6 recovery in the PVP group vs TURP (45.6% vs 18.2%; P=0.001). The TURP treatment showed greater catheterization time (4.67 vs 1.25; P<0.01) while PVP showed greater recovery experience (82.4 vs 58.2; <0.01). Postoperative ejaculatory dysfunctions were observed in both groups, 58.8% in TURP and 34.5% in PVP group. The multivariate logistic regression analysis, adjusted for preoperative variables, showed that PVP was independently associated with BPH6 recovery end point (odds ratio=3.77; P<0.01). This study showed data in favor of PVP. Although IPSS and peak flow improvements were similar, PVP showed better clinical outcomes.

Impact of combination therapy 5-alpha reductase inhibitors (5-ARI) plus alpha-blockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/BPH: a systematic review with meta-analysis

Lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) represent one of the most common clinical complaints in adult men. Several drugs used for LUTS/BPO may strongly affect sexual function and bother. The aim of this systematic review and meta-analysis was to evaluate the impact of combination therapy with alpha-blockers (AB), 5-alpha reductase inhibitors (5-ARI) on the risk of erectile dysfunction(ED) and libido alterations (LA) from randomized clinical trial (RCT). Based on the inclusion and exclusion criteria, five RCTs involving 6131 patients were included in the analysis. According to the analysis, the overall prevalence of ED and LA were significantly greater in the combination treatment group than in the AB group (7.93% versus 4.66%; OR 1.81; p < 0.0001 and 3.69% versus 2.36%; OR 1.58; p = 0.003, respectively). The combination therapy increased the risk of ED compared to monotherapy with 5-ARI (7.93% versus 6.47%; OR 1.25; p = 0.04) but not the risk of LA (3.51% versus 3.37; OR 1.03; p = 0.84). In our systematic meta-analysis, we demonstrated that combination therapy with ABs and 5-ARIs was associated with significantly higher risk of ED and LA compared with single monotherapy. Combination therapy showed similar risk of LA compared with 5-ARI monotherapy.

Association between long-term erectile dysfunction and biochemical recurrence after permanent seed I(125) implant brachytherapy for prostate cancer. A longitudinal study of a single-institution

We aimed to investigate the predictive factor of erectile dysfunction (ED) in prostate cancer (PCa) patients who underwent low-dose permanent I(125) seed implant brachytherapy and to investigate if ED could represent a patient's reported outcome measures (PROMs) of efficacy of BT and indirectly associated with biochemical recurrence free survival (BRFS). From 2000 to 2012, 176 consecutive patients with low-risk PCa underwent BT. ED was evaluated with the International Index of Erectile Function (IIEF-5). Cox regression analysis was performed to assess significant predictors of mild-to-severe ED and BRFS after BT, including covariates. The 10-year actuarial rate of ED was 66%. Subjects with severe ED had higher values of D90 (183.0 versus 177.0; p < 0.05) and V100% (40.1 versus 31.4; p < 0.05) compared with normal. At the multivariate logistic regression analysis, D90 (OR: 1.10; p < 0.05) was an independent predictor of ED. Multivariate Cox-regression analysis did not demonstrate significant association between erectile preservation and biochemical recurrence (BCR) after 10 years of follow up (HR: 2.15; p = 0.20), while D90 ≤ 180 Gy independently predicted BCR (HR: 4.65; [95%CI: 1.25-17.34]; p < 0.05). Erectile preservation should be addressed as valuable PROMs after permanent seed I(125) implant, but it is not associated with better BRFS.

Predicting erectile dysfunction in sexually active patients seeking prostate health screening: proposal for a multivariable risk stratification

To address the severity of erectile dysfunction (ED) in consecutive sexually active men seeking a prostate health screening through a multivariable risk stratification including comorbidities and lower urinary tract symptoms (LUTS). Four hundred and twenty five consecutive subjects with stable sexual relationship with normal testosterone levels were enrolled. The International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS) questionnaires were collected and health-significant comorbidities were scored with the Charlson comorbidity index (CCI). All the independent predictors of ED were combined to form four different risk categories of ED: low (age⩽65 years and IPSS<8 and CCI=0), intermediate (one of the following: age>65 years, IPSS⩾8 or CCI⩾1), high (two of the following: age>65 years, IPSS⩾8 or CCI⩾1) and very high (age >65 years, IPSS⩾8 and CCI⩾1). The prevalence of ED increased with increase of CCI (χ(2) likelihood ratio: 40.85, P=0.001). The median of the IIEF-5 significantly reduced with the increase of the CCI (P<0.001) and with the worsening of our risk group stratification (P<0.001). At univariate logistic regression analysis very high risk was significantly associated with of ED (odds ratio: 26.85, P<0.001). Very high-risk group predicted ED with 88% and 56% of specificity and sensitivity, respectively. Combining these risk factors through our risk stratification may be usefulness in revealing an underling ED.

Alga Ecklonia bicyclis, Tribulus terrestris, and glucosamine oligosaccharide improve erectile function, sexual quality of life, and ejaculation function in patients with moderate mild-moderate erectile dysfunction: a prospective, randomized, placebo-controlled, single-blinded study

We aimed to evaluate the efficacy of oral therapy with alga Ecklonia bicyclis, Tribulus terrestris, and glucosamine oligosaccharide (Tradamix TX1000) in patients with erectile dysfunction (ED) at 3 months of follow-up. From January 2013 to September 2013, 177 patients diagnosed with mild-moderate ED (IIEF-EF < 26) were enrolled in this multicenter, single-blinded, placebo-controlled study and randomized in Group A (Tradamix, n = 87) and Group B (placebo, n = 90). Penile color Doppler ultrasound measures, IIEF-15 questionnaire, male sexual health questionnaire-ejaculation disorder (MSHQ-EjD), and sexual quality of life (SQoL-M) were collected. We observed significant changes of the IIEF-15 in Group A (mean difference: 11.54; P < 0.05) at 3 months versus Group B (P < 0.05). PSV (P < 0.05), IIEF-intercourse satisfaction (P < 0.05), IIEF-orgasmic function (mean P < 0.05), IIEF-sexual desire (P < 0.05), IIEF-overall satisfaction (P < 0.05), MSHQ-EjD (mean difference: 1.21; P < 0.05), and SQoL-M (mean difference: 10.2; P < 0.05) were significantly changed in Group A versus baseline and Group B. Patients with moderate arterial dysfunction showed significant increase of PSV (P < 0.05), IIEF-EF (P < 0.05), MSHQ-EjD (P < 0.05), and SQoL-M (P < 0.05) in Group A. Therapy with Tradamix improves erectile and ejaculation function and sexual quality of life in patients with mild-moderate ED and in particular for those with moderate arterial dysfunction.

Patient-reported sexual outcomes after holmium laser enucleation of the prostate: a 3-year follow-up study

OBJECTIVE

To evaluate the long-term patient reported sexual function outcomes of holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms secondary to prostate enlargement.

METHODS

Three hundred ninety-three patients underwent a HoLEP between August 2007 and July 2013 and were reviewed in this retrospective analysis. Sexual function outcomes were assessed before HoLEP, and again at 3, 6, 12, 24, and 36 months after surgery using the International Index of Erectile Function 5 survey. International Prostate Symptom Scores (IPSS) were included for comparison and contextual functional outcome analysis.

RESULTS

At the time of surgery, the mean age was 70.9 years (52.0-89.0 years), mean body mass index was 27.7 kg/m(2) (18.0-48.0 kg/m(2)), and mean prostate volume was 96.7 g (20.1-375.0 g). Mean International Index of Erectile Function 5 scores at 3 (13.3 ± 8.37), 6 (12.1 ± 8.76), 12 (12.1 ± 8.83), 24 (12.6 ± 8.80), and 36 months (12.5 ± 8.45) showed no significant change from baseline. There was, however, a significant improvement from baseline seen in IPSS over the same time period (P = .0001).

CONCLUSION

These data confirm HoLEP has a significant impact on IPSS and no adverse impact on long-term patient reported sexual function. We believe this series represents the largest cohort with the longest follow-up to date. It represents an important tool for preoperative patient counseling for those patients considering surgical therapy for benign prostatic hyperplasia.

Insulin resistance is an independent predictor of severe lower urinary tract symptoms and of erectile dysfunction: results from a cross-sectional study

INTRODUCTION

Several studies have linked the association between lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and the presence of insulin resistance (IR) due to an underlined metabolic syndrome (MetS).

AIM

This study aims to determine the relationship between IR, sexual function, and LUTS and to demonstrate the ability of IR in predicting ED and severe LUTS.

METHODS

Between January 2008 to January 2013, 544 consecutive patients with benign prostatic hyperplasia-related LUTS were enrolled. LUTS and sexual function of the patients were evaluated by the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS). MetS was defined by the International Diabetes Federation. IR was defined as a homeostasis model assessment (HOMA) index of 3 or greater.

MAIN OUTCOME MEASURES

Uni- and multivariate logistic regression analysis was performed to assess significant predictors of severe LUTS (IPSS ≥ 20) and ED (IIEF-Erectile Function [IIEF-EF] <26), including MetS component, prostate volume, prostate-specific antigen, total testosterone, and HOMA index.

RESULTS

IR patients resulted in higher values of IPSS (19.0 vs. 15.0; P<0.01), IPSS-storage (6.0 vs. 5.0; P<0.01), IPSS-voiding (12.0 vs. 9.0; P<0.01), total prostate volume (54.8 vs. 36.5; P<0.01), and lower values of IIEF-EF (17.0 vs. 20.0; P<0.01), IIEF-Intercourse Satisfaction (3.0 vs. 10.0; P<0.01), IIEF-Orgasmic Function (8.0 vs. 9.0; P<0.01), IIEF-Overall Satisfaction (6.0 vs. 8.0; P<0.01), and total testosterone (3.83 vs. 4.44; P<0.01). IR was demonstrated to be a strong predictor of ED (IIEF-EF <26) (odds ratio [OR] =6.20, P<0.01) after adjusting for confounding factors. Finally, IR was also an independent predictor of severe LUTS (IPSS ≥ 20) (OR=2.0, P<0.01) after adjusting for confounding factors.

CONCLUSIONS

IR patients are at high risk of having severe LUTS and contemporary sexual dysfunctions. We strongly suggest to prevent LUTS and ED by reducing insulin resistance.