Sexual dysfunction in patients with benign prostatic hyperplasia

How can we best characterize the relationship between erectile dysfunction and benign prostatic hyperplasia?

INTRODUCTION

Considerable epidemiological literature exists, showing a relationship between voiding dysfunction and sexual dysfunction. However, few basic science or prospective data are available to determine the nature of the relationship between benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and sexual dysfunction.

METHODS AND DISCUSSION

A critical evaluation of the nature of the relationship between LUTS and erectile dysfunction (ED) must include a look at the nature of the data establishing the relationship, precise definitions of the disease states being evaluated, and adherence to established normative relationships. Criteria for causality will be utilized to best determine the relationship between LUTS and ED. This article will attempt to take a critical and provocative look at where we are presently in establishing a relationship between voiding dysfunction and sexual dysfunction in order to better direct research efforts through evidence-based studies.

CONCLUSION

At present, the epidemiological data do not support a causal relationship based on Hill's criteria for causality between LUTS and ED but suggest a less rigorous association. Additional research is needed to better characterize this relationship.

The association between lower urinary tract symptoms and sexual dysfunction: fact or fiction?

PURPOSE OF REVIEW

Both lower urinary tract symptoms and sexual dysfunction are common conditions in aging men. In the past few years, increasing attention has been paid to the question of whether these conditions are associated in any way. The conventional belief of the majority of urologists so far has been that the coexistence of these two conditions is coincidental. This review was conducted to discuss the recent literature on this issue. In addition we will concisely address the effect of the different treatment modalities on sexual function.

RECENT FINDINGS

Several trials were conducted recently to assess the association between lower urinary tract symptoms and sexual dysfunction. These trials all made use of self-reported questionnaires on urinary symptoms and sexual function sent to representative samples of the community. The occurrence of urinary symptoms appeared to be a risk factor for the development of erectile dysfunction, ejaculation disorder and decreased libido. Importantly, this association was independent of age and various co-morbidities.

SUMMARY

In contrast to long-established opinion, an age-independent association between lower urinary tract symptoms and sexual dysfunction was found in several recent population-based trials. The nature of this association, however, remains unclear. Future study is required to gain a better understanding of the possible underlying mechanisms.

Correlation between voiding and erectile function in patients with symptomatic benign prostatic hyperplasia

BACKGROUND

The relationship between lower urinary tract symptoms and male sexual dysfunction remains controversial. In this study, we aimed to evaluate the relationship between voiding and erectile function (EF) using the American Urological Association Symptom Index (AUA-SI) and International Index of EF (IIEF-15) in patients with benign prostatic hyperplasia (BPH).

METHODS

From March 2001 to January 2002, 50 men (aged 43-92 years) with symptomatic BPH were enrolled in the study. They completed the AUA-SI and IIEF-15 questionnaires. An additional question about subjective erectile dysfunction (ED) was also evaluated. AUA-SI scores were divided into 3 categories (irritative, obstructive, and total), and IIEF-15 scores were divided into 6 categories (EF, orgasmic function [OF], sexual desire [SD], intercourse satisfaction [IS], overall satisfaction [OS], and total).

RESULTS

Irritative, obstructive and total AUA-SI scores were 7.8 +/- 3.7, 8.4 +/- 5.6 and 16.3 +/- 8.2, respectively. Scores in the 6 categories of the IIEF-15 questionnaire were as follows: EF, 12.1 +/- 10.1; OF, 3.7 +/- 3.8; SD, 4.4 +/- 2.0; IS, 4.5 +/- 4.4; OS, 4.4 +/- 2.6; and total, 29.4 +/- 22.2. No obvious correlation was noted between AUA-SI and IIEF-15 scores. Further, no statistical significance was noted, either between AUA-SI and IIEF-15 severity, or between AUA-SI and EF severity. Among 22 patients who self-reported the absence of ED, 17 (77%) had an EF-domain score less than 26. The mean age of patients with, versus those without, ED was significantly greater.

CONCLUSION

Voiding and EF, assessed by the AUA-SI and IIEF-15 questionnaires, respectively, are not correlated in patients with BPH.

Quality of Life in Sexually Active Men with Symptomatic Benign Prostatic Hyperplasia

Quality of life (QOL), sexuality in particular, has become an important consideration in treatment decisions for men with lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). To determine the impact of these conditions on sexual function and QOL in older men, this article provides a review of clinical data on the relationship between sexual dysfunction and symptom severity, effective clinical assessment, treatment options, and the influence of current therapies on sexual function and QOL. The various symptoms of BPH can adversely affect sexual functioning and therefore QOL. Moreover, there may be a direct association between symptom severity and sexual dysfunction that may affect QOL.Patients base their decisions regarding treatment choices for BPH more on anticipated relief of lower urinary tract symptoms and improved QOL (including sexual functioning) than on improvements in physical measures. Although medications and surgery may relieve LUTS, sexual dysfunction is a common adverse result. Newer pharmacological interventions such as specific alpha-adrenergic blocking agents like tamsulosin may help improve sexual function and QOL in men with symptomatic BPH.

Sexual function in patients treated for benign prostatic hyperplasia

CONTEXT

What is the effect of different treatment options for benign prostatic hyperplasia (BPH) on sexual function or dysfunction? With increasing age, sexual dysfunction and BPH become more prevalent. Some treatments for BPH can affect sexual function. Different surgical treatments have different effects on sexual function depending on how much the internal involuntary sphincter is affected. The same is true for medical therapies, each class of drug having a unique affect on sexual function.

STARTING POINT

In the past, many articles suggested a causal relation between BPH and sexual dysfunction. But a recent report by H Leliefeld and colleagues (BJU International 2002; 89: 208-13) confirms the idea that the relation is coincidental. Prospectively, these investigators examined patients at baseline and 9 months after various treatments for BPH with questionnaires on voiding symptoms, related complications, and sexual function. 84% of patients reported no change in sexual function. All treatments showed both improvement and deterioration in 3-14% and 0-16% of patients, respectively. As expected, age was the most important determinant of sexual function. In addition, the effect of severe irritative symptoms or the presence of urological comorbidity, such as bladder stones, increased the rate of sexual dysfunction. In this study, most patients underwent surgical therapy or watchful waiting while fewer had medical therapy. Too few patients had minimally invasive procedures to comment on their effect on sexual function. WHRE NEXT? Thus the relation between treatment of BPH (or watchful waiting) and sexual dysfunction is usually coincidental, unless symptoms become severe or complications (such as bladder stones or urinary retention) develop. More prospective studies are needed to assess the effect of BPH and its treatment on sexual function. Medical therapy is now more common than surgery in developed countries and treatment of BPH is commonly advocated for improvement in quality of life. Therefore any effects on sexual function become even more important. As minimally invasive surgical operations become more common, more data will be required for such interventions. The difficulty will be in keeping up with the rapidly evolving techniques of minimally invasive therapies.