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Yoosuf BT, Panda AK, Kt MF, Bharti SK, Devana SK, Bansal D. Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis. Sci Rep 2024; 14:11116. [PMID: 38750153 PMCID: PMC11096304 DOI: 10.1038/s41598-024-61977-5] [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: 02/27/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024] Open
Abstract
Despite the availability of various drugs for benign prostatic hyperplasia (BPH), alpha(α)-blockers are the preferred first-line treatment. However, there remains a scarcity of direct comparisons among various α-blockers. Therefore, this network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of α-blockers in the management of BPH. A comprehensive electronic search covered PubMed, Embase, Ovid MEDLINE, and Cochrane Library until August 2023. The primary endpoints comprised international prostate symptom score (IPSS), maximum flow rate (Qmax), quality of life (QoL), and post-void residual volume (PVR), while treatment-emergent adverse events (TEAEs) were considered as secondary endpoints. This NMA synthesized evidence from 22 studies covering 3371 patients with six kinds of α-blockers with 12 dose categories. IPSS has been considerably improved by tamsulosin 0.4 mg, naftopidil 50 mg and silodosin 8 mg as compared to the placebo. Based on the p-score, tamsulosin 0.4 mg had the highest probability of ranking for IPSS, PVR, and Qmax, whereas doxazosin 8 mg had the highest probability of improving QoL. A total of 297 adverse events were reported among all the α-blockers, silodosin has reported a notable number of TEAEs. Current evidence supports α-blockers are effective in IPSS reduction and are considered safer. Larger sample size with long-term studies are needed to refine estimates of IPSS, QoL, PVR, and Qmax outcomes in α-blocker users.
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Affiliation(s)
- Beema T Yoosuf
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Mohali, Punjab, India
| | - Abhilash Kumar Panda
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Mohali, Punjab, India
| | - Muhammed Favas Kt
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Mohali, Punjab, India
| | - Saroj Kundan Bharti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Mohali, Punjab, India
| | - Sudheer Kumar Devana
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipika Bansal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Mohali, Punjab, India.
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2
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Yoshizumi M, Ise SN, Yonezawa A, Watanabe C, Sakurada S, Mizoguchi H. Characteristics of α 1-adrenoceptor antagonists-induced ejaculatory dysfunction on spontaneous seminal emission in rats. Basic Clin Pharmacol Toxicol 2024; 134:704-711. [PMID: 38409579 DOI: 10.1111/bcpt.13993] [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] [Received: 10/31/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/28/2024]
Abstract
Although α1-adrenoceptor (α1-AR) antagonists used to treat benign prostatic hyperplasia can cause ejaculation disorders, the aetiology of this adverse event is still controversial. Therefore, we investigated the effects of antagonists with different affinities for α1-AR subtypes on ejaculatory function and their mechanisms of action in normal rats. In the spontaneous seminal emission (SSE) test, systemically administered prazosin, terazosin, tamsulosin and naftopidil decreased the weight of ejaculated seminal material in a dose-dependent manner; the potency order was as follows: tamsulosin > terazosin > prazosin > naftopidil. The selective α1D-AR antagonist BMY7378 had no effect on SSE. Intrathecal tamsulosin and naftopidil did not inhibit SSE. Tamsulosin, the most potent, was ineffective as a single dose and significantly increased seminal vesicle fluid in rats treated for 2 weeks but did not significantly change retrograde ejaculation. These results indicated that the difference in inhibitory potency of the five α1-AR antagonists against SSE was due to the involvement of α1A-AR subtypes. Our results further suggested that α1-AR antagonist-induced ejaculatory dysfunction at the peripheral level was mainly due to the loss of seminal emission, although some retrograde ejaculation may also be involved.
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Affiliation(s)
- Masaru Yoshizumi
- Division of Physiology and Anatomy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Shin-Nosuke Ise
- Division of Physiology and Anatomy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Akihiko Yonezawa
- Division of Pharmaceutical Center, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Chizuko Watanabe
- Division of Physiology and Anatomy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Shinobu Sakurada
- Division of Physiology and Anatomy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hirokazu Mizoguchi
- Division of Physiology and Anatomy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D, Magri V, Mourmouris P, Ouattara A, Perletti G, Philipraj J, Trinchieri A, Buchholz N. Effect of alpha-adrenoceptor antagonists on sexual function. A systematic review and meta-analysis. Arch Ital Urol Androl 2022; 94:252-263. [PMID: 35775356 DOI: 10.4081/aiua.2022.2.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Alpha-adrenoreceptor antagonists or alpha-blockers are used in the treatment of hypertension, in the therapy of benign prostatic hyperplasia and in medical expulsive treatment of ureteral stones. These agents may affect the sexual function, with differences between drugs within the same class, depending on their selectivity for receptor subtypes. The aim of this review was to analyze the effects of alpha-blockers on sexual function. MATERIALS AND METHODS We conducted a systematic review and meta-analysis by searching PubMed, EMBASE and other databases for randomized controlled trials (RCTs) reporting sexual adverse effects in patients treated with alpha-blockers. Odds ratios for sexual dysfunction were calculated using random effects Mantel-Haenszel statistics. RESULTS Out of 608 records retrieved, 75 eligible RCTs were included in the meta-analysis. Compared with placebo, alphablockers were associated with increased odds of ejaculatory disorders both in patients with lower urinary tract symptoms (LUTS) associated to benign prostatic hyperplasia (BPH) (OR: 7.53, 95% CI: 3.77-15.02, Z = 5.73, p < 0.00001, I2 = 55%) and in patients with ureteral stones (OR: 2.88, 95% CI: 1.50-5.44, Z = 3.19, p < 0.001, I2 = 31%). Uroselective alpha-blockers showed higher odds of ejaculatory disorders. Conversely, nonselective alpha-blockers were not associated with higher odds of ejaculatory dysfunction. Silodosin was associated with increased odds of ejaculatory dysfunction compared with tamsulosin (OR: 3.52, 95% CI: 2.18-5.68, 15 series, 1512 participants, Z = 5.15, p < 0.00001, I2 = 0%). Naftopidil and alfuzosin showed lower odds of ejaculatory dysfunction compared to uroselective alpha-blockers.No statistically significant differences in the odds of erectile dysfunction were observed when alpha-blockers were compared to placebo.
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Affiliation(s)
- Rawa Bapir
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Smart Health Tower, Sulaymaniyah, Kurdistan region.
| | - Kamran Hassan Bhatti
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Urology Department, HMC, Hamad Medical Corporation.
| | - Ahmed Eliwa
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Zagazig University, Zagazig, Sharkia.
| | | | - Nazim Gherabi
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Faculty of Medicine Algiers 1, Algiers.
| | - Derek Hennessey
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Mercy University Hospital, Cork.
| | - Vittorio Magri
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and ASST Nord Milano, Milan.
| | - Panagiotis Mourmouris
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens.
| | - Adama Ouattara
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Division of Urology, Souro Sanou University Teaching Hospital, Bobo-Dioulasso.
| | - Gianpaolo Perletti
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese.
| | - Joseph Philipraj
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry.
| | - Alberto Trinchieri
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Urology School, University of Milan.
| | - Noor Buchholz
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Sobeh's Vascular and Medical Center, Dubai Health Care City, Dubai.
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[Treatment of Ta and T1 intermediate or high risk bladder cancer with intravesical Bacillus Calmette-Guérin or mitomycin C]. Urologe A 2021; 60:234-237. [PMID: 33479803 DOI: 10.1007/s00120-021-01443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
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Lee LJ, Kwon CS, Forsythe A, Mamolo CM, Masters ET, Jacobs IA. Humanistic and Economic Burden of Non-Muscle Invasive Bladder Cancer: Results of Two Systematic Literature Reviews. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:693-709. [PMID: 33262624 PMCID: PMC7695604 DOI: 10.2147/ceor.s274951] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/29/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Non-muscle invasive bladder cancer (NMIBC) is a malignancy restricted to the inner lining of the bladder. Intravesical Bacillus Calmette-Guerin (BCG) following transurethral resection of the bladder tumor is the mainstay first-line treatment for high-risk NMIBC patients. Two systematic literature reviews (SLRs) were conducted to further assess the current evidence on BCG use in NMIBC and the humanistic and economic burden of disease. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Embase® and MEDLINE® were searched using the Ovid platform to identify interventional or real-world evidence studies on the health-related quality of life (HRQoL) and economic burden in NMIBC. Limited evidence was found from initial economic SLR searches in NMIBC, so additional targeted searches for bladder cancer were conducted to expand findings. RESULTS Fifty-nine publications were included in the HRQoL SLR, of which 23 reported HRQoL and symptoms in NMIBC. At diagnosis, HRQoL was comparable with population norms but worsened considerably 2 years following diagnosis. Maintenance therapy with intravesical BCG was associated with reduced HRQoL, and treatment-related adverse events (AEs) resembled typical NMIBC symptoms. Twenty-two studies reported decreasing BCG compliance over time. Common AEs with BCG were frequent urination, lower urinary tract symptoms, pain, and hematuria. Forty-two publications were included in the economic SLR, of which nine assessed healthcare costs and resource use in NMIBC or bladder cancer. High-risk disease and high-intensity treatment were associated with increased healthcare costs. CONCLUSION NMIBC has a considerable symptomatic, HRQoL, and economic burden. Symptoms persisted and HRQoL worsened despite intravesical BCG treatment. NMIBC is a costly disease, with higher healthcare costs associated with increased risk of disease progression and recurrence. There is a high unmet need for safe and effective treatments that reduce the risk of disease progression and recurrence, provide symptomatic relief, and improve HRQoL for patients.
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Affiliation(s)
- Lauren J Lee
- Patient Health and Impact, Pfizer Inc, New York, NY, USA
| | - Christina S Kwon
- Evidence Generation, Purple Squirrel Economics, New York, NY, USA
| | - Anna Forsythe
- Evidence Generation, Purple Squirrel Economics, New York, NY, USA
| | | | | | - Ira A Jacobs
- Worldwide Research and Development, Pfizer Inc, New York, NY, USA
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Xiang P, Wang M, Guan D, Liu D, Wang Y, Hao Y, Li S, Liu Y, Ping H. A Systematic Review and Meta-analysis of Prostatic Urethral Lift for Male Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. EUR UROL SUPPL 2020; 19:3-15. [PMID: 34337448 PMCID: PMC8317884 DOI: 10.1016/j.euros.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 02/03/2023] Open
Abstract
CONTEXT Recently, prostatic urethral lift (PUL) is being used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Although preliminary clinical studies on PUL are increasing, the long-term efficacy and safety of this procedure are still not well evaluated. OBJECTIVE The objective of our study is to synthesize the existing literature evidence, and make a comprehensive and long-term systematic review for the PUL procedure. EVIDENCE ACQUISITION A systematic search was performed from the electronic databases including PubMed, Embase, and OVID. The search period was up to January 1, 2020. Comprehensive retrospective and prospective studies on PUL were collected in accordance with specific inclusion and exclusion criteria. Pooled prostatic symptom scores, sexual health scores, and functional outcomes were calculated by using a fixed or random-effect model. EVIDENCE SYNTHESIS Nineteen articles meet our determined inclusion and exclusion criteria, and 11 independent patient series were included in the final analysis. Meta-analysis results indicated improvement after the PUL procedure, including International Prostate Symptom Score improvement of 9.73-12.16 points, BPH Impact Index improvement of 3.74-4.50 points, maximum flow rate improvement of 3.44-4.26 ml/s, and quality of life improvement of 2.20-2.55 points. Postvoid residual volume at most of the intervals was not significantly variable. Data regarding sexual function remained stable or improved slightly during the 24-mo follow-up period. Pooled estimates were largely heterogeneous except for sexual function. CONCLUSIONS PUL can continue to relieve prostatic symptoms for 24 mo without causing serious complications. The extremely important advantage of the PUL procedure is that it can preserve or slightly improve sexual function. Longer-term and more comprehensive clinical trials are still needed to further clarify the functional outcomes and cost effectiveness of PUL. PATIENT SUMMARY Prostatic urethral lift is an attractive option for selected patients who seek rapid and durable relief of lower urinary tract symptoms with complete preservation of sexual function.
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Affiliation(s)
- Peng Xiang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mingdong Wang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Di Guan
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dan Liu
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yonghui Wang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yongxiu Hao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shuang Li
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuexin Liu
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hao Ping
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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7
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Schmidt S, Kunath F, Coles B, Draeger DL, Krabbe LM, Dersch R, Kilian S, Jensen K, Dahm P, Meerpohl JJ. Intravesical Bacillus Calmette-Guérin versus mitomycin C for Ta and T1 bladder cancer: Abridged summary of the Cochrane Review. Investig Clin Urol 2020; 61:349-354. [PMID: 32665991 PMCID: PMC7329645 DOI: 10.4111/icu.2020.61.4.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/03/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Frank Kunath
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.,Department of Urology, University Hospital Erlangen, Erlangen, Germany
| | - Bernadette Coles
- Velindre NHS Trust, Cardiff University Library Services, Cardiff, United Kingdom
| | - Desiree Louise Draeger
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.,Department of Urology, University of Rostock, Rostock, Germany
| | - Laura-Maria Krabbe
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.,Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Rick Dersch
- Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Samuel Kilian
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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Cheng BKC, Li TCF, Yu CHT. Sexual outcomes of endoscopic enucleation of prostate. Andrologia 2020; 52:e13724. [PMID: 32557813 DOI: 10.1111/and.13724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/24/2020] [Accepted: 05/30/2020] [Indexed: 12/28/2022] Open
Abstract
The emergence of various endoscopic enucleation techniques in the past decade has provided surgeons with more options and opportunities in performing enucleation. With the same surgical principle as holmium laser enucleation of prostate, the early results of different techniques were comparable. However, sexual outcomes of endoscopic enucleation of the prostate (EEP) were less commonly reported than the voiding and urodynamic outcomes. In this review, the sexual outcomes including erectile function, ejaculatory and orgasmic function of various endoscopic enucleation technique would be studied. The overall sexual outcomes were heterogeneous and inconclusive. Outcomes measurement, sample size calculation, hypothesis generation and selection criteria were not specifically designed for sexual outcomes or even available. There were also limitations in the individual sexual assessment tools. Nonetheless, most studies showed no significant deterioration of erectile function after EEP, and ejaculation dysfunction was common. Looking forward in the field of benign prostatic enlargement surgery, the 'one size fits all' notion should be abandoned. Treatment should be tailor-made according to the prostate size, co-morbidities and sexual needs. The sexual outcomes of enucleation have to be better studied and defined. More prospective controlled studies focusing primarily on sexual functions are needed. For enucleation surgeons, exploring different ejaculatory-sparing technique could be the golden opportunities in further consolidating the role and expanding the indication of enucleation surgery.
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Affiliation(s)
| | | | - Chloe Hui-Tung Yu
- Department of Surgery, United Christian Hospital, Hong Kong, Hong Kong
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9
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Baek JM, Kim HJ, Nam MW, Park HJ, Yeon SH, Oh MH, Yoon JS, Kwon HJ, Lee KP, Lim JH. Standardized Seed Extract of Quisqualis indica (HU-033) Attenuates Testosterone Propionate-Induced Benign Prostatic Hyperplasia via α1-Adrenergic Receptors and Androgen/Estrogen Signaling. Prev Nutr Food Sci 2019; 24:492-497. [PMID: 31915646 PMCID: PMC6941726 DOI: 10.3746/pnf.2019.24.4.492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is an age-related disease characterized by prostatic enlargement and is the most common urologic symptoms in elderly men 60 years of age and older. Previously, we documented that 70% ethanol (EtOH) seed extract of Quisqualis indica (QI) attenuates pathological condition of testosterone propionate (TP)-induced BPH rat model via modulation of proliferation and apoptosis of prostate cells. Based on this potential of QI, we produced standardized seed extract of QI (HU-033) in order to prove further mechanisms. In this study, we aimed to suggest further mechanisms underlying the relationship between BPH and HU-033. Through not only cellular and nuclear receptor functional assays, but TP-mediated BPH rat model treated with HU-033, we demonstrated that HU-033 exerted antagonist effect on α1A- and α1D-adrenergic receptors in vitro and inhibitory effect on protein expression of androgen receptor and estrogen receptor alpha in vivo. Taken together, these results suggest that HU-033 is a novel candidate for the management of BPH.
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Affiliation(s)
| | | | - Min Woo Nam
- HUONS Research Center, Gyeonggi 15588, Korea
| | | | | | | | - Ji Soo Yoon
- HUONS Research Center, Gyeonggi 15588, Korea
| | - Hyo Jung Kwon
- Department of Veterinary Pathology, Chungnam National University, Daejeon 34134, Korea
| | - Kyu Pil Lee
- Laboratory of Physiology, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
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Tuong N, Reines K, Mikula M, Smith R. Contemporary Review of BPH Medical and Surgical Treatments on Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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11
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Descazeaud A, Robert G, de La Taille A. [Sexual consequences of BPH treatments]. Prog Urol 2018; 28:839-847. [PMID: 30195716 DOI: 10.1016/j.purol.2018.07.278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the literature on the sexual adverse effects of pharmacological, instrumental and surgical treatments of lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH). METHOD A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review. RESULTS AND CONCLUSION Sexual dysfunction and SBAU/BPH are intimately linked by a cross-over effect in the population of men over 50, a possible common pathophysiology and treatments for BPH with sexual consequences. Evaluating the sexuality of patients in care for SBAU/BPH is therefore essential. Patients should be informed of potential adverse drug effects of BPH, including ejaculation disorders with alpha blockers and loss of libido and erectile dysfunction with 5 alpha reductase inhibitors. After BPH surgery, loss of antegrade ejaculation is common, although preservation possibilities exist. The improvement of urinary function and the decrease of possible ejaculatory pains have a beneficial effect on the sexuality of the BPH patients operated. More rarely, patients may experience orgasmic dysfunction or even erectile dysfunction with a possible thermal effect on the vasculo-nerve bundles. LEVEL OF EVIDENCE Consensus d'experts.
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Affiliation(s)
- A Descazeaud
- Service de chirurgie urologique, CHU de Limoges, 87042 Limoges, France.
| | - G Robert
- Service d'urologie, CHU de Bordeaux, 33000 Bordeaux, France
| | - A de La Taille
- Service d'urologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
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12
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α1L-adrenoceptors mediate contraction of human erectile tissue. J Pharmacol Sci 2018; 137:366-371. [DOI: 10.1016/j.jphs.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 11/24/2022] Open
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13
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Welliver C, Essa A. Sexual Side Effects of Medical and Surgical Benign Prostatic Hyperplasia Treatments. Urol Clin North Am 2017; 43:393-404. [PMID: 27476132 DOI: 10.1016/j.ucl.2016.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatments for lower urinary tract symptoms due to benign prostatic hyperplasia can be evaluated by multiple metrics. A balance within the confines of patient expectations is key to determining the ideal treatment. A troubling adverse event for some patients is sexual dysfunction. Because the cohort of men who seek treatment of sexual dysfunction and lower urinary tract symptoms is essentially identical, these disease processes frequently overlap. This article considers potential pathophysiologic causes of dysfunction with treatment and attempts to critically review the available data to assess the true incidence of sexual adverse events with treatment.
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Affiliation(s)
- Charles Welliver
- Division of Urology, Albany Medical College, 23 Hackett Boulevard, Albany, NY 12208, USA; Division of Urology, Albany Stratton Veterans Affairs Medical Center, 113 Holland Ave, Albany, NY 12208, USA; Division of Urology, Urological Institute of Northeastern New York, 23 Hackett Boulevard, Albany, NY 12208, USA.
| | - Ahmed Essa
- Division of Urology, University of Al - Iraqi School of Medicine, Adhamyia, Haibetkhaoon, Street 22, District 308, Box office 7366, Baghdad, Iraq; Department of Urology, Al-Numan Teaching Hospital, Adhamyia, Haibetkhaoon, Street 22, District 308, Box office 7366, Baghdad, Iraq
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14
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Adegun PT, Areo PO, Solomon A, Dada SA, Adebayo PB. Erectile Dysfunction in Men with and without Lower Urinary Tract Symptoms in Nigeria. World J Mens Health 2017; 35:107-114. [PMID: 28868819 PMCID: PMC5583367 DOI: 10.5534/wjmh.2017.35.2.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Much attention has been focused in recent decades on the effects of erectile dysfunction (ED) secondary to lower urinary tract symptoms (LUTS), potentially underestimating its effects in men without LUTS. This study aimed to compare the prevalence and predictors of ED in men with and without LUTS. MATERIALS AND METHODS The International Index of Erectile Function questionnaire was administered to 303 patients between January 2014 and June 2016. Within this sample, 147 patients with LUTS (cases) were compared to 156 men without LUTS who were matched for age, level of education, and occupation (controls). RESULTS The mean age was 66.03±9.64 years and 65.78±8.61 years for the cases and controls, respectively. The prevalence of ED was 64.6% and 73.7% (odds ratio [OR], 1.54; 95% confidence interval [CI], 0.94~2.51) in the case cohort and controls, respectively (p=0.086). There was no difference in the prevalence of impaired erectile function (p=0.067), impaired orgasmic function (p=0.108), impaired sexual desire (p=0.291), impaired intercourse satisfaction (p=0.869), or impaired overall satisfaction (p=0.191). Multivariate logistic regression analysis showed that being currently employed was a significant predictor of ED both in men with LUTS (OR, 8.08; 95% CI, 1.51~9.27; p=0.004) and in men without LUTS (OR, 7.00; 95% CI, 1.49~14.51; p=0.008). Being married only predicted for impaired EF in men without LUTS (OR, 6.34; 95% CI, 1.40~15.20; p<0.05). CONCLUSIONS ED was not found to be more prevalent in men with LUTS. Being employed was a predictor of ED in both groups of men, while being married was also a predictor of ED in men without LUTS.
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Affiliation(s)
- Patrick Temi Adegun
- Urology Division, Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Peter Olufemi Areo
- Urology Division, Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.
| | - Abidemi Solomon
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Samuel Ayokunle Dada
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
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Zhao F, Li J, Chen Y, Tian Y, Wu C, Xie Y, Zhou Y, Wang J, Xie X, Liu H. Design, Synthesis, and Biological Evaluation of Indoline and Indole Derivatives as Potent and Selective α1A-Adrenoceptor Antagonists. J Med Chem 2016; 59:3826-39. [DOI: 10.1021/acs.jmedchem.5b02023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Fei Zhao
- Antibiotics
Research and Re-evaluation Key Laboratory of Sichuan Province, Sichuan
Industrial Institute of Antibiotics, Chengdu University, 168 Hua Guan
Road, Chengdu 610052, People’s Republic of China
| | - Jing Li
- CAS
Key Laboratory of Receptor Research, Shanghai Institute of Materia
Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, People’s Republic of China
| | - Ying Chen
- CAS
Key Laboratory of Receptor Research, Shanghai Institute of Materia
Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, People’s Republic of China
| | - Yanxin Tian
- CAS
Key Laboratory of Receptor Research, Shanghai Institute of Materia
Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, People’s Republic of China
| | - Chenglin Wu
- CAS
Key Laboratory of Receptor Research, Shanghai Institute of Materia
Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, People’s Republic of China
| | - Yanan Xie
- CAS
Key Laboratory of Receptor Research, Shanghai Institute of Materia
Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, People’s Republic of China
| | - Yu Zhou
- CAS
Key Laboratory of Receptor Research, Shanghai Institute of Materia
Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, People’s Republic of China
| | - Jiang Wang
- CAS
Key Laboratory of Receptor Research, Shanghai Institute of Materia
Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, People’s Republic of China
| | - Xin Xie
- CAS
Key Laboratory of Receptor Research, Shanghai Institute of Materia
Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, People’s Republic of China
| | - Hong Liu
- CAS
Key Laboratory of Receptor Research, Shanghai Institute of Materia
Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, People’s Republic of China
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16
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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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Capogrosso P, Serino A, Ventimiglia E, Boeri L, Dehò F, Damiano R, Briganti A, Montorsi F, Salonia A. Effects of silodosin on sexual function - realistic picture from the everyday clinical practice. Andrology 2015; 3:1076-81. [DOI: 10.1111/andr.12095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 07/02/2015] [Accepted: 07/14/2015] [Indexed: 12/16/2022]
Affiliation(s)
- P. Capogrosso
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - A. Serino
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - E. Ventimiglia
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - L. Boeri
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - F. Dehò
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - R. Damiano
- Research Doctorate Program in Urology; Magna Graecia University; Catanzaro Italy
| | - A. Briganti
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
- Research Doctorate Program in Urology; Magna Graecia University; Catanzaro Italy
| | - F. Montorsi
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - A. Salonia
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
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Welliver C, Butcher M, Potini Y, McVary KT. Impact of alpha blockers, 5-alpha reductase inhibitors and combination therapy on sexual function. Curr Urol Rep 2015; 15:441. [PMID: 25118850 DOI: 10.1007/s11934-014-0441-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Medical treatments for lower urinary tract symptoms due to benign prostatic hyperplasia are frequently associated with changes in sexual function. While these medications are generally well-tolerated and have both reduced and delayed more invasive surgical options, the ramifications of long-term chronic use are largely unknown. Sexual side effects of these medications are frequently either reported as part of a short-term initial drug study or have inflexible endpoints that are not able to gauge more subtle changes in sexual performance. This review will delineate the currently known effects of these medications on sexual function and will consider mechanisms of dysfunction.
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Song J, Shao Q, Tian Y, Chen S. Lower urinary tract symptoms, erectile dysfunction, and their correlation in men aged 50 years and above: a cross-sectional survey in Beijing, China. Med Sci Monit 2014; 20:2806-10. [PMID: 25543209 PMCID: PMC4285920 DOI: 10.12659/msm.891180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background The aim of this study was to investigate the correlation between incidence of lower urinary tract symptoms and erectile dysfunction in men aged ≥50 years. Material/Methods A cross-sectional study was performed in 1644 men aged >50 years in Beijing. The International Index of Erectile Function (IIEF)-5 and International Prostate Symptom Score were recorded for each patient. Pearson’s chi-square test and Spearman correlation coefficients were used to analyze the International Prostate Symptom Scores and lower urinary tract symptoms, and their correlations with erectile dysfunction. Results The incidence rates of erectile dysfunction among men with mild, moderate, and severe lower urinary tract symptoms were 85.7, 93.7, and 97.9%, respectively. Interestingly, the total IIEF-5 score significantly correlated with the total International Prostate Symptom Score (r=−0.335; P<0.01), obstructive symptoms (r=−0.276; P<0.01), and irritative symptoms (r=−0.326; P<0.01). The correlation between the severity of lower urinary tract symptoms and that of erectile dysfunction was consistently maintained (r=0.304; P<0.01). Age significantly correlated with International Prostate Symptom Score (r=0.388; P<0.01), lower urinary tract symptoms severity (r=0.457; P<0.01), total IIEF-5 score (r=−0.533; P<0.01), and erectile dysfunction severity (r=0.529; P<0.01). Conclusions The incidence of lower urinary tract symptoms and erectile dysfunction in aging men increase with age, and the severity of erectile dysfunction is positively correlated with the severity of lower urinary tract symptoms.
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Affiliation(s)
- Jian Song
- Department of Urology, Beijing Friendship Hospital, Capital Medical Universty, Beijing, China (mainland)
| | - Qiang Shao
- Department of Urology, Beijing Friendship Hospital, Capital Medical Universty, Beijing, China (mainland)
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical Universty, Beijing, China (mainland)
| | - Shan Chen
- Department of Urology, Beijing Friendship Hospital, Capital Medical Universty, Beijing, China (mainland)
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Perera M, Roberts MJ, Doi SAR, Bolton D. Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Urol 2014; 67:704-13. [PMID: 25466940 DOI: 10.1016/j.eururo.2014.10.031] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/21/2014] [Indexed: 01/30/2023]
Abstract
CONTEXT Treatment for lower urinary tract symptoms resulting from benign prostatic hyperplasia (BPH) is varied, and significant side effects, particularly concerning sexual function, affect uptake. The prostatic urethral lift (PUL) procedure is a recent addition to the armamentarium for BPH treatment, with independent reports suggesting improvement of symptoms, sexual function, and urinary flow. OBJECTIVE We undertook a systematic review and meta-analysis of reported symptomatic, functional, and sexual outcomes following the PUL procedure. EVIDENCE ACQUISITION We performed a critical review of Medline, Embase, ScienceDirect, Cochrane Library, and Web of Science databases in May 2014 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Quality assessment was performed using a modification of the Methodological Index for Non-Randomized Studies tool. All retrospective, prospective, and controlled trials were included for analysis. Symptom scores, sexual health scores, and functional outcomes were pooled and meta-analysed using quality and random-effects models. EVIDENCE SYNTHESIS Ten articles comprising six independent patient cohorts were included for analysis. Pooled estimates from between 452 and 680 patients suggested overall improvement following PUL, including symptoms (large gain; standardised mean gain range of 1.3-1.6, International Prostate Symptom Score difference of -7.2 to -8.7 points), maximum flow rate (3.8-4.0 ml/s), and quality of life (2.2-2.4 points). Sexual function was preserved with a small improvement estimated at 12 mo (standardised mean gain range of 0.3-0.4). Pooled estimates were mostly heterogeneous across study groups. CONCLUSIONS PUL is a well-tolerated, minimally invasive therapy for BPH that provides favourable symptom, sexual health, and functional outcomes during follow-up to 12 mo. Longer follow-up and larger randomised studies are required to further confirm these preliminary results. PATIENT SUMMARY We reviewed the early results of an innovative procedure directed towards the management of prostate enlargement. The results revealed a well-tolerated procedure that produces improvement in urinary symptoms and function while preserving sexual function.
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Affiliation(s)
- Marlon Perera
- Mackay Base Hospital, Mackay, Queensland, Australia; Urological Society of Australia and New Zealand, Edgecliff, New South Wales, Australia
| | - Matthew J Roberts
- Mackay Base Hospital, Mackay, Queensland, Australia; Urological Society of Australia and New Zealand, Edgecliff, New South Wales, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Suhail A R Doi
- School of Population Health, The University of Queensland, Brisbane, Queensland, Australia; Department of Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Damien Bolton
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, Victoria, Australia.
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