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Hawks-Ladds N, Cook R, Babar M, Zhu M, Schulz A, Loloi J, Masoud Z, Singh J, Jamil H, Sayed R, Ines M, Ciatto M. Four years of real-world sexual function outcomes after Rezum therapy in men with and without baseline erectile dysfunction. J Sex Med 2024; 21:777-786. [PMID: 39084676 DOI: 10.1093/jsxmed/qdae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/28/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Rezum alleviates lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) while preserving sexual function, but long-term sexual function outcomes are lacking in patients with baseline erectile dysfunction (ED). AIM The study sought to analyze 4 years of real-world sexual function outcomes of Rezum using the International Index of Erectile Function (IIEF) questionnaire, stratified by baseline ED status. METHODS Participants included multiethnic Rezum-treated patients from a single outpatient office. IIEF domains and BPH medication usage were compared at baseline and 6, 12, and 48 months using t tests, Mann-Whitney U tests, chi-square tests, and Wilcoxon signed rank tests. OUTCOMES Primary outcomes over 4 years included the IIEF functional domains (erectile function [EF], orgasmic function [OF], sexual desire [SD], intercourse satisfaction [IS], overall satisfaction [OS]) and BPH medication usage. RESULTS A total of 91 patients were included: 40 (44%) in the ED cohort and 51 (56%) in the no ED cohort. History of diabetes was more prevalent in the ED cohort (35% vs 15.7%; P = .048). Baseline scores in the EF, OF, IS, and OS domains were lower in the ED cohort. Compared with baseline, there were no significant changes in any IIEF domains in either cohort at 6 months. At 12 months, the ED cohort had significant percent decreases in OF (-25%; P = .02), SD (-22.2%; P = .04), and OS (-33.3%; P = .004); the no ED cohort had a significant percent increase in EF (5%; P = .04). At 48 months, the no ED cohort had no significant changes in any IIEF domains, while the ED cohort had significant percent increases in EF (30%; P = .01), SD (22.5%; P = .02), IS (20%; P = .01), and OS (58.3%; P = .008). Both cohorts significantly discontinued BPH medications at all follow-ups. At 48 months, there were no cases of de novo ED in the no ED cohort. CLINICAL IMPLICATIONS As modern BPH therapies continue to demonstrate efficacy in alleviating lower urinary tract symptoms, the preservation or improvement of sexual function emerges as an increasingly important consideration for patients, with our study suggesting Rezum as a compelling option. STRENGTHS AND LIMITATIONS Our study has the strength of long-term Rezum outcomes in an ethnically diverse patient population, stratified by the presence of baseline ED, but is limited by retrospective design, single-center nature, and small sample sizes at long-term follow-ups. CONCLUSION Rezum preserved long-term sexual function in patients without baseline ED and improved sexual function in those with baseline ED; however, individuals with ED may experience temporary decreases in sexual function at 12 months.
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Affiliation(s)
- Noah Hawks-Ladds
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Ryan Cook
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Mustufa Babar
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Michael Zhu
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Alison Schulz
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, NY 10467, United States
| | - Zaki Masoud
- Department of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, United States
| | | | - Hasan Jamil
- School of Public Health, St. Luke International University, Tokyo 104-8560, Japan
| | - Rahman Sayed
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Matthew Ines
- DSS Urology, Queens Village, NY 11427, United States
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Khan J, Shaw S. Risk of multiple lower and upper urinary tract problems among male older adults with type-2 diabetes: a population-based study. Aging Male 2023; 26:2208658. [PMID: 37256730 DOI: 10.1080/13685538.2023.2208658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 06/02/2023] Open
Abstract
AIM This study explores the risk of diabetes-associated lower and upper urinary tract diseases among male older adults aged 45 and above in India. METHODS Longitudinal Ageing Study in India (LASI), 2017-2018 data was used in this study. The prevalence of various urinary tract problems and diabetes among male older adults was estimated by background characteristics using bivariate cross-tabulation. In addition, multivariate logistic regression was applied to examine the likelihood of urological disorders associated with diabetes. RESULT The prevalence of incontinence was highest among male older adults with diabetes, followed by kidney stones, benign prostatic hyperplasia, and chronic renal failure. Multivariate logistic regression estimation showed that men diagnosed with diabetes were 80% more likely to experience chronic renal failure, 78% more likely to suffer from incontinence, and 37% more likely to suffer from kidney stones than those without diabetes when controlling for various socio-demographic, behavioral, and co-morbidity status of the older adults. CONCLUSIONS The study findings suggest that diabetes is associated with multiple urinary complications among male older adults in India and needs more careful investigation of the phenomenon. Independent risk factors such as changes in lifestyle with regular monitoring and diagnosis may help to prevent the progression of diabetes and reduce the risk of diabetes-associated lower and upper urinary tract diseases among male older adults.
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Affiliation(s)
- Junaid Khan
- International Institute for Population Sciences, Mumbai, India
| | - Subhojit Shaw
- International Institute for Population Sciences, Mumbai, India
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3
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Pitta RM, de Lima Queiroga L, Louzada ACS, Ritti-Dias RM, Kaufmann OG, Wolosker N. What are the Main Risk Factors Associated with Erectile Dysfunction in the Elderly? A Cross-Sectional Study of 2436 Brazilian Elderly Men. Clin Interv Aging 2023; 18:1047-1054. [PMID: 37448757 PMCID: PMC10337775 DOI: 10.2147/cia.s405121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Background Erectile dysfunction (ED) is a multifactorial medical disorder often neglected in clinical practice between elderly men, defined as the inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual intercourse and a common clinical entity among men and associated with impaired quality of life and cardiovascular diseases in elderly men. The aim of this study is to evaluate the association between ED and clinical, demographic and behavioral parameters in elderly men. Methods A total of 2436 males aged 60 years and over who participated in the health screening between January 2008 and December 2018 were included in this study. Laboratory exams, clinical and behavior profiles were analyzed. Logistic regression models were used. Results Men with ED were older (65.87±5.49 vs. 63.85±4.05 years old. p<0.001), higher prevalence of physical inactivity (23.8 vs. 19%, p = 0.039) and had a higher body mass index (BMI; 28.36±4.06 vs. 27.72±3.89 kg/m2. p<0.001) than men without ED. The multivariate model shown that hypertension (p = 0.001), diabetes mellitus (p<0.001), lower urinary tract symptoms (LUTS), depressive symptoms (p<0.001) and age (p<0.001), were strongly associated with ED. Conclusion The main risk factors associated with ED in elderly men were hypertension, diabetes mellitus, LUTS, depressive symptoms and age.
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Affiliation(s)
- Rafael Mathias Pitta
- Postgrad Program Health Science, Instituto Israelita de Ensino & Pesquisa, São Paulo, SP, Brazil
| | - Luana de Lima Queiroga
- Postgrad Program Health Science, Instituto Israelita de Ensino & Pesquisa, São Paulo, SP, Brazil
| | | | | | - Oskar Grau Kaufmann
- Postgrad Program Health Science, Instituto Israelita de Ensino & Pesquisa, São Paulo, SP, Brazil
| | - Nelson Wolosker
- Postgrad Program Health Science, Instituto Israelita de Ensino & Pesquisa, São Paulo, SP, Brazil
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Gupta R, Trivedi S, Vaddi SP, Borgohain M, Mittal R, Pandit S, Mane A. Electronic medical records-based retrospective, longitudinal, observational study to understand the patient management of benign prostatic hyperplasia with alpha-blockers monotherapy in Indian population. Urol Ann 2023; 15:138-147. [PMID: 37304518 PMCID: PMC10252785 DOI: 10.4103/ua.ua_114_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023] Open
Abstract
Objective The present retrospective study evaluates the effectiveness and tolerability of alpha-blockers as monotherapy in patients with benign prostatic hyperplasia associated with lower urinary tract symptoms (LUTS). Materials and Methods A total of 335 male patients >50 years were categorized into four groups (Alfuzosin: 166, Silodosin: 67, Tamsulosin: 70, Prazosin: 32). The efficacy evaluated as a change in International Prostate Symptom Score (IPSS), peak flow rate (Qmax), residual urine volume, and relief from LUTS, and tolerability of the various alpha-blockers was assessed across the study group. Results At baseline, most of the patients in alfuzosin (60%), silodosin (77%), and tamsulosin (90%) groups presented with severe IPSS (20-35), whereas patients in the prazosin group (69%) presented with a moderate score. At the end of the study, the mean IPSS gradually improved to moderate (41%, 62%, 66%, and 28%) and mild (59%, 38%, 28%, and 72%) in the alfuzosin, silodosin, tamsulosin, and prazosin groups, respectively (P = 0.004), with improvement in mean change in residual urine volume and complete relief from LUTS symptoms with no surgical or radiological interventions. Overall, 194 adverse events (AEs) were observed in 38.8% of patients. Of the total AEs, patients in the alfuzosin, silodosin, tamsulosin, and prazosin groups experienced 21%, 22%, 39%, and 18% of AEs, respectively. Conclusion The nonselective alpha-adrenergic receptor antagonist, alfuzosin, emerged as noninferior in effectiveness and superior in tolerability than other selective alpha-blockers, silodosin, tamsulosin, and prazosin.
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Affiliation(s)
- Rahul Gupta
- Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Sameer Trivedi
- Department of Urology, IMS-BHU, Varanasi, Uttar Pradesh, India
| | | | - Mrinal Borgohain
- Medical Affairs, Dr. Reddy’s Laboratories Ltd., Hyderabad, Telangana, India
| | - Rajan Mittal
- Medical Affairs, Dr. Reddy’s Laboratories Ltd., Hyderabad, Telangana, India
| | - Sucheta Pandit
- Medical Affairs, Dr. Reddy’s Laboratories Ltd., Hyderabad, Telangana, India
| | - Amey Mane
- Medical Affairs, Dr. Reddy’s Laboratories Ltd., Hyderabad, Telangana, India
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Pitta RM, Kaufmann O, Louzada ACS, Astolfi RH, de Lima Queiroga L, Ritti Dias RM, Wolosker N. The association between physical activity and erectile dysfunction: A cross-sectional study in 20,789 Brazilian men. PLoS One 2022; 17:e0276963. [PMID: 36383526 PMCID: PMC9668147 DOI: 10.1371/journal.pone.0276963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Erectile dysfunction, defined as the inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual intercourse is associated with impaired quality of life and cardiovascular diseases in men older than 40 years. Objective To evaluate the association between erectile dysfunction and physical activity levels in a large cohort of men. Methods Data from 20,789 males aged 40 years and over who participated in the check-up screening between January of 2008 and December of 2018 were included in this study. In this sample, data about erectile dysfunction, physical activity levels, clinical profile and laboratory exams were obtained. Logistic regression models were performed. Results Individuals with erectile dysfunction were older (49.1 ±6.9 vs. 54.8±8.8 years old, p<0.001), had a higher body mass index (27.6 ±3.9 vs. 28.5 ± 4.3 kg/m2, p<0,001), and presented with a higher prevalence of physical inactivity (25 vs. 19%, p<0.001) than individuals without erectile dysfunction. The multivariate model revealed that age (p<0.001), hypertension (p = 0.001), diabetes mellitus (p<0.001), high body mass index (p<0.001), lower urinary tract symptoms and depressive symptoms (p<0.001) were independent risk factors for erectile dysfunction. Low or high physical activity levels (OR = 0.77; CI95%: 0.68–0.87, p<0.001 and OR = 0.85; CI95%: 0.72–0.99, p = 0.04 respectively) were protective factors against erectile dysfunction. Conclusion Low and high physical activity levels were associated with more than 20% reduction in the risk of erectile dysfunction in men aged 40 years or older.
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Affiliation(s)
- Rafael Mathias Pitta
- Inst Israelita Ensino & Pesquisa, Postgrad Program Hlth Sci, São Paulo, SP, Brazil
- * E-mail:
| | - Oskar Kaufmann
- Inst Israelita Ensino & Pesquisa, Postgrad Program Hlth Sci, São Paulo, SP, Brazil
| | | | | | | | | | - Nelson Wolosker
- Inst Israelita Ensino & Pesquisa, Postgrad Program Hlth Sci, São Paulo, SP, Brazil
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6
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Kim SH, Ock M, Jo MW, Park S. Estimation of utility weights for prostate-related health states in Korea. J Prev Med Public Health 2022; 55:243-252. [PMID: 35677998 PMCID: PMC9201095 DOI: 10.3961/jpmph.21.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Seon-Ha Kim
- Department of Nursing, Dankook University, Cheonan,
Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul,
Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
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7
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Gong ZC, Wu ZL, Wen YA, Zou JP, Wang X, Leng X, Bleyer AJ, Deng C, Feloney MP, Zhang Y, Zhao SC. Sexual Dysfunction in Patients With Urinary Bladder Stones but no Bladder Outlet Obstruction. Front Med (Lausanne) 2021; 8:704360. [PMID: 34604254 PMCID: PMC8482996 DOI: 10.3389/fmed.2021.704360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/10/2021] [Indexed: 12/22/2022] Open
Abstract
Objective: To explore the correlates of sexual dysfunction and lower urinary tract symptoms (LUTS) in male patients with urinary bladder stones and to determine the effect of stone extraction on recovery of sexual function. Materials and Methods: A total of 87 male patients with primary bladder stones were studied from January 2015 to May 2016. All patients underwent pneumatic lithotripsy for bladder stones. Sexual dysfunction was assessed based on sexual function assessment scales. The relationship of bladder stones with sexual dysfunction or LUTS was assessed using a two-sample t-test. Postoperative improvement of sexual function was assessed by repeated measures Analysis of Variance (ANOVA). Results: Forty-one patients had primary bladder stones and 46 had secondary stones from the kidneys. Eighty-three of 87 patients (95%) had sexual dysfunction; 79 patients (91%) had both sexual dysfunction and LUTS. There was a significant association between bladder stones and sexual dysfunction, between sexual dysfunction and LUTS, and between bladder stone and LUTS (p < 0.05). There was no significant association between the course of illness, size and number of bladder stones, or urinary tract infection with sexual function (p > 0.05). In addition, among 83 patients with both bladder stone and sexual dysfunction, 61 patients (73%) had benign prostatic hyperplasia (BPH) and 22 patients (27%) had no BPH. On postoperative evaluation at 3 months, sexual dysfunction scores were significantly improved in 77 patients (88.5%) Conclusion: Patients with bladder stones have a high incidence of sexual dysfunction, particularly those with co-existing LUTS and BPH. About 1/3 patients without BPH had sexual dysfunction and surgical removal of bladder stones significantly improved sexual function and LUTS.
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Affiliation(s)
- Zhi-Cheng Gong
- Department of Urology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Urology, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Zhi-Liang Wu
- Department of Urology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Urology, Dongfeng Zhongshan People's Hospital, Zhongshan, China
| | - Yao-An Wen
- Department of Urology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jie-Peng Zou
- Department of Urology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xisheng Wang
- Department of Urology, Shenzhen Longhua New District Central Hospital, Shenzhen, China
| | - Xiaoyan Leng
- Public Health Sciences, Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Anthony J Bleyer
- Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Chunhua Deng
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Michael P Feloney
- Department of Urology, School of Medicine, Creighton University, Omaha, NE, United States
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Shan-Chao Zhao
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Department of Urology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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8
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Qiao J, Gan Y, Gong Y, Song Q, Zhang B, Li B, Ru F, Li Y, He Y. Combination therapy with curcumin plus tamsulosin and finasteride in the treatment of men with benign prostatic hyperplasia: a single center, randomized control study. Transl Androl Urol 2021; 10:3432-3439. [PMID: 34532268 PMCID: PMC8421839 DOI: 10.21037/tau-21-567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022] Open
Abstract
Background To perform a prospective, randomized, single center study to investigate the efficacy of combined use of curcumin, an anti-inflammatory agent, with the best standard management (BSM, tamsulosin and finasteride) in benign prostatic hyperplasia (BPH) patients. Methods One hundred and twenty-two consecutive patients were randomized to receive tamsulosin 0.2 mg, finasteride 5 mg, and curcumin 2,250 mg once a day (curcumin + BSM group, n=61) versus tamsulosin 0.2 mg, finasteride 5 mg, and placebo (BSM group, n=61) for 6 months. The safety of treatments and their efficacy on improving waist circumference (WC), periprostatic fat thickness (PPFT), lower urinary tract symptoms (LUTS), and sexual function were assessed at baseline and month 6. Results One hundred and sixteen patients completed the whole procedure (116/122, 95.1%). There were significant improvements in prostate volume (PV), maximum flow rate (Qmax), the International Prostate Symptom Score (IPSS), IPSS-voiding subscore (IPSS-V), IPSS-storage subscore (IPSS-S), and quality of life (QoL) from baseline after treatment in both groups. Additionally, both WC and PPFT decreased significantly after treatments than those at baseline in the curcumin + BSM group. Also, WC and PPFT in the curcumin + BSM group were significantly lower than those in the BSM group. In addition, IPSS-S, QoL score, and the 5-item version of the International Index of Erectile Function (IIEF-5) in the curcumin + BSM group improved significantly compared with those in the BSM group. Conclusions We conclude that curcumin combined with tamsulosin and finasteride has more beneficial effects in reducing PPFT, protecting erectile function, improving urinary retention symptoms, and QoL scores in BPH patients compared to tamsulosin and finasteride alone. Trial Registration Chinese Clinical Trial Registry ChiCTR2100043800.
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Affiliation(s)
- Jing Qiao
- Department of Ophthalmology, Hunan Children's Hospital, Changsha, China
| | - Yu Gan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yuchen Gong
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Qingtian Song
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Bo Zhang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Bingsheng Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Ru
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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9
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Bravo-Balado A, Trujillo CG, Caicedo JI, García S, Azuero J, Rondón M, Plata M. Assessment of Female Sexual Dysfunction and Erectile Dysfunction and Its Association with Lower Urinary Tract Symptoms in Women and Men Over 18 Years Old: Results From the COBaLT Study. J Sex Med 2021; 18:1065-1074. [PMID: 33992556 DOI: 10.1016/j.jsxm.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Female sexual dysfunction and erectile dysfunction (FSD/ED) have been linked with lower urinary tract symptoms (LUTS), from both epidemiological data and basic research studies, but few studies have been conducted in Latin America addressing these issues and most of them do not include the young population. AIM To determine the prevalence of FSD/ED and its association with LUTS in Colombia. METHODS Sub-analysis of a cross-sectional, population-based study conducted in subjects ≥18 years old to evaluate LUTS/OAB. The estimated sample size was 1,054. ED was defined as ≤21 points in the SHIM and FSD as ≤19 in the FSFI-6. For LUTS/OAB, we used the 2002 ICS and 2010 IUGA/ICS definitions and validated questionnaires. Descriptive and inferential statistics were employed. OUTCOMES Prevalence of FSD/ED and association of FSD/ED and LUTS. RESULTS We included 1,060 participants; the median age was 40 (IQR 27-54) years. Fifty-seven (11.4%) men and 182 (32.7%) women were sexually inactive. The prevalence of FSD/ED in sexually active participants was 47% (men 52.9%, women 38.9%). The most common FSD/ED symptoms were diminished/absent lubrication in women (42%) and diminished erection maintenance after penetration in men (13%). Individuals with FSD/ED had higher rates of various LUTS. The multivariable logistic regression model found that the city of residence (OR = 0.4, 95% CI 0.2-0.9), diabetes mellitus (DM) (OR = 8.4, 95% CI 1.4-48.7), menopause (OR=3.5, 95% CI 1.9-6.2), urge urinary incontinence (UUI) (OR=1.9, 95% CI 1.1-3.3) and nocturia ≥2 (OR = 2.2, 95% CI 1.2-4.2) were associated with FSD. In men, age 40-59 (OR = 2.3, 95% CI 1.4-3.7) and ≥60 (OR = 5.5, 95% CI 2.4-12.5), the city of residence (OR = 0.2, 95% CI 0.1-0.3), less than a high-school diploma vs higher education (OR = 2.0, 95% CI 1.2-3.2), depression (OR = 4.6, 95% CI 1.8-11.5), UUI (OR = 3.2, 95% CI 1.1-10.2) and feeling of incomplete bladder emptying (OR = 2.1, 95% CI 1.3-3.5) were associated with ED. CLINICAL IMPLICATIONS This study underlines the importance of assessing LUTS in women and men of all affected age groups who present with symptoms of FSD/ED and vice versa, which could help achieve a better approach for these patients. STRENGTHS & LIMITATIONS This is the first study in Colombia and one of the few in Latin America that addresses both FSD/ED and LUTS in men and women aged 18 years and older. Limitations include being a sub-analysis of a study aiming to determine the prevalence of LUTS/OAB and not FSD/ED. CONCLUSIONS Regardless of age, LUTS were observed more frequently in patients with FSD/ED. Various LUTS were associated with FSD/ED. Bravo-Balado A, Trujillo CG, Caicedo JI, et al. Assessment of Female Sexual Dysfunction and Erectile Dysfunction and Its Association with Lower Urinary Tract Symptoms in Women and Men Over 18 Years Old: Results From the COBaLT Study. J Sex Med 2021;18:1065-1074.
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Affiliation(s)
- Alejandra Bravo-Balado
- Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine; Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Carlos Gustavo Trujillo
- Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine
| | - Juan Ignacio Caicedo
- Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine
| | - Sandra García
- Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine
| | - Julián Azuero
- Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine
| | - Martín Rondón
- Pontificia Universidad Javeriana School of Medicine, Department of Clinical Epidemiology and Biostatistics, Bogotá, Colombia
| | - Mauricio Plata
- Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine.
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10
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Lloyd GL, Wiesen B, Atwell M, Malykhina A. Marijuana, Alcohol, and ED: Correlations with LUTS/BPH. Curr Urol Rep 2021; 22:21. [PMID: 33554319 PMCID: PMC8054558 DOI: 10.1007/s11934-020-01031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) is a disease complex with enormous societal burden and yet the pathogenesis of LUTS/BPH is poorly understood. We set out to review the literature on the relationship between depression, marijuana usage, and erectile dysfunction (ED) to LUTS/BPH. RECENT FINDINGS LUTS/BPH has independent associations with depression as well as with ED. In each case, the causality and mechanistic relationship is unknown. The impact of marijuana, as it increasingly pervades the general population, on the disease complex of LUTS/BPH is not well studied but recent results support short-term benefit and long-term caution. Depression, a form of central nervous dysfunction, and ED, which is likely mediated via endothelial dysfunction, are independently associated with LUTS/BPH. The presence of cannabinoid receptors in urologic organs, coupled with recent population studies, supports a modulatory effect of marijuana on voiding although an enormous knowledge gap remains.
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Affiliation(s)
- Granville L Lloyd
- Rocky Mountain Regional Veterans Hospital, Aurora, CO, USA.
- Department of Surgery/Urology, University of Colorado Anschutz School of Medicine, Aurora, CO, 80045, USA.
| | - Brett Wiesen
- University of Colorado Anschutz School of Medicine, Aurora, CO, 80045, USA
| | - Mike Atwell
- Division of Urology, Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO, 80045, USA
| | - Anna Malykhina
- Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, CO, 80045, USA
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11
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Impact of early vs. delayed initiation of dutasteride/tamsulosin combination therapy on the risk of acute urinary retention or BPH-related surgery in LUTS/BPH patients with moderate-to-severe symptoms at risk of disease progression. World J Urol 2020; 39:2635-2643. [PMID: 33337513 PMCID: PMC8332595 DOI: 10.1007/s00345-020-03517-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/30/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the effect of delayed start of combination therapy (CT) with dutasteride 0.5 mg and tamsulosin 0.4 mg on the risk of acute urinary retention or benign prostatic hyperplasia (BPH)-related surgery (AUR/S) in patients with moderate-to-severe lower urinary tract symptoms (LUTS) at risk of disease progression. Methods Using a time-to-event model based on pooled data from 10,238 patients from Phase III/IV dutasteride trials, clinical trial simulations (CTS) were performed to assess the risk of AUR/S up to 48 months in moderate-to-severe LUTS/BPH patients following immediate and delayed start of CT for those not responding to tamsulosin monotherapy. Simulation scenarios (1300 subjects/arm) were investigated, including immediate start (reference) and alternative delayed start (six scenarios 1–24 months). AUR/S incidence was described by Kaplan–Meier survival curves and analysed using log-rank test. The cumulative incidence of events as well as the relative and attributable risks were summarised stratified by treatment. Results Survival curves for patients starting CT at month 1 and 3 did not differ from those who initiated CT immediately. By contrast, significant differences (p < 0.001) were observed when switch to CT occurs ≥ 6 months from the initial treatment. At month 48, AUR/S incidence was 4.6% vs 9.5%, 11.0% and 11.3% in patients receiving immediate CT vs. switchers after 6, 12 and 24 months, respectively. Conclusions Start of CT before month 6 appears to significantly reduce the risk of AUR/S compared with delayed start by ≥ 6 months. This has implications for the treatment algorithm for men with LUTS/BPH at risk of disease progression. Electronic supplementary material The online version of this article (10.1007/s00345-020-03517-0) contains supplementary material, which is available to authorized users.
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12
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Yu ZJ, Yan HL, Xu FH, Chao HC, Deng LH, Xu XD, Huang JB, Zeng T. Efficacy and Side Effects of Drugs Commonly Used for the Treatment of Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia. Front Pharmacol 2020; 11:658. [PMID: 32457631 PMCID: PMC7225336 DOI: 10.3389/fphar.2020.00658] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is the most common benign disease of the prostate gland and is caused by benign hyperplasia of the smooth muscle cells and stromal cells in this important gland. BPH is also the most common disease underlying lower urinary tract symptoms (LUTS). The incidence of BPH increases with age and affects more than half of all men 50 years or older. BPH mainly exerts effects on urinary function and can seriously reduce a patient's quality of life. At present, treatment for BPH aims primarily to improve the quality of life and reduce the risk of BPH-related complications. Pharmacological therapy is recommended for moderate-to-severe cases of LUTS that are suggestive of BPH. A range of drugs is currently available to treat this condition, including α1-adrenoceptor antagonists, 5α-reductase inhibitors (5-ARIs), phosphodiesterase type 5 inhibitors (PDE5Is), muscarinic receptor antagonists (MRAs), β3-adrenoceptor agonists, and plant extracts. Of these, the most commonly used drugs in the clinic are α1-adrenoceptor antagonists, 5-ARIs, and combination therapy. However, these drugs exert their effects via various mechanisms and are associated with adverse reactions. The purpose of this review is to provide current comprehensive perspectives on the mechanisms of action, efficacy, and adverse reactions associated with the drugs most commonly used for the treatment of BPH.
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Affiliation(s)
- Zhao-Jun Yu
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Department of Graduate School, Nanchang University, Nanchang, China
| | - Hai-Lan Yan
- Department of Clinical Medicine, Xi'an Jiao Tong University Health Science Center, Xi'an, China
| | - Fang-Hua Xu
- Department of Pathology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Hai-Chao Chao
- Institute of Clinical Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Lei-Hong Deng
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang-Da Xu
- Medical Department of Graduate School, Nanchang University, Nanchang, China
| | - Jian-Biao Huang
- Medical Department of Graduate School, Nanchang University, Nanchang, China
| | - Tao Zeng
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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13
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Transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a feasibility study. Results at 6 and 12 months from a retrospective multi-centric study. Prostate Cancer Prostatic Dis 2019; 23:356-363. [DOI: 10.1038/s41391-019-0196-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/12/2019] [Accepted: 11/28/2019] [Indexed: 12/30/2022]
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14
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Goldstein I, Goren A, Liebert R, Tang WY, Hassan TA. National Health and Wellness Survey exploratory cluster analysis of males 40-70 years old focused on erectile dysfunction and associated risk factors across the USA, Italy, Brazil and China. Int J Clin Pract 2019; 73:1-15. [PMID: 31120179 DOI: 10.1111/ijcp.13376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/25/2019] [Accepted: 05/20/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Prior studies of erectile dysfunction (ED) tend to narrowly focus on relationships with specific comorbidities, rather than evaluating a more comprehensive array of risk factors and assessing naturalistic patterns among them. This study identifies natural clusters of male characteristics from a general population sample per country, quantifies ED dynamics in these profiles and compares profiles across the US, Italy, Brazil and China samples. METHODS National Health and Wellness Survey 2015 and 2016 patient-reported data on men aged 40-70 years (USA n = 15,652; Italy n = 2,521; Brazil n = 2,822; China n = 5,553) were analysed. Hierarchical agglomerative clustering identified clusters where predictors included demographics, health characteristics/behaviours, ED risk factors and provider visits in the past 6 months. Multinomial logistic regression assessed the independent utility of variables in predicting cluster membership, compared with the healthiest control cluster per country. RESULTS Different natural clusters were found across countries, with four clusters for the USA, Italy and China and three clusters for Brazil. Age, income, employment, health behaviours and ED risk factors predicted different cluster membership across countries. In the USA, Italy and Brazil, younger clusters were predicted by ED, unhealthy behaviours and ED risk factors. Unique cluster profiles were identified in China, with ED and ED risk factors (aside from hypertension) not predicting cluster membership, while socio-demographics and health behaviours were strongly predictive. CONCLUSIONS Natural cluster profiles revealed notable ED rates among adult males of age 40-70 in four different countries. Clusters were mainly predicted by unhealthy behaviours, ED risk factors and ED, regardless of level or presence of positive health characteristics and behaviours. This analysis identified meaningful subgroups of men with heightened ED risk factors, which can help healthcare providers to better recognise specific populations with the greatest need for intervention.
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Affiliation(s)
- Irwin Goldstein
- Director of Sexual Medicine, Alvarado Hospital, San Diego, California
| | - Amir Goren
- Health Outcomes Practice, Kantar Health, New York, New York
| | - Ryan Liebert
- Health Outcomes Practice, Kantar Health, New York, New York
| | - Wing Yu Tang
- Patient and Health Impact, Health Economics and Outcomes Research, Pfizer Inc, New York, New York
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15
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Calogero AE, Burgio G, Condorelli RA, Cannarella R, La Vignera S. Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. Aging Male 2019; 22:12-19. [PMID: 29392976 DOI: 10.1080/13685538.2018.1434772] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is very common in aging men and causes lower urinary tract symptoms (LUTS), which decrease health-related quality of life. A number of evidence suggests that other than ageing, modifiable factors, such as increasing prostate volume, obesity, diet, dyslipidemia, hormonal imbalance, hypertension, metabolic syndrome, alcohol, and smoking, also contribute to the development of BPH and/or LUTS. More recently, erectile dysfunction (ED) has been linked to LUTS/BPH as a part of this syndrome, suggesting that patients with BPH or LUTS easily develop ED, and that LUTS/BPH symptoms often coexist with ED. This article focuses on the epidemiology and risk factors of the combined phenotype LUTS/BPH - ED.
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Affiliation(s)
- Aldo E Calogero
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Giovanni Burgio
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Rosita A Condorelli
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Rossella Cannarella
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Sandro La Vignera
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
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Pattanaik S, Mavuduru RS, Panda A, Mathew JL, Agarwal MM, Hwang EC, Lyon JA, Singh SK, Mandal AK. Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia. BJU Int 2019; 124:27-34. [PMID: 30681264 DOI: 10.1111/bju.14689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the effects of phosphodiesterase inhibitors (PDEI) compared to placebo and other standard of care drugs i.e alpha blockers (AB) and 5-alpha reductase inhibitors (5-ARI) in men with LUTS consistent with benign prostatic hyperplasia (BPH). METHODS We conducted a systematic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science, and clinical trials registries of the World Health Organization (WHO) and the National Institutes of Health (NIH) (updated 2 August 2018). Citation tracking and hand-searching of abstracts and conference proceedings was done. We also attempted to contact the study authors in case additional information was needed. Randomised controlled trials (RCT) comparing PDEI versus placebo, AB, or 5-ARI used for at least four weeks in men with BPH-LUTS were included. Three review authors independently screened the literature and extracted data. Primary outcomes were effects on urinary symptoms as assessed by the International Prostate Symptom Score (IPSS-total; score ranging from 0 to 35, with higher values reflecting more symptoms), urinary bother as assessed by the Benign Prostatic Hyperplasia Impact Index (BPHII; score ranging from 0 to 13, with higher values reflecting more bother), and adverse events (AE). We used GRADE to rate the quality of evidence. We considered short-term (up to 12 weeks) and long-term (12 weeks or longer) results separately. RESULTS We included a total of 16 randomised trials in this review. Primary outcomes: PDEI versus placebo: PDEI may result in a small improvement in IPSS-total score (mean difference (MD) 1.89 lower, 95% confidence interval (CI) 2.27 lower to 1.50 lower; n = 4293; low-quality evidence) compared to placebo, and may reduce the BPHII score slightly (MD 0.52 lower, 95% CI 0.71 lower to 0.33 lower; n = 3646; low-quality evidence). Rates of AEs may be increased (risk ratio (RR) 1.42, 95% CI 1.21 to 1.67; n = 4386; low-quality evidence). This corresponds to 95 more AEs per 1000 participants (95% CI 47 more to 151 more per 1000). Study results were limited to a treatment duration of six to 12 weeks. PDEI versus AB: PDEI and AB probably provide similar improvement in IPSS-total score (MD 0.22 higher, 95% CI 0.49 lower to 0.93 higher; n = 933; moderate-quality evidence) and may have a similar effect on BPHII score (MD 0.03 higher, 95% CI 1.10 lower to 1.16 higher; n = 550; low-quality evidence) and AE (RR 1.35, 95% CI 0.80 to 2.30; n = 936; low-quality evidence). This corresponds to 71 more AEs per 1000 participants (95% CI 41 fewer to 264 more per 1000). Study results were limited to a treatment duration of six to 12 weeks. PDEI and AB versus AB : The combination of PDEI and AB may provide a small improvement in IPSS-total score (MD 2.56 lower, 95% CI 3.92 lower to 1.19 lower; n = 193; low-quality evidence) compared to AB alone. We found no evidence for BPHII scores. AE may be increased (RR 2.81, 95% CI 1.53 to 5.17; n = 194; moderate-quality evidence). This corresponds to 235 more AE per 1000 participants (95% CI 69 more to 542 more per 1000). Study results were limited to treatment duration of four to 12 weeks. PDEI and AB versus PDEI alone: The combination of PDEI and AB may provide a small improvement in IPSS-total (MD 2.4 lower, 95% CI 6.47 lower to 1.67 higher; n = 40; low-quality evidence) compared to PDEI alone. We found no data on BPHII or AE. Study results were limited to a treatment duration of four weeks. PDEI and 5-ARI versus 5-ARI alone: in the short term (up to 12 weeks), the combination of PDEI and 5-ARI probably results in a small improvement in IPSS-total score (MD 1.40 lower, 95% CI 2.24 lower to 0.56 lower; n = 695; moderate-quality evidence) compared to 5-ARI alone. We found no evidence on BPHII scores or AE. In the long term (13 to 26 weeks), the combination of PDEI and 5-ARI likely results in a small reduction in IPSS-total score (MD 1.00 less, 95% CI 1.83 lower to 0.17 lower; n = 695; moderate-quality evidence). We found no evidence about effects on BPHII scores. There may be no difference in rates of AE (RR 1.07, 95% CI 0.84 to 1.36; n = 695; low-quality evidence). This corresponds to 19 more AE per 1000 participants (95% CI 43 fewer to 98 more per 1000). We found no trials comparing other combinations of treatments or comparing different PDEI for BPH-LUTS. CONCLUSIONS Compared to placebo, PDEI likely leads to a small reduction in IPSS-total and BPHII sores, with a possible increase in AE. There may be no differences between PDEI and AB with regards to improvement in IPSS-total, BPHII, and incidence of AE. There appears to be no added benefit of PDEI combined with AB compared to PDEI or AB or PDEI combined with 5-ARI compared to ARI with regards to urinary symptoms. Most evidence was limited to short-term treatment up to 12 weeks and of moderate or low certainty.
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Affiliation(s)
- Smita Pattanaik
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan S Mavuduru
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arabind Panda
- Department of Urology, Christian Medical College, Vellore, India
| | - Joseph L Mathew
- Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mayank M Agarwal
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jenifer A Lyon
- Library Services, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shrawan K Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arup K Mandal
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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17
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Liu XY, Liu X, Xu L, Gui B, Yang QY, Yan JY, Sun ZY. A mathematical model for predicting putative association between E2/T ratio and the development of benign prostate hyperplasia in rats. Biol Reprod 2019; 100:133-138. [PMID: 30052867 DOI: 10.1093/biolre/ioy170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/25/2018] [Indexed: 11/12/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) develops more likely with increasing age and changing serum concentrations of circulating estradiol (E2) and/or testosterone (T). In this study, we explored the relationship between serum E2/T ratio and BPH risk in rats by fitting a mathematical model. A total of 176 rats were randomized to one of the following treatment groups: normal control, castrated control, and 20 more groups of castrated animals treated with increasing dose combinations of T and E2, once daily for 30 days. Serial blood samples were obtained to determine serum T and E2 levels by magnetic bead enzyme-linked immunosorbent assay. Prostate tissue was taken to measure prostate volume. MATLAB software was used to simulate the relationship between prostate/body weight ratio (PBR) and E2/T ratio with a mathematical equation. The values of PBR, E2 and T in the treatment groups were significantly higher than those in the control groups. Stepwise regression showed that PBR was a function of E2 and T. PBR = -0.1782 + 0.0081 E2 + 0.063 T - 0.6 × 10-5 E22 - 0.28 × 10-3 T2. E2/T ratio change may be one of the risk factors for PBR, which is associated with the development of BPH.
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Affiliation(s)
- Xiang-Yun Liu
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Shanghai, China
| | - Xin Liu
- College of Science, Donghua University, Shanghai, China
| | - Li Xu
- Department of Pharmacology and Toxicology, Shanghai Institute of Planned Parenthood Research, Shanghai, China
| | - Bo Gui
- Department of Pharmacology and Toxicology, Shanghai Institute of Planned Parenthood Research, Shanghai, China
| | - Qin-Yu Yang
- College of Science, Donghua University, Shanghai, China
| | - Jian-Yan Yan
- Department of Pharmacology and Toxicology, Shanghai Institute of Planned Parenthood Research, Shanghai, China
| | - Zu-Yue Sun
- Department of Pharmacology and Toxicology, Shanghai Institute of Planned Parenthood Research, Shanghai, China
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18
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Pattanaik S, Mavuduru RS, Panda A, Mathew JL, Agarwal MM, Hwang EC, Lyon JA, Singh SK, Mandal AK. Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia. Cochrane Database Syst Rev 2018; 11:CD010060. [PMID: 30480763 PMCID: PMC6517182 DOI: 10.1002/14651858.cd010060.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) refers to non-malignant enlargement of the prostate gland that may cause bothersome lower urinary tract symptoms (LUTS). Alpha-blockers (ABs) and 5-alpha reductase inhibitors (5-ARIs) are the mainstay of medical treatment. Recently, phosphodiesterase inhibitors (PDEIs) that so far have been used mainly to treat erectile dysfunction were introduced to treat male LUTS. OBJECTIVES To assess the effects of PDEIs compared to placebo and other standard of care drugs (ABs and 5-ARIs) in men with LUTS consistent with BPH. SEARCH METHODS We conducted a systematic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, and clinical trials registries of the World Health Organization (WHO) and the National Institutes of Health (NIH) (updated 2 August 2018). We performed citation tracking and handsearching of abstracts and conference proceedings. We also contacted study authors to ask for additional information. SELECTION CRITERIA We considered for inclusion in this systematic review randomised controlled trials (RCTs) comparing PDEIs versus placebo, ABs, or 5-ARIs for at least four weeks in men with BPH-LUTS. DATA COLLECTION AND ANALYSIS Three review authors independently screened the literature and extracted data. Primary outcomes were effects on urinary symptoms as assessed by the International Prostate Symptom Score (IPSS-total; score ranging from 0 to 35, with higher values reflecting more symptoms), urinary bother as assessed by the Benign Prostatic Hyperplasia Impact Index (BPHII; score ranging from 0 to 13, with higher values reflecting more bother), and adverse events (AEs). We used GRADE to rate the quality of evidence. We considered short-term (up to 12 weeks) and long-term (12 weeks or longer) results separately. MAIN RESULTS We included a total of 16 randomised trials in this review. The results for primary outcomes are as follows.PDEI versus placebo: PDEIs may result in a small improvement in IPSS-total score (mean difference (MD) 1.89 lower, 95% confidence interval (CI) 2.27 lower to 1.50 lower; n = 4293; low-quality evidence) compared to placebo, and may reduce the BPHII score slightly (MD 0.52 lower, 95% CI 0.71 lower to 0.33 lower; n = 3646; low-quality evidence). Rates of AEs may be increased (risk ratio (RR) 1.42, 95% CI 1.21 to 1.67; n = 4386; low-quality evidence). This corresponds to 95 more AEs per 1000 participants (95% CI 47 more to 151 more per 1000). Study results were limited to a treatment duration of six to 12 weeks.PDEI versus AB: PDEIs and ABs probably provide similar improvement in IPSS-total score (MD 0.22 higher, 95% CI 0.49 lower to 0.93 higher; n = 933; moderate-quality evidence) and may have a similar effect on BPHII score (MD 0.03 higher, 95% CI 1.10 lower to 1.16 higher; n = 550; low-quality evidence) and AEs (RR 1.35, 95% CI 0.80 to 2.30; n = 936; low-quality evidence). This corresponds to 71 more AEs per 1000 participants (95% CI 41 fewer to 264 more per 1000). Study results were limited to a treatment duration of six to 12 weeks.PDEI and AB versus AB alone: the combination of PDEI and AB may provide a small improvement in IPSS-total score (MD 2.56 lower, 95% CI 3.92 lower to 1.19 lower; n = 193; low-quality evidence) compared to AB alone. We found no evidence for BPHII scores. AEs may be increased (RR 2.81, 95% CI 1.53 to 5.17; n = 194; moderate-quality evidence). This corresponds to 235 more AEs per 1000 participants (95% CI 69 more to 542 more per 1000). Study results were limited to treatment duration of four to 12 weeks.PDEI and AB versus PDEI alone: the combination of PDEI and AB may provide a small improvement in IPSS-total (MD 2.4 lower, 95% CI 6.47 lower to 1.67 higher; n = 40; low-quality evidence) compared to PDEI alone. We found no data on BPHII or AEs. Study results were limited to a treatment duration of four weeks.PDEI and 5-ARI versus 5-ARI alone: in the short term (up to 12 weeks), the combination of PDEI and 5-ARI probably results in a small improvement in IPSS-total score (MD 1.40 lower, 95% CI 2.24 lower to 0.56 lower; n = 695; moderate-quality evidence) compared to 5-ARI alone. We found no evidence on BPHII scores or AEs. In the long term (13 to 26 weeks), the combination of PDEI and 5-ARI likely results in a small reduction in IPSS-total score (MD 1.00 less, 95% CI 1.83 lower to 0.17 lower; n = 695; moderate-quality evidence). We found no evidence about effects on BPHII scores. There may be no difference in rates of AEs (RR 1.07, 95% CI 0.84 to 1.36; n = 695; low-quality evidence). This corresponds to 19 more AEs per 1000 participants (95% CI 43 fewer to 98 more per 1000).We found no trials comparing other combinations of treatments or comparing different PDEI agents. AUTHORS' CONCLUSIONS Compared to placebo, PDEI likely leads to a small reduction in IPSS-total and BPHII sores, with a possible increase in AEs. There may be no differences between PDEI and AB with regards to improvement in IPSS-total, BPHII, and incidence of AEs. There appears to be no added benefit of PDEI combined with AB compared to PDEI or AB alone or PDEI combined with 5-ARI compared to ARI alone with regards to urinary symptoms. Most evidence was limited to short-term treatment up to 12 weeks and of moderate or low certainty.
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Affiliation(s)
- Smita Pattanaik
- Post Graduate Institute of Medical Education and ResearchDepartment of PharmacologyChandigarhIndia160012
| | - Ravimohan S Mavuduru
- Post Graduate Institute of Medical Education and ResearchDepartment of UrologyChandigarhIndia
| | - Arabind Panda
- Christian Medical CollegeDepartment of UrologyVelloreIndia
| | - Joseph L Mathew
- Post Graduate Institute of Medical Education and ResearchDepartment of PediatricsChandigarhIndia160012
| | - Mayank M Agarwal
- Post Graduate Institute of Medical Education and ResearchDepartment of UrologyChandigarhIndia
| | - Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun HospitalDepartment of UrologyHwasunKorea, South
| | - Jennifer A Lyon
- Children's Mercy HospitalLibrary Services2401 Gillham RoadKansas CityMissouriUSA64118
| | - Shrawan K Singh
- Post Graduate Institute of Medical Education and ResearchDepartment of UrologyChandigarhIndia
| | - Arup K Mandal
- Post Graduate Institute of Medical Education and ResearchDepartment of UrologyChandigarhIndia
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Sahebalzamani M, Mostaedi Z, Farahani H, Sokhanvar M. Relationship between Health Literacy and Sexual Function and Sexual Satisfaction in Infertile Couples Referred to The Royan Institute. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2018; 12:136-141. [PMID: 29707930 PMCID: PMC5936611 DOI: 10.22074/ijfs.2018.5185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 09/17/2017] [Indexed: 11/24/2022]
Abstract
Background Health science and technology today is a rapidly growing field. Health is a multifaceted concept influ-
enced by several factors, and health literacy is essential to deal properly with the current situation. In this study, the
association between health literacy and sexual function and sexual satisfaction were investigated in 2016. Materials and Methods This descriptive and correlational study was conducted on 193 couples in the Royan Insti-
tute, Tehran. Data collection instruments were three standard questionnaires which included the Test of Functional
Health Literacy, the Female Sexual Function Index (FSFI) and the International Index of Erectile Function, and the
Iranian version of the Sexual Satisfaction Scale. The data were analyzed using SPSS-v23 software at a significance
level of 0.05. Results Marginal health literacy, 49.7% among men and 44.1% among women, was more common than adequate
or inadequate health literacy. Erectile function for the majority of men was appropriate (53.3%), compared to 16.6%
who had perfect function and 30.1% for whom function was less than appropriate. The majority of women (57.0%)
had sexual dysfunction. One hundred and three (53.3%) men had appropriate sexual function and 57% of women had
normal sexual function. The greater proportion of men (50.8%) and women (46.1%) had good, rather than very good
or less than good, sexual satisfaction. The results of chi-square tests indicated that greater health literacy was associ-
ated with higher levels of sexual function and sexual satisfaction among men and women. However, application of the
Cramer’s V test indicates that the strength of these associations is moderate to weak. Conclusion Health literacy was marginal among most couples and its adverse impacts on sexual function and sexual
satisfaction were confirmed. Accordingly, it is recommended that plans be developed to promote health literacy among
infertile couples.
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Affiliation(s)
- Mohammad Sahebalzamani
- Department of Management, Tehran Medical Sciences Branch Islamic Azad University, Tehran, Iran
| | - Zahra Mostaedi
- Department of Nursing and Midwifery, Tehran Medical Sciences Branch Islamic Azad University, Tehran, Iran
| | - Hojjatollah Farahani
- Department of Psychology, Tehran Medical Sciences Branch Islamic Azad University, Tehran, Iran. Electronic Address:
| | - Mobin Sokhanvar
- Iranian Center of Excellence in Health Management (IceHM), Tabriz University of Medical Sciences, Tabriz, Iran
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Helo S, Holland B, McVary KT. Convective Radiofrequency Water Vapor Thermal Therapy with Rezūm System. Curr Urol Rep 2018; 18:78. [PMID: 28780635 DOI: 10.1007/s11934-017-0728-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are amongst the most commonly treated conditions by urologists. Minimally invasive therapies for the treatment of BPH/LUTS have garnered increased interest as new technology has emerged, improving durability, efficacy, and safety. This paper reviews the most recent literature regarding water vapor therapy, a convective thermal therapy that ablates prostatic tissue. RECENT FINDINGS The current literature includes a pilot study of 65 men and a randomized controlled trial (RCT) of 197 men investigating the efficacy and safety profile of water vapor therapy up to 2 years. Subjects treated with water vapor therapy demonstrated a 51% reduction in IPSS from baseline, sustained at 24 months (p < 0.0001). Durable improvements in max flow rate (Qmax) and quality of life (QoL) were also achieved, while no changes in sexual function were observed. Reporting of adverse events (AEs) reveals predominantly Clavien grade I complications that were self-limited. The clinical efficacy and safety of water vapor therapy are durable to 24 months making it an attractive alternative for patients seeking a minimally invasive treatment for LUTS due to BPH.
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Affiliation(s)
- Sevann Helo
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA
| | - Bradley Holland
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA
| | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA.
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Takahashi R, Miyazato M, Nishii H, Sumino Y, Takayama K, Onzuka M, Oshiro T, Saito S, Fujimoto N, Mimata H, Eto M. Tadalafil Improves Symptoms, Erectile Function and Quality of Life in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia (KYU-PRO Study). Low Urin Tract Symptoms 2018; 10:76-83. [PMID: 29341501 DOI: 10.1111/luts.12143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/28/2016] [Accepted: 05/09/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Effect of tadalafil on lower urinary tract symptoms (LUTS), erectile function and quality of life (QoL) were prospectively evaluated in patients with benign prostatic hyperplasia (BPH) at multicenter. METHODS Eligible men were ≥40 years who had no treatment with alpha-blocker for BPH, with total International Prostate Symptom Score (IPSS) ≥8, IPSS-QOL ≥2 and prostate volume ≥20 mL. Data were collected on age, body mass index (BMI), and prostate specific antigen (PSA). Patients were asked to complete a self-reported questionnaire regarding the IPSS, Overactive Bladder Symptom Score (OABSS), International Index of Erectile Function 5 (IIEF5), and Medical Outcome Study 8-Item Short-Form Health Survey (SF-8). These measures were assessed at baseline, 4-, 8-, 12-week of tadalafil treatment. In addition, uroflowmetry was also performed at baseline, and 12-week end point visit. RESULTS Thirty five patients with mean age 67.3 years, mean BMI 23.6 kg/m2 , mean prostate volume 36 mL, and mean PSA 3.4 ng/mL were enrolled. Treatment with tadalafil significantly improved IPSS total score, IPSS voiding subscore, IPSS storage subscore, OABSS and IPSS-QoL score after 4 weeks and these improvements were maintained for 12-week treatment period. IIEF5 score and general health in SF-8 are significantly improved with the treatment of tadalafil. However, maximum flow rate and postvoiding residual volume were not significantly changed. There were not any serious adverse events. CONCLUSIONS These results indicate that tadalafil 5 mg once daily would be effective and well tolerated treatment in Japanese men with BPH-LUTS.
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Affiliation(s)
- Ryosuke Takahashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Minoru Miyazato
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hisae Nishii
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasuhiro Sumino
- Department of Urology, Oita University Faculty of Medicine, Oita, Japan
| | - Kazuo Takayama
- Department of Urology, Takayama Hospital, Fukuoka, Japan
| | - Masako Onzuka
- Department of Urology, Kano Hospital, Fukuoka, Japan
| | - Takuma Oshiro
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiromitsu Mimata
- Department of Urology, Oita University Faculty of Medicine, Oita, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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De Nunzio C, Roehrborn CG, Andersson KE, McVary KT. Erectile Dysfunction and Lower Urinary Tract Symptoms. Eur Urol Focus 2017; 3:352-363. [PMID: 29191671 DOI: 10.1016/j.euf.2017.11.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/12/2017] [Accepted: 11/13/2017] [Indexed: 01/10/2023]
Abstract
CONTEXT Lower urinary tract symptoms (LUTSs) and erectile dysfunction (ED) are substantial health concerns with a significant impact on the overall male quality of life. OBJECTIVE To evaluate the available evidence of the association between LUTSs and ED in patients with benign prostatic hyperplasia (BPH), and discuss possible clinical implications for the management of LUTS/BPH. EVIDENCE ACQUISITION A systematic review of the existing literature published between 1997 and June 2017 and available in the Medline, Scopus, and Web of Science databases was conducted using both the Medical Subject Heading (MeSH) and free-text protocols. The MeSH search was conducted by combining the following terms: "lower urinary tract symptoms," "LUTS," "benign prostatic hyperplasia," "BPH," "erectile dysfunction," "sexual dysfunction," "BPE," and "benign prostatic enlargement." The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. EVIDENCE SYNTHESIS Several community-based studies in different geographical areas have provided strong evidence of an age-independent association between LUTSs and ED. Several biological mechanisms have been proposed to explain this association, but further research is required to better understand the molecular pathways involved. It is necessary to evaluate the possible impact of the metabolic syndrome treatment on LUTS/ED management. Considering the possible relationship between LUTSs and ED, their impact on the quality of life, and the possible adverse effects associated with LUTS medical treatment, clinicians should always evaluate ED in patients with LUTSs and take the opportunity to evaluate patients reporting ED for LUTSs. CONCLUSIONS Data from the peer-reviewed literature suggest the existence of an association between LUTS/BPH and ED, although their casual relationship has not been established yet. Emerging data also suggest that pathophysiological mechanisms involved in the metabolic syndrome are key factors in both disorders. Considering the association, it is also recommended that men presenting with LUTSs or ED should be evaluated for both disorders. A better understanding of the molecular pathways behind this association may also help identify new possible targets and develop novel therapeutic approaches to manage LUTSs and ED. PATIENT SUMMARY In this manuscript, we report on all the available evidence linking erectile dysfunction and lower urinary tract symptoms. Our findings suggest the existence of a strong relationship between these two conditions. On the basis of these findings, we recommend that clinicians always explore both conditions in male patients presenting with either of symptoms.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, "La Sapienza" University, Roma, Italy.
| | - Claus G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kevin T McVary
- Southern Illinois University School of Medicine, Springfield, IL, USA
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23
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Apostolidis A, Rantell A, Anding R, Kirschner-Hermanns R, Cardozo L. How does lower urinary tract dysfunction (LUTD) affect sexual function in men and women? ICI-RS 2015-Part 2. Neurourol Urodyn 2017; 36:869-875. [DOI: 10.1002/nau.23088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/20/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Angie Rantell
- Department of Urogynaecology; King's College Hospital; London UK
| | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | | | - Linda Cardozo
- Department of Urogynaecology; King's College Hospital; London UK
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Koprowski C, Kim C, Modi PK, Elsamra SE. Ureteral Stent-Associated Pain: A Review. J Endourol 2016; 30:744-53. [DOI: 10.1089/end.2016.0129] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christopher Koprowski
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Christopher Kim
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Parth K. Modi
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sammy E. Elsamra
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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25
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McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, Levin RM, Rousseau M, Beahrs JR, Kaminetsky J, Cowan BE, Cantrill CH, Mynderse LA, Ulchaker JC, Larson TR, Dixon CM, Roehrborn CG. Erectile and Ejaculatory Function Preserved With Convective Water Vapor Energy Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Randomized Controlled Study. J Sex Med 2016; 13:924-33. [DOI: 10.1016/j.jsxm.2016.03.372] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/26/2022]
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26
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Ilias I. Re: DPP-4 inhibition improves a sexual condition? Med Hypotheses 2016; 89:96. [PMID: 26968918 DOI: 10.1016/j.mehy.2016.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ioannis Ilias
- Dept of Endocrinology, E Venizelou Hosp, 2, E Venizelou Sq, Athens GR-11521, Greece.
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27
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Colson MH. Dysfonctions sexuelles de la maladie chronique, l’état des lieux. Première partie : fréquence, impact et gravité. SEXOLOGIES 2016. [DOI: 10.1016/j.sexol.2016.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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28
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Colson MH. Sexual dysfunction and chronic illness. Part 1. Epidemiology, impact and significance. SEXOLOGIES 2016. [DOI: 10.1016/j.sexol.2016.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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29
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Lee LK, Goren A, Boytsov NN, Donatucci CF, McVary KT. Treatment satisfaction among men with concurrent benign prostatic hyperplasia and erectile dysfunction treated with tadalafil or other phosphodiesterase type-5 inhibitor combinations. Patient Prefer Adherence 2016; 10:1205-15. [PMID: 27471377 PMCID: PMC4948688 DOI: 10.2147/ppa.s105241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) frequently co-occur in men aged ≥40, along with lower urinary tract symptoms (LUTS) secondary to BPH. Given little real-world evidence on treatment use or satisfaction with treatment for concurrent BPH/LUTS and/or ED, this study examined medication regimens and differences in satisfaction and health-related quality of life (HRQoL) across regimens among men with concurrent BPH and ED. METHODS A cross-sectional study was conducted using an Internet survey of participants recruited through an online panel. Respondents (N=736) included men (aged ≥40) who self-reported a diagnosis of both ED and BPH with prescription treatment in the past 3 months for both conditions. Treatment satisfaction (eg, convenience and ease of planning) and HRQoL (eg, International Prostate Symptom Score, sleep quality) were self-reported. Generalized linear models examined the association of regimen with treatment satisfaction and HRQoL, adjusting for covariates (eg, age and comorbidities). RESULTS Final analyses included participants (N=507) using: tadalafil once-daily monotherapy (22%), tadalafil for ED with an alternate BPH therapy (36%), or another phosphodiesterase type-5 inhibitor (PDE5-I) combination (41%). These groups represented the major categories of treatment regimens found in the sample, excluded participants with ambiguous regimens, and were aligned with current standard of care for BPH and ED. Overall, patients reported moderate levels of BPH and a moderate-to-severe degree of ED. Tadalafil monotherapy patients had higher treatment satisfaction scores and greater reported ease of treatment planning and convenience than PDE5-I combination patients. No significant intergroup differences were found on HRQoL. CONCLUSION A majority of patients (59%) took tadalafil alone or in combination for BPH/ED treatment. Tadalafil monotherapy patients reported greater treatment satisfaction than patients taking PDE5-I combination therapy. Higher satisfaction for both effectiveness and convenience of once-daily tadalafil may inform both patient and clinician decisions regarding pharmacotherapy regimens.
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Affiliation(s)
- Lulu K Lee
- Health Outcomes Practice, Kantar Health, New York, NY
- Correspondence: Lulu K Lee, Health Outcomes Practice, Kantar Health, 11 Madison Avenue, 12th Floor, New York, NY 10010, USA, Tel +1 650 720 2246, Fax +1 212 647 7659, Email
| | - Amir Goren
- Health Outcomes Practice, Kantar Health, New York, NY
| | - Natalie N Boytsov
- US Real World Outcomes Research, Eli Lily & Company, Indianapolis, IN
| | - Craig F Donatucci
- US Real World Outcomes Research, Eli Lily & Company, Indianapolis, IN
| | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
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30
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Yim PWC, Wang W, Jiang Y, Zakir HAS, Toh PC, Lopez V, He HG. Health-related quality of life, psychological well-being, and sexual function in patients with benign prostatic hyperplasia after prostatic surgery. Appl Nurs Res 2015; 28:274-80. [PMID: 26608425 DOI: 10.1016/j.apnr.2015.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/07/2015] [Accepted: 02/21/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND BACKGROUND Patients with benign prostatic hyperplasia (BPH) may receive prostatic surgery due to severe lower urinary tract symptoms (LUTS). This study aimed to investigate the health-related quality of life (HRQoL), psychological well-being, and sexual function of patients with BPH after prostatic surgery and identify the predictors of HRQoL among this group of patients. METHODS This was a cross-sectional, descriptive, correlational study. A convenience sample of 94 participants was recruited from a urology center in a tertiary public hospital in Singapore. The 12-item Short Form Health Survey version 2 (SF-12v2), International Prostate Symptom Score (IPSS), Hospital Anxiety and Depression Scale (HADS), and 5-item International Index of Erectile Function (IIEF-5) were used to measure the study variables. RESULTS Compared to the general population norms and the findings of similar studies conducted in western countries, this group of patients reported poorer physical health but better mental health as assessed by SF-12v2. Despite the prostatic surgery, over a quarter of the patients experienced moderate LUTS, and 13.8% experienced severe erectile dysfunction. Multiple linear regression analysis identified that LUTS (B=-0.51, p=0.02) and maximum flow rate (B=-0.23, p=0.02) predicted poor physical health, accounting for 45.9% of variance, while HADS-Anxiety (B=-1.07, p<0.01) and LUTS (B=-0.32, p=0.03) predicted poor mental health, accounting for 57.2% of variance. CONCLUSION The physical health of BPH patients with prostatic surgery was poor, with many suffering moderate LUTS and sexual dysfunction. Special attention should be given to those patients with severe LUTS who have a low maximum flow rate or have anxiety symptoms.
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Affiliation(s)
- Pierre W C Yim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Hussain Abdul Salam Zakir
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Poh Choo Toh
- Department of Urology, University Surgical Cluster, National University of Hospital, Singapore.
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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31
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The Impact of Medical and Surgical Treatment for Benign Prostatic Hypertrophy on Erectile Function. Curr Urol Rep 2015; 16:80. [PMID: 26438220 DOI: 10.1007/s11934-015-0549-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is a well-known link between treatment for lower urinary tract symptoms (LUTS) and erectile dysfunction. Surgical and medical management of LUTS all have side effect profiles which may affect erectile dysfunction, ejaculatory dysfunction, or libido. These should be taken into consideration during patient counseling. This article reviews the common side effects of the medical and surgical treatments of LUTS.
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Egan KB, Burnett AL, McVary KT, Ni X, Suh M, Wong DG, Rosen RC. The Co-occurring Syndrome—Coexisting Erectile Dysfunction and Benign Prostatic Hyperplasia and Their Clinical Correlates in Aging Men: Results From the National Health and Nutrition Examination Survey. Urology 2015. [DOI: 10.1016/j.urology.2015.04.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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33
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Ilo D, Raluy-Callado M, Graham-Clarke P, Sadasivan R, Birt J, Donaldson R, Zhu E, Kirby MG, Neasham D. Patient characteristics and treatment patterns for patients with benign prostatic hyperplasia, erectile dysfunction or co-occurring benign prostatic hyperplasia and erectile dysfunction in general practices in the UK: a retrospective observational study. Int J Clin Pract 2015; 69:853-62. [PMID: 26011100 DOI: 10.1111/ijcp.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIMS The aim of this study was to assess patient characteristics, medication treatment patterns and healthcare resource utilization among men with existing erectile dysfunction (ED) or benign prostatic hyperplasia (BPH), who are newly diagnosed with the second condition (BPH or ED) compared with those with only one condition. METHODS This retrospective cohort study utilized the Clinical Practice Research Datalink. Males, aged 40 years or older, newly diagnosed with ED or symptomatic BPH between 1 June 2010 and 31 May 2011, were selected. Patient demographics, existing comorbidities and baseline medication use were analysed. Treatments initiated for the incident condition and treatment patterns were reported at 6, 12, 18 and 24-months postdiagnosis. Referrals to urologists and visits to general practitioners were reported around diagnosis and during follow-up. RESULTS This study included 11,501 incident patients with BPH, of which 23% had a prior ED diagnosis and 9,734 incident patients with ED, of which 17% had a prior BPH diagnosis. The average age at diagnosis of BPH was similar across both cohorts. Among incident patients with ED, those with prior diagnosis of BPH were diagnosed at an older average age (65 ± 9.2 years) compared to those without BPH (57 ± 9.1 years). The majority of patients in both incident BPH cohorts (62.9-65.5%) were prescribed alpha-blockers as initial treatment. The majority of patients in both incident ED cohorts (49.6-51.6%) were prescribed sildenafil as initial treatment followed by tadalafil (24.3-26.0%). At 12 months, 50% of incident patients with BPH and 80% of patients with ED had discontinued the therapy initiated. CONCLUSION This study found that in the UK, patients with co-occurring BPH and ED when newly diagnosed with the second condition initiated the same treatments as those without prior ED or BPH. During the first year, treatment patterns including discontinuation were comparable in the groups with one of the conditions and co-occurring BPH and ED.
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Affiliation(s)
- D Ilo
- Lilly UK, Basingstoke Hampshire, UK
| | | | | | | | - J Birt
- Eli Lilly & Company, Indianapolis, IN, USA
| | | | - E Zhu
- Eli Lilly & Company, Indianapolis, IN, USA
| | - M G Kirby
- University of Hertfordshire and the Prostate Centre, London, UK
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Shrinkage of Prostate and Improved Quality of Life: Management of BPH Patients with Croton membranaceus Ethanolic Root Extract. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:365205. [PMID: 26106434 PMCID: PMC4461762 DOI: 10.1155/2015/365205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/13/2015] [Accepted: 02/23/2015] [Indexed: 11/18/2022]
Abstract
Benign prostatic hyperplasia (BPH) is an enlargement of the prostate. The study aimed at validating the use of freeze-dried Croton membranaceus ethanolic root extract for BPH management. Thirty-three patients were observed before and after 3-month administration of 20 mg t.i.d orally. The International Prostate Symptom Score (IPSS), and the International Index of Erectile Function (IIEF) questionnaires were used. Total/free PSA (tPSA, fPSA), renal, liver function, lipid tests, and ultrasonographic imaging were performed. Thirty (30) patients (66 ± 11 years) completed the study. IPSS results showed 37% had severe, 40% moderate, and 23% mild symptoms before; 57% and 43% had moderate and mild symptoms, respectively, after treatment. IIED of patients' results showed 30% with severe, 40% moderate, 24% mild-moderate, 3% mild, and 3% no erectile dysfunction before treatment and 20% severe, 43% moderate, and 37% mild-moderate dysfunction, after treatment. Quality of life (QoL) improved (P = 0.001). Significant but non-pathological increases in total and indirect bilirubin as well as apolipoprotein A occurred. Mean tPSA reduced from 27.9 ± 19.0 to 16.2 ± 11.8 ng/mL (P = 0.002); fPSA from 6.1 ± 4.8 to 3.9 ± 2.9 ng/mL (P = 0.045); and prostate volume from 101.8 ± 41.3 to 54.5 ± 24.8 cm3 (P = 0.023). C. membranaceus shrinks the prostate and improves QoL.
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Garcia C, Chin P, Rashid P, Woo HH. Prostatic urethral lift: A minimally invasive treatment for benign prostatic hyperplasia. Prostate Int 2015; 3:1-5. [PMID: 26157759 PMCID: PMC4494639 DOI: 10.1016/j.prnil.2015.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/01/2014] [Indexed: 12/02/2022] Open
Abstract
Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The procedure may be performed under local, spinal, or general anesthesia. The PUL procedure involves the delivery of implants that retract obstructing prostate lobes. Unlike other benign prostatic hyperplasia treatment options including pharmacological therapy, and the current invasive gold-standard transurethral resection of the prostate, the PUL procedure achieves quantifiable improvements in functional outcomes and quality of life, in the absence of major adverse events. Furthermore, improvement in LUTS may be attained while preserving erectile and ejaculatory function. Adverse effects associated with the PUL procedure are mild to moderate, and are transient in nature. The PUL procedure provides an alternative for men seeking treatment for bothersome LUTS, with fewer side-effects.
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Affiliation(s)
- Cindy Garcia
- Sydney Adventist Hospital Clinical School, University of Sydney, NSW, Australia
| | - Peter Chin
- Department of Urology, The Wollongong Hospital, Wollongong, NSW, Australia ; Graduate School of Medicine, University of Wollongong, NSW, Australia ; Figtree Private Hospital, Figtree, NSW, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, NSW, Australia ; Rural Clinical School, The University of New South Wales, Port Macquarie, NSW, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, NSW, Australia
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Zhang LT, Park JK. Are phosphodiesterase type 5 inhibitors effective for the management of lower urinary symptoms suggestive of benign prostatic hyperplasia? World J Nephrol 2015; 4:138-147. [PMID: 25664256 PMCID: PMC4317624 DOI: 10.5527/wjn.v4.i1.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/22/2014] [Accepted: 10/10/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the efficacy of phosphodiesterase type 5 inhibitors (PDE5-Is) in lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (LUTS/BPH).
METHODS: A comprehensive research was conducted to identify all publications relating to benign prostate hyperplasia and treatment with sildenafil, vardenafil and tadalafil. To assess the efficacy, the changes in total international prostate symptom score (IPSS), IPSS subscore including voiding, storage and quality of life (QoL), Benign prostatic hyperplasia Impact Index (BII), maximum urinary flow rate (Qmax) and the International Index of Erectile Function (IIEF) were extracted. A meta-analytical technique was used for the analysis of integrated data from the included studies to evaluate the mean difference in the results.
RESULTS: Total IPSS score, IIEF and BII showed a significant improvement in trials in which LUTS/BPH with or without erectile dysfunction (ED) were compared with the placebo. For LUTS/BPH, the mean differences of total IPSS score, IIEF and BII are -2.17, 4.88 and -0.43, P < 0.00001, respectively. For LUTS/BPH with comorbid ED, the mean difference are -1.97, 4.54 and -0.52, P < 0.00001, respectively. PDE5-Is appear to improve IPSS storage, voiding and QoL subscore (mean difference = -0.71, -1.23 and -0.33, P < 0.00001, respectively). Although four doses of tadalafil (2.5, 5, 10 and 20 mg) failed to reach significance in Qmax (mean difference = 0.22, P = 0.10), the 5 mg dose of tadalafil significantly improved the Qmax (mean difference = 0.33, P = 0.03).
CONCLUSION: PED5-Is demonstrated efficacy for improving LUTS in BPH patients with or without ED and could be considered to be the first line treatment for LUTS/BPH.
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Yoon S, Choi JH, Lee SH, Choi SM, Jeh SU, Kam SC, Hwa JS, Chung KH, Hyun JS. Efficacy of Long-Term Daily Dosage of Alfuzosin 10 mg upon Sexual Function of Benign Prostatic Hypertrophy Patients: Two-Year Prospective Observational Study. World J Mens Health 2014; 32:133-8. [PMID: 25606561 PMCID: PMC4298815 DOI: 10.5534/wjmh.2014.32.3.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/04/2014] [Accepted: 08/06/2014] [Indexed: 12/05/2022] Open
Abstract
Purpose To identify sexual function improvement associated with alfuzosin (10 mg daily for 2 years). Materials and Methods We enrolled 30 men with lower urinary tract symptom (LUTS) who visited Gyeongsang National University Hospital between 2010 and 2012. At first visit, urinalysis, prostate specific antigen, transrectal ultrasound, and uroflowmetry were performed. The nternational Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), and Male Sexual Health Questionnaire Ejaculation Function Domain (MSHQ-EjFD) questionnaires were administered, and the subjects answered the same questionnaires at 1 month, 6 months, 1 year, and 2 years of follow-up. Results Twelve men completed of the entire study. After administration of alfuzosin, the median IPSS at first visit, 1 month, 6 months, 1 year, and 2 years was 18.00 (interquatile range [IQR]: 14.00~29.75), 20.00 (IQR: 11.50~30.00), 15.50 (IQR: 8.50~25.25), 14.50 (IQR: 9.25~19.50), and 11.50 (IQR: 5.00~17.75), respectively, which showed an improvement. The median QoL at the same times was 4.50 (IQR: 4.00~5.00), 4.50 (IQR: 4.00~5.00), 3.00 (IQR: 2.00~4.00), 3.50 (IQR: 2.25~4.00), and 3.00 (IQR: 1.00~3.00), respectively, and also showed improvement. Likewise, the median IIEF was 36.50 (IQR: 24.50~46.75), 37.50 (IQR: 26.75~47.25), 45.50 (IQR: 35.00~59.75), 48.50 (IQR: 34.75~62.75), and 47.50 (IQR: 43.25~61.00), while the median MSHQ-EjFD was 19.00 (IQR: 12.0~24.75), 19.50 (IQR: 13.50~27.75), 23.00 (IQR: 19.25~32.25), 26.50 (IQR: 18.25~34.50), 27.00 (IQR: 21.50~32.50), respectively, with both showing improvement. Conclusions After administration of alfuzosin (10 mg daily for 2 years), the IPSS, QoL, IIEF, and MSHQ-EjFD all improved significantly. This means long-term administration of 10 mg of alfuzosin daily would be effective not only for LUTS but also erectile function and ejaculation.
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Affiliation(s)
- Sol Yoon
- Department of Urology, School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jae Hwi Choi
- Department of Urology, School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Hyun Lee
- Department of Urology, School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - See Min Choi
- Department of Urology, School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Seong Uk Jeh
- Department of Urology, School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sung Chul Kam
- Department of Urology, School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jeong Seok Hwa
- Department of Urology, School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Ky Hyun Chung
- Department of Urology, School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jae Seog Hyun
- Department of Urology, School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
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Droupy S. Sexualité et pathologies urologiques. Presse Med 2014; 43:1106-10. [DOI: 10.1016/j.lpm.2014.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 11/25/2022] Open
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Ko K, Yang DY, Lee WK, Kim SW, Moon DG, Moon KH, Park NC, Park JK, Son HC, Lee SW, Hyun JS, Park K. Effect of improvement in lower urinary tract symptoms on sexual function in men: tamsulosin monotherapy vs. combination therapy of tamsulosin and solifenacin. Korean J Urol 2014; 55:608-14. [PMID: 25237463 PMCID: PMC4165924 DOI: 10.4111/kju.2014.55.9.608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/29/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate how much the improvement of lower urinary tract symptoms (LUTS) affects sexual function and which storage symptoms or voiding symptoms have the greatest effect on sexual function. MATERIALS AND METHODS A total of 187 patients were enrolled in this study. Patients were randomly assigned to receive either tamsulosin 0.2 mg (group A) or tamsulosin 0.2 mg and solifenacin 5 mg (group B). At 4 weeks and 12 weeks, the LUTS and sexual function of the patients were evaluated by use of the International Index of Erectile Function-5 (IIEF5), International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) questionnaire, uroflowmetry, and bladder scan. RESULTS Both groups A and B showed statistically significant improvements in IPSS, OABSS, and quality of life (QoL). Group A showed improved maximum flow rate, mean flow rate, and residual urine volume by time. Group B did not show an improvement in flow rate or residual urine volume but total voiding volume increased with time. The IIEF5 score was not improved in either group. In group A, the IIEF5 score dropped from 13.66 ± 4.97 to 11.93 ± 6.14 after 12 weeks (p=0.072). Group B showed a decline in the IIEF5 score from 13.19 ± 5.91 to 12.45 ± 6.38 (p=0.299). Although group B showed a relatively smaller decrease in the IIEF5 score, the difference between the two groups was not significant (p=0.696). CONCLUSIONS Tamsulosin monotherapy and combination therapy with solifenacin did not improve erectile function despite improvements in voiding symptoms and QoL. The improvement in storage symptoms did not affect erectile function.
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Affiliation(s)
- Kyungtae Ko
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Dae Yul Yang
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Won Ki Lee
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sae Woong Kim
- Department of Urology, The Catholic University College of Medicine, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Ki Hak Moon
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Nam Cheol Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Hwan Cheol Son
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Won Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Russo A, La Croce G, Capogrosso P, Ventimiglia E, Colicchia M, Serino A, Mirone V, Damiano R, Montorsi F, Salonia A. Latest pharmacotherapy options for benign prostatic hyperplasia. Expert Opin Pharmacother 2014; 15:2319-28. [DOI: 10.1517/14656566.2014.955470] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Andrea Russo
- Università Vita-Salute San Raffaele,
Milan, Italy
- URI-Urological Research Institute, Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele,
Via Olgettina 60 20132 Milan, Italy ;
| | - Giovanni La Croce
- Università Vita-Salute San Raffaele,
Milan, Italy
- URI-Urological Research Institute, Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele,
Via Olgettina 60 20132 Milan, Italy ;
| | - Paolo Capogrosso
- Università Vita-Salute San Raffaele,
Milan, Italy
- URI-Urological Research Institute, Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele,
Via Olgettina 60 20132 Milan, Italy ;
| | - Eugenio Ventimiglia
- Università Vita-Salute San Raffaele,
Milan, Italy
- URI-Urological Research Institute, Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele,
Via Olgettina 60 20132 Milan, Italy ;
| | - Michele Colicchia
- Università Vita-Salute San Raffaele,
Milan, Italy
- URI-Urological Research Institute, Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele,
Via Olgettina 60 20132 Milan, Italy ;
| | - Alessandro Serino
- Università Vita-Salute San Raffaele,
Milan, Italy
- URI-Urological Research Institute, Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele,
Via Olgettina 60 20132 Milan, Italy ;
| | - Vincenzo Mirone
- Federico II University, Department of Neurosciences, Reproductive Science and Odontostomatology,
Naples, Italy
| | - Rocco Damiano
- Magna Graecia University, Research Doctorate Program in Urology,
Catanzaro, Italy
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele,
Milan, Italy
- URI-Urological Research Institute, Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele,
Via Olgettina 60 20132 Milan, Italy ;
| | - Andrea Salonia
- URI-Urological Research Institute, Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele,
Via Olgettina 60 20132 Milan, Italy ;
- Magna Graecia University, Research Doctorate Program in Urology,
Catanzaro, Italy
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Choi JH, Hwa JS, Kam SC, Jeh SU, Hyun JS. Effects of tamsulosin on premature ejaculation in men with benign prostatic hyperplasia. World J Mens Health 2014; 32:99-104. [PMID: 25237660 PMCID: PMC4166377 DOI: 10.5534/wjmh.2014.32.2.99] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Previous studies have revealed that tamsulosin is effective in improving lower urinary tract symptoms (LUTS) and erectile functioning but has some inhibitory effects on ejaculation, including decreased ejaculatory volume. However, these inhibitory effects on ejaculation can be beneficial to patients with premature ejaculation (PE). Therefore, this study was conducted to understand the effect of tamsulosin on PE in men with benign prostatic hyperplasia. MATERIALS AND METHODS Twenty-nine patients who visited with LUTS were categorized into 2 groups of LUTS-only patients (n=12) and LUTS combined with PE (LUTS+PE) patients (n=17), and 0.4 mg of tamsulosin was administered to the patients of both groups for 12 weeks. Comparative analyses of before and after the treatment were conducted for calculating the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), intravaginal ejaculatory latency time (IELT), premature ejaculation diagnostic tool (PEDT), and premature ejaculation profile (PEP). The patients with an IPSS score of 8 or higher were determined as LUTS patients, and the patients with IELT of less than 2 minutess and a PEDT score of 9 or higher were determined as PE patients. RESULTS After treatment, the IPSS score significantly decreased in both groups. There was no statistically significant change in the PEDT for the LUTS group, but there was a significant decrease in PEDT (p=0.012; from 12.1±3.31 to 8.4±4.49) in the LUTS+PE group. CONCLUSIONS Tamsulosin not only has a treatment effect for LUTS but also improves the PE of LUTS+PE patients. Therefore, further studies are needed to confirm the effects of tamsulosin on PE.
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Affiliation(s)
- Jae Hwi Choi
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jung Seog Hwa
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung Chul Kam
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
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Foster SA, Shortridge EF, DiBonaventura M, Viktrup L. Predictors of self-reported benign prostatic hyperplasia in European men: analysis of the European National Health and Wellness Survey. World J Urol 2014; 33:639-47. [PMID: 25100623 DOI: 10.1007/s00345-014-1366-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 07/13/2014] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study aimed to identify predictors of European men who self-reported being diagnosed with benign prostatic hyperplasia (DxBPH) compared to men with moderate-to-severe lower urinary tract symptoms [American Urological Association Symptom Index (AUA-SI) score ≥8] who did not self-report a BPH diagnosis (non-DxBPH). METHODS Data were taken from the 2010 European National Health and Wellness Survey; a cross-sectional, self-administered, Internet-based questionnaire. This analysis included males ≥40 years with DxBPH or without DxBPH, but with AUA-SI ≥8. Chi-square tests were used for categorical variables and independent samples t tests were used for continuous variables. Logistic regressions were conducted among all men ≥40 years to predict being DxBPH. RESULTS About 1,638 DxBPH and 3,676 non-DxBPH men were included. The estimated prevalence of DxBPH and non-DxBPH was 8.53 and 19.13 %. Men with DxBPH were older than non-DxBPH males (mean age 66.1 and 58.3, P < 0.001). The mean AUA-SI score was 11.3 for DxBPH and 13.2 for non-DxBPH. Being older (OR = 1.077), having a university education (OR = 1.252), having private health insurance (OR = 1.186), and specific health behaviors/attitudes [regular exercise (OR = 1.191), visiting a doctor within the previous 6 months (OR = 2.398), consulting with a medical professional when not feeling well (OR = 1.097), reporting having an attentive doctor (OR = 1.112)], and higher voiding symptoms (OR = 1.032) were significant predictors of DxBPH. CONCLUSIONS Older men with higher education and access to care and more engagement in their healthcare were more likely to self-report being diagnosed.
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Affiliation(s)
- Shonda A Foster
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA,
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Chevallier D, Amiel J. Prise en charge médicale des symptômes du bas appareil urinaire (SBAU) en rapport avec une hyperplasie bénigne de la prostate (HBP) (SBAU-HBP) : Impact sur la fonction sexuelle - Revue de la littérature. SEXOLOGIES 2014. [DOI: 10.1016/j.sexol.2014.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Change in Sexual Function in Men with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Associated with Long-Term Treatment with Doxazosin, Finasteride and Combined Therapy. J Urol 2014; 191:1828-34. [DOI: 10.1016/j.juro.2013.12.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2013] [Indexed: 01/23/2023]
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45
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Droupy S. L’hyperplasie bénigne de la prostate. SEXOLOGIES 2014. [DOI: 10.1016/j.sexol.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bouwman II, Kollen BJ, van der Meer K, Nijman RJM, van der Heide WK. Are lower urinary tract symptoms in men associated with cardiovascular diseases in a primary care population: a registry study. BMC FAMILY PRACTICE 2014; 15:9. [PMID: 24422708 PMCID: PMC3898227 DOI: 10.1186/1471-2296-15-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 01/03/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although lower urinary tract symptoms (LUTS) seem to be related to cardiovascular disease (CVD) in men, it is unclear whether this relationship is unbiased. In order to investigate this relationship, we used longitudinal data for establishing the possible predictive value of LUTS for the development of CVD in a primary care population. METHODS We performed a registry study using data from the Registration Network Groningen (RNG). All data from men aged 50 years and older during the study period from 1 January 1998 up to 31 December 2008 were collected. Cox proportional hazard regression analysis was used to determine the association between the proportions of CVD (outcome) and LUTS in our population. RESULTS Data from 6614 men were analysed. The prevalence of LUTS increased from 92/1000 personyears (py) in 1998 up to 183/1000 py in 2008. For cardiovascular diseases the prevalence increased from 176/1000 py in 1998 up to 340/1000 py in 2008. The incidence numbers were resp. 10.2/1000 py (1998) and 5.1/1000 py (2008) for LUTS, and 12.9/1000 py (1998) and 10.4/1000 py (2008) for CVD. Of all men, 23.2% reported CVD (41.1% in men with LUTS vs 19.5% in men without LUTS, p < 0.01). The hazard ratio of LUTS for cardiovascular events, compared to no LUTS, in the adjusted multivariate model, was 0.921(95% CI: 0.824 - 1.030; p = 0.150). CONCLUSION Based on the results, LUTS is not a factor that must be taken into account for the early detection of CVD in primary care.
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Affiliation(s)
- Inge I Bouwman
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
| | - Boudewijn J Kollen
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
| | - Klaas van der Meer
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
| | - Rien JM Nijman
- Department of urology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, GZ 9713, Netherlands
| | - Wouter K van der Heide
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
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Carson CC, Rosenberg M, Kissel J, Wong DG. Tadalafil - a therapeutic option in the management of BPH-LUTS. Int J Clin Pract 2014; 68:94-103. [PMID: 24341303 DOI: 10.1111/ijcp.12305] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 08/23/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND/AIMS Men with signs of benign prostatic hyperplasia (BPH) may experience lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, intermittence, nocturia, straining, incomplete emptying or a weak urinary stream. The effective management of LUTS suggestive of BPH (BPH-LUTS) requires careful consideration of several factors, including the severity of a patient's symptoms, concurrent or other coexisting medical conditions, the ability to improve symptoms and impact quality of life (QOL), as well as the potential side effects of available treatment options. Several clinical studies have assessed phosphodiesterase type 5 (PDE5) inhibitors in reducing LUTS; however, tadalafil is the only PDE5 inhibitor approved for the treatment of signs and symptoms of BPH, as well as in men with both erectile dysfunction (ED) and the signs and symptoms of BPH. This review examined articles that assessed tadalafil in patients with signs and symptoms of BPH, with or without erectile dysfunction (ED), which led to regulatory approval in the United States and Europe. RESULTS In dose-ranging and confirmatory studies, results demonstrate that tadalafil significantly improved total International Prostate Symptom Score (IPSS) following 12 weeks of treatment with once daily tadalafil 5 mg. Statistically significant improvements in Benign Prostatic Hyperplasia Impact Index (BII), IPSS subscores, IPSS QOL and International Index of Erectile Function (IIEF) were also observed. Improvement in urinary symptoms occurred regardless of age, previous treatment with an α1 -adrenergic blocker, BPH-LUTS severity at baseline or ED status. CONCLUSIONS While tadalafil is most frequently recognised as a standard treatment option for men with ED, it also represents a well-tolerated and effective treatment option in men with moderate to severe BPH-LUTS.
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Affiliation(s)
- C C Carson
- University of North Carolina, Chapel Hill, NC, USA
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Park HJ, Won JEJ, Sorsaburu S, Rivera PD, Lee SW. Urinary Tract Symptoms (LUTS) Secondary to Benign Prostatic Hyperplasia (BPH) and LUTS/BPH with Erectile Dysfunction in Asian Men: A Systematic Review Focusing on Tadalafil. World J Mens Health 2013; 31:193-207. [PMID: 24459652 PMCID: PMC3888888 DOI: 10.5534/wjmh.2013.31.3.193] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 10/24/2013] [Accepted: 11/07/2013] [Indexed: 01/03/2023] Open
Abstract
This review assesses lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with or without erectile dysfunction (ED) and related therapies focusing on tadalafil. A literature search was obtained and reviewed for the epidemiology, treatment therapies, pathophysiology, and efficacy and safety of phosphodiesterase type 5 inhibitor (PDE5i) tadalafil in patients with LUTS/BPH. Approximately 42% of men aged 51 to 60 years have BPH. Approximately 90% of men aged 45 to 80 years have LUTS. Occurrence of LUTS increases with age for almost all racial/ethnic groups (range, 32% to 56%) with prevalence of LUTS highest among Hispanic men, then Blacks, Caucasians, and Asians. There is an independent relationship with LUTS/BPH and ED, with approximately 70% of men with LUTS/BPH having ED with severity of one disease often correlating with the other. The European Urological Association guidelines include the use of the PDE5i tadalafil. Tadalafil is the only therapy recommended for treatment of co-existing BPH and ED, while other therapies have unwanted ED side effects. The mode of action of tadalafil may involve different areas of the lower urinary tract such as smooth muscle cell relaxation in the bladder neck, prostate, and urethra, but there may also be resulting modulation of the afferent nerve activity. Tadalafil (5 mg) in Asian men with LUTS/BPH, similar to global studies, is efficacious and safe. Tadalafil (5 mg) improves co-existing LUTS/BPH and ED, independently. Men with LUTS/BPH likely also have ED. Asian men with LUTS/BPH have similar incidence rates, co-existing ED, comorbid diseases, and risks as non-Asian men. Tadalafil can improve co-existing LUTS/BPH and ED.
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Affiliation(s)
- Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
| | | | | | | | - Seung Wook Lee
- Department of Urology, Hanyang University Guri Hospital, Guri, Korea
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Foster SA, Annunziata K, Shortridge EF, Freedman D, Viktrup L. Erectile dysfunction with or without coexisting benign prostatic hyperplasia in the general US population: analysis of US National Health and Wellness Survey. Curr Med Res Opin 2013; 29:1709-17. [PMID: 23971532 DOI: 10.1185/03007995.2013.837385] [Citation(s) in RCA: 13] [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 benign prostatic hyperplasia (BPH) commonly affect older men. There is limited epidemiology information on coexisting ED and BPH. This study assessed self-reported prevalence of ED with or without a diagnosis of BPH (ED/DxBPH versus ED only) in US men. METHODS Men ≥40 years old, who reported experiencing ED in the past 6 months with or without a diagnosis of BPH, were identified from the nationally representative 2011 US National Health and Wellness Survey (NHWS) - a cross-sectional, self-administered online survey. Unpaired t-tests were used to compare characteristics between ED-only and ED/DxBPH populations. RESULTS The prevalence of ED only and ED/DxBPH was 24.6% and 4.9% (mean ages of 60 and 68 years, respectively). About two-thirds of those with ED only and ED/DxBPH reported speaking to their physician about ED. About 23% of either group reported currently using ED medication and 11.7% of men with ED only were prescribed ED medication by a urologist, compared to 31.1% with ED/DxBPH. Approximately 51.7% of men with ED/DxBPH were taking BPH medication. Overall, 37.3% of men with ED only and 74.6% with ED/DxBPH reported moderate-to-severe urinary symptoms on the American Urological Association-Symptom Index (AUA-SI ≥8). CONCLUSION While self-reported ED is common, few men with ED in the US population report being diagnosed with BPH. The majority of ED only and ED/DxBPH men reported speaking to a physician about ED; however, few reported currently taking ED medication. A majority of men with ED/DxBPH reported an AUA-SI score ≥8, but only half reported taking BPH medications. Thus, although men are experiencing erectile or urinary symptoms, many remain untreated. A limitation of this study is that symptoms and diagnosis were self-reported and may not reflect how these conditions are diagnosed in a healthcare setting; however, patient self-report provides a unique perspective on the burden associated with these conditions.
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Seyam R. A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men. Ther Adv Urol 2013; 5:254-97. [PMID: 24082920 DOI: 10.1177/1756287213497231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A better understanding of ejaculatory disorders has led to an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). Current reviews on the subject use a symptom-based classification to describe ejaculatory dysfunction even when it is a single case report. While these reviews provide important information on the disorder, a clearer picture of the prevalence of non-PE EjD in relation to the community and various pathophysiologic states is needed. OBJECTIVES The objective of this study was to provide a systematic review of studies of non-PE EjD excluding single case reports. METHODS A systematic review of Medline for terms including ejaculation, orgasm or hematospermia. Association with terms delay, pain or headache was made. The search was restricted to male gender and articles written in English. Abstracts were reviewed and those mainly concerned with premature ejaculation were excluded. RESULTS A total of 333 articles on non-PE EjD were identified. The condition was reported in community-based studies. In certain patient populations, non-PE EjD was commonly reported in association with antidepressant and antipsychotic treatments, in patients with chronic prostatitis/chronic pelvic pain syndrome, patients with lower urinary tract symptoms particularly in association with medical or surgical treatment, patients with retroperitoneal surgery and in patients with neurological diseases. Few articles were concerned with treatment options. CONCLUSION There is a significant prevalence of non-PE EjD in the community and in association with particular disease states or as a side effect of medical or surgical interventions. There is a need to direct efforts to prevent and treat these conditions.
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Affiliation(s)
- Raouf Seyam
- King Faisal Specialist Hospital and Research Center, PO Box 3354, MBC 83, Riyadh 11211, Saudi Arabia
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