Sexuality and the management of BPH with alfuzosin (SAMBA) trial

The association of medications and supplements with human male reproductive health: a systematic review

Some medications used to treat comorbidities and conditions in reproductive-aged individuals could have a negative impact on fertility. This may occur through hormonal disruption, toxicity to germ cells and spermatozoa, functional impact on the sperm, teratogenicity potential, or ejaculatory abnormalities. Having knowledge of these potential interactions between medications and reproductive potential is important for clinicians to be aware of and guide the patient, along with their treating clinicians, to reproductively favorable alternatives when available. This review aims to summarize the state of the literature regarding medication interactions with human male reproduction using the Anatomical Therapeutic Chemical Classification System of medications.

Alfuzosin and Its Effect on Ejaculatory Dysfunction: A Systematic Review

Studies have demonstrated that alfuzosin not only improves lower urinary tract symptoms (LUTS) but also appears to preserve ejaculatory dysfunction (EjD). The objective of this study was to evaluate the impact of alfuzosin on ejaculatory function using the ‘Male Sexual Health Questionnaire (MSHQ)-EjD Short Form’ – a validated, abridged-version of the 25-item MSHQ specifically assessing EjD. A systematic search of MEDLINE, PubMed, Scopus, Embase, and grey literature was performed in January 2017 to identify relevant cohort studies. Search terms were ‘alfuzosin’, ‘benign prostatic hyperplasia’, ‘ejaculatory dysfunction’ and their synonyms without exclusions. Six cohort studies conducted between 2008 to 2015 were selected for analysis. Three of these were conducted in Korea, one in Thailand, one in China, and one in Tunisia. Overall, 1,371 patients were enrolled in these studies with a median age of 62.3 years. All studies quantified patient LUTS and ejaculatory function using the International Prostate Symptom Score (IPSS) and MSHQ-EjD Short Form, respectively. IPSS had a median decrease of 6.6 while MSHQ-EjD had a median increase of 1.9. This review highlights the very real association between sexual function and LUTS. This systematic review confirms that alfuzosin may improve ejaculatory function in addition to LUTS and should be considered in men who are sexually active or who already complain of deteriorating ejaculation.

[Benign prostatic hyperplasia and its treatment: impact on quality of life and sexual function]

OBJECTIVES

To evaluate the impact of benign prostatic hyperplasia (BPH) on health related quality of life (HRQoL) and sexual function, in patients with moderate-severe lower tract urinary symptoms (LUTS/BPH) under treatment with alpha-blockers; to study differences associated to age, urinary symptom severity and time under treatment.

MATERIAL AND METHODS

1580 patients diagnosed of BPH and LUTS/BPH, and in treatment with alpha-blockers were recruited in urology practices all around Spain. Socio-demographic- and clinic-data together with LUTS/HBP severity assessment (IPSS questionnaire) and responses to EQ-5D and the Sexual Function Index Questionnaire (SFI) were collected. A descriptive statistical analysis was performed, as well as test to contrast the results by age, LUTS/HBP severity and time under treatment; multiple linear regression models were adjusted for the answers to EQ-5D and SFI.

RESULTS

Analysis database contained information of 1514 patients. Mean age (SD) was 63 (5.5) years (26.75% under 60 years), mean treatment time 1.8 (2.09) years (51.19% under one year). Mean questionnaire scores were: IPSS 17.29 (5.66) (65.85% moderate symptoms), EQ-5D 90 (14). The SFI-domains with worse scores were satisfaction and sexual drive. 52.58% of patients presented deteriorated HRQoL (IPSS-item 8). Age, symptom severity and time under treatment showed association with HRQoL and sexual function.

CONCLUSIONS

BPH and its treatment impact negatively on HRQOL and sexual function, with a more pronounced deterioration in patients with severe LUTS/HBP, in older patients and in patients in treatment over a year.

Impact of alfuzosin on sexual function in Taiwanese men with benign prostatic hyperplasia

To assess the effect of alfuzosin (XATRAL) 10 mg once daily on sexual function in men with moderate to severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), patients with suggestive symptomatic BPH, an International Prostate Symptom Score (IPSS) >8 (range of scores, 0-35), and sexual attempts at least once per month were enrolled. All patients received alfuzosin 10 mg once daily for 24 weeks and were asked to complete the IPSS test and Male Sexual Health Questionnaire at weeks 0 (baseline), 1, 4, 12, and 24. Other assessments included the International Index of Erectile Function-five-item version (range of scores: 5-25), as well as onset of action and peak urinary flow rate (Q(max)). From September 2006 to May 2008, 279 patients were enrolled from nine centers in Taiwan. At 24 weeks, alfuzosin effectively improved LUTS and quality of life, as demonstrated by a reduction in the IPSS total score (17.3 vs. 9.9, p < 0.001) and the IPSS bother score (3.8 vs. 2.5, p < 0.001). The majority (85%) of patients perceived an improvement of urinary symptoms within 1 month of administration. In patients with an International Index of Erectile Function-five-item version score of ≤16, alfuzosin significantly improved erectile disorder and satisfaction subscores at each time point (p ≤ 0.02). Prolonged-release alfuzosin effectively improved LUTS, quality of life, erectile function, and sexual satisfaction in men with BPH and mild to severe erectile dysfunction. Alfuzosin is an effective treatment option for the management of patients with BPH/LUTS and concomitant sexual dysfunction.

Benign prostatic hyperplasia: current clinical practice

Benign prostatic hyperplasia (BPH) is the most common benign adenoma in men, affecting nearly all of them. BPH represents a clinically significant cause of bladder outflow obstruction in up to 40% of men. The growing frequency of diagnosis is due to increasing life expectancy and a trend toward seeking medical advice at earlier stages of the disease. The last decade has witnessed a significant shift in emphasis in the management of BPH, with medical therapies and, to a lesser extent, minimally invasive therapies becoming the predominant active therapy choices. The development of effective therapies such as alpha-adrenergic blockers and 5-alpha-reductase inhibitors and the possibility of their combined use represent the most significant advance in the treatment of BPH.

Measurement of benign prostatic hyperplasia treatment effects on male sexual function

Benign prostatic hyperplasia (BPH) is the leading cause of lower urinary tract symptoms among the aging male population. Epidemiological, pathophysiological and clinical studies indicate that many of these men also suffer from declining sexual function, especially those undergoing treatment for their BPH-related urinary symptoms. Although urinary symptoms and quality of life may improve with BPH therapy, the resulting effects on sexual function vary by medical, surgical and minimally invasive approaches and have not been consistently reported. As comprehensive, validated instruments to measure male sexual function are now available for routine use in the clinical setting, urologists and primary care providers caring for patients with BPH have the opportunity to monitor both urinary and sexual function before, during and after BPH therapy. Herein, we describe the relationship between BPH and its treatments on male sexual function, the role of new measures for sexual functioning and opportunities for future work to improve the care of men suffering from both maladies.