The beneficial effect of alfuzosin 10 mg once daily in 'real-life' practice on lower urinary tract symptoms (LUTS), quality of life and sexual dysfunction in men with LUTS and painful ejaculation

Effects of inflammatory prostatitis on the development and progression of benign prostatic hyperplasia: A literature review

Benign prostatic hyperplasia is a major disease that affects the quality of life of middle-aged and older men. Although >70% of men aged >70 years have pathological benign prostatic hyperplasia, its pathogenesis and progression remain unclear. In this article, we reviewed the scientific literature on this condition and examined the development of lower urinary tract symptoms. Clinically, the weight of the prostate is not always proportional to the severity of the symptoms, and many factors can influence the progression of benign prostatic hyperplasia. Other than androgens, chronic inflammation can play an essential role in its development and the induction of symptoms, especially in symptomatic hyperplasia, because inflammatory cell infiltration is frequently observed in the prostate. Inflammation-induced changes in the prostate environment lead to changes in gene expression and subsequent chronicity of inflammation. It has been suggested that chronic asymptomatic prostatitis might be associated with changes in prostate structure and subsequent symptoms. In animal studies, the administration of anti-inflammatory drugs in rats with chronic prostatitis prevented the infiltration of inflammatory cells and increased the gland-to-stroma ratio. It is hoped that future research on the molecular biology of asymptomatic prostatitis might help to develop new therapeutic strategies for lower urinary tract symptoms associated with symptomatic prostatitis. Our conclusions provide a comprehensive insight into the prevalence and development of benign prostate hyperplasia and the treatment methods that can be used to treat it.

A randomized controlled trial of levofloxacin, terazosin, and combination therapy in patients with category III chronic prostatitis/chronic pelvic pain syndrome

OBJECTIVE

To explore the efficacy of levofloxacin, terazosin, and their combination in patients with category III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

METHODS

A total of 115 patients with category III CP/CPPS receiving 6-week therapy were randomly divided into the levofloxacin group (n = 38), terazosin group (n = 38), and combination group (n = 39). The primary endpoint was the response rate (i.e., the change from baseline) in the total and domain scores of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Secondary endpoints were expressed as prostatic secretion-white blood cell (EPS-WBC) and International Index of Erectile Function-5 (IIEF-5).

RESULTS

After 6 weeks, the response rate of NIH-CPSI scores was 45.1, 22.4, and 50.0 % in the levofloxacin group, terazosin group, and combination group, respectively. Furthermore, no significant difference in NIH-CPSI scores was observed between IIIA and IIIB patients in each arm. Levofloxacin alone or levofloxacin plus terazosin could significantly reduce EPS-WBC counts compared with terazosin alone. Finally, no significant difference was found between the three arms in terms of IIEF-5 scores.

CONCLUSION

A 6-week short-term treatment of levofloxacin or levofloxacin plus terazosin was more effective than terazosin alone in patients with category III CP/CPPS. Furthermore, levofloxacin treatment was not different from levofloxacin plus terazosin treatment in terms of treatment effect.

Multicenter, prospective, comparative cohort study evaluating the efficacy and safety of alfuzosin 10 mg with regard to blood pressure in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia with or without antihypertensive medications

Background

The objective of this study was to assess the efficacy and safety of alfuzosin 10 mg monotherapy or combined antihypertensive medication on blood pressure (BP) in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS) with or without antihypertensive medication.

Methods

This was a 3-month, multicenter, randomized, open-label study in 335 patients aged ≥45 years with a clinical diagnosis of BPH/LUTS by medical history and clinical examination, a total International Prostatic Symptom Score (IPSS) ≥8 points, a maximum flow rate >5 mL/sec and ≤15 mL/sec, and a voided volume ≥120 mL. Eligible subjects were randomized to receive alfuzosin 10 mg as monotherapy (group 1) or alfuzosin 10 mg + antihypertensive combination therapy (group 2). Based on baseline BP and hypertensive history with or without antihypertensive medications at first medical examination, group 1 was divided into two subgroups of normotensive and untreated hypertensive patients, and group 2 into two subgroups of controlled hypertensive and uncontrolled hypertensive patients. The primary study outcomes were change in IPSS, BP, and heart rate from baseline. Secondary outcomes were change in IPSS-quality of life score, maximum flow rate, average flow rate, voided volume, and post-voided volume.

Results

The overall BP change was not significantly different between groups 1 and 2 (systolic BP, P=0.825; diastolic BP, P>0.999). In patients with uncontrolled or untreated hypertension, alfuzosin 10 mg alone or combined with antihypertensive therapy significantly decreased systolic and diastolic BP. The mean difference in total IPSS and IPSS-quality of life scores from baseline between groups 1 and 2 was 0.45 (95% CI: −1.26, 2.16) and 0.12 (95% CI: −0.21, 0.45), respectively (both P>0.05). Maximum flow rate, average flow rate, voided volume, and post-voided volume at endpoint were numerically, but not significantly, changed from baseline (all P>0.05).

Conclusion

This study shows that alfuzosin 10 mg is effective and well tolerated in patients with BPH/LUTS with or without antihypertensive medications. However, in patients with uncontrolled or untreated hypertension, alfuzosin 10 mg alone or in combination with antihypertensive medication appears to decrease systolic and diastolic BP, and these patients should be warned about a decrease in BP on initiation of therapy.

[Painful ejaculation]

OBJECTIVE

To clarify definition, epidemiology, diagnosis, evaluation, etiologies and treatment of painful ejaculation (PE).

MATERIAL AND METHODS

Review of the literature performed by searching the Medline database using keywords ejaculation, orgasm, pain, pelvic pain, sexual behavior.

RESULTS

PE is a pelviperineal pain caused by ejaculation or orgasm. Its prevalence rate is between 1 and 4% amongst the general population. Mainly located in the penis, pain usually lasts less than 5 minutes. Assessment is clinical and there is no level of evidence about the strategy of complementary investigations. Benign prostatic hyperplasia, chronic pelvic pain syndrome, radical prostatectomy, prostate brachytherapy and some antidepressant medications are the best estimated etiologies found in the literature. A link between urogenital infections and PE is likely but not clearly established. Alpha-blockers had good therapeutic results in few low level of evidence studies.

CONCLUSION

The assessment of PE is not clearly defined. Some etiologies are known but PE may be a functionnal pain. Only high level of evidence studies would validate the use of the alpha-blockers as an efficient therapeutic option.

A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men

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.

Classification and treatment of men with chronic prostatitis/chronic pelvic pain syndrome using the UPOINT system

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition; however, many of the traditional therapies used in clinical practice fail to show efficacy when subjected to large randomized placebo-controlled trials. This may be because CP/CPPS is a heterogeneous syndrome rather than a specific disease which would explain the failure of "one size fits all" therapy. In order to direct appropriate therapy, we have developed a six-point clinical phenotyping system to evaluate patients with chronic urologic pelvic pain. The clinical domains are urinary symptoms, psychosocial dysfunction, organ-specific findings, infection, neurologic/systemic, and tenderness of muscles, which produces the acronym UPOINT. Each domain is diagnosed clinically and is associated with specific therapies. This approach is simple and has proven effective in our hands for patients even after many years of failed therapies.

Sexual dysfunction in chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), or NIH category III prostatitis, is a common clinical syndrome characterized by genital/pelvic pain and lower urinary tract symptoms in the absence of urinary tract infection. There is also growing recognition of the association of sexual dysfunction with CP/CPPS including erectile dysfunction, ejaculatory pain, and premature ejaculation. In this review, we discuss the association between CP/CPPS and sexual dysfunction, potential mechanisms for sexual dysfunction, and treatment strategies for erectile dysfunction in CP/CPPS.

Effect of patient-optimized doses of tamsulosin on erectile function in men with erectile dysfunction and lower urinary tract symptoms

PURPOSE

To investigate the relationship of improvement in erectile function (EF) with improvement in lower urinary tract symptoms (LUTS) and to assess the contribution of tamsulosin dose to the improvement of EF apart from the indirect influence of LUTS improvement in men with LUTS and erectile dysfunction (ED).

MATERIALS AND METHODS

Fifty patients received tamsulosin 0.2 mg/d for the first 4 weeks and were subsequently divided into two groups by patient-reported outcomes. Nonescalators were maintained starting dose and escalators increased to 0.4 mg for the remaining 8 weeks. International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5), and underwent uroflowmetry were evaluated at baseline, and weeks 4 and 12.

RESULTS

LUTS parameters were significantly improved in both groups but insignificant between the 2 groups. The degree of the improvement in the total IPSS and in the voiding, storage, and quality of life (QoL) subscores were significantly correlated with the degree of the improvement in EF; this was especially prominent in patients successfully treated LUTS. The escalators experienced a significantly greater increase in IIEF-5 scores than did the nonescalators (3.3 vs. 1.5).

CONCLUSIONS

Dose escalation provided similar LUTS improvement in patients with refractory to starting dose. The improvements of LUTS were correlated with the improvement of EF. The increase in the IIEF-5 score was significantly higher in escalators. These findings imply that tamsulosin may contribute to the improvement in EF through the improvement of LUTS and QoL and direct relaxation of the corpus cavernosum in a dose-dependent fashion.

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.

Correlation between lower urinary tract symptoms and premature ejaculation in Korean men older than 40 years old [corrected]

PURPOSE

To evaluate the correlation between lower urinary tract symptoms (LUTS) and premature ejaculation (PE) in Korean men older than 40 years.

MATERIALS AND METHODS

In total, 258 men older than 40 years completed the International Prostate Symptom Score (IPSS; total score, storage symptoms [ST], and voiding symptoms [VD]), a 5-item version of the International Index of Erectile Function (IIEF-5), and the Premature Ejaculation Diagnostic Tool (PEDT). The study examined the relationship between LUTS and PE. In the PEDT, PE is defined as a score ≥11.

RESULTS

The prevalence of PE was 29.1% with the PEDT versus a self-reported value of 49.5%. The prevalence of PE was 30.9% in 40 to 59-year-old men (21.3%) and 28.1% in 60 to 79 year-old men (78.7%). In men 40 to 59 and 60 to 79 years old, the mean PEDT, IPSS, and IIEF-5 scores were 8.65 and 7.88, 13.5 and 12.38, and 15.83 and 13.69, respectively. No significant correlations were observed between the total and subscale scores of the IPSS (p=0.204) and the PEDT (p=0.309) with increasing age, whereas a significant negative correlation was detected between the IIEF-5 and age (p=0.002). The PEDT score was significantly correlated with the IPSS-ST (r=0.326, p<0.001), IPSS-VD (r=0.183, p=0.005), IPSS-total (r=0.310, p<0.001), and IIEF-5 total (r=-0.248, p<0.001).

CONCLUSIONS

LUTS, especially storage symptoms, were related to PE. In elderly men, control of both erectile dysfunction and LUTS may play an important role in managing PE.

Changes in sexual function in benign prostatic hyperplasia patients taking dutasteride: 1-year follow-up results

Purpose

Sexual adverse events (AEs), a major cause for discontinuing 5α-reductase inhibitor (5ARI) therapy for benign prostatic hyperplasia (BPH), are known to occur most frequently early in therapy and appear to decline over time. The aim of this study was to investigate the changes in sexual function occurring with dutasteride treatment during a 1-year follow-up period in Korean men.

Materials and Methods

Using the International Index of Erectile Function, we prospectively evaluated, after 1, 3, 6, 9, and 12 months of treatment, the changes in sexual function of 55 outpatients (mean age 62.3±7.2 years) with BPH (mean volume 48.9±16.0 g) who had relatively good erectile function (EF) and were treated with dutasteride for at least 1 year.

Results

EF scores showed the most significant decrease at 1 month (p<0.01). Function gradually recovered thereafter but was still significantly decreased after 12 months of treatment (p<0.05). The scores for orgasmic function and sexual desire also showed the most significant reduction at 1 month but were restored to the baseline level at 6 months. No significant correlation was observed between changes in sexual function and prostate-specific antigen level, prostate volume, or International Prostate Symptom Scores.

Conclusions

After 1 month of treatment, dutasteride therapy resulted in a significant reduction in all investigated sexual functions. Overall, recovery in sexual function was noted at 3 months, and orgasmic function and sexual desire were restored to baseline levels at 6 months. However, EF was still significantly reduced at 12 months.

Impact of lower urinary tract symptoms/benign prostatic hyperplasia treatment with tamsulosin and solifenacin combination therapy on erectile function

PURPOSE

To examine the effects on erectile function of concomitant treatment with an alpha-blocker (tamsulosin) and an antimuscarinic agent (solifenacin) in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

Fifty-seven male patients with LUTS/BPH were assessed for the degree of LUTS and erectile function. In group 1 (tamsulosin) and group 2 (tamsulosin and solifenacin), changes in the International Prostate Symptom Score [IPSS: total scores, storage symptoms (ST), voiding symptoms (VD), and quality of life (QoL)], prostate-specific antigen, trans-rectal ultrasonography, urine flowmetry, residual urine, and a 5-item version of the International Index of Erectile Function (IIEF-5) were assessed after a 3-month treatment period. In both groups, it was determined whether treatment was associated with changes in LUTS and erectile function and whether improvement in the IPSS was correlated with the IIEF-5. Comparative analysis was also done to examine the linear relationship between improved IPSS scores and IIEF-5 scores.

RESULTS

A comparison of the degree of improvement in all the parameters indicated that both groups showed significant improvement in total IPSS, IPSS-ST, IPSS-VD, and IPSS-QoL (p<0.05). A comparison of the degree of improved sexual function associated with improved LUTS in each patient showed significant improvement in the IIEF-5 score associated with the degree of improvement in the IPSS-ST domain in group 1, but no significant associations were found in group 2. In cases in which tamsulosin was administered, the IIEF-5 score significantly improved as the IPSS-ST domain score improved. In the group in which tamsulosin and solifenacin were concomitantly administered, improvement of the IPSS-ST domain score had no significant effect on the IIEF-5 score.

CONCLUSIONS

In patients with LUTS/BPH, tamsulosin and solifenacin combination therapy was effective for LUTS, but erectile function was not significantly improved. Therefore, although effective for improving LUTS, combination therapy with an alpha-blocker and an antimuscarinic agent was not effective for improving erectile function.

Prevalence of premature ejaculation and its correlation with chronic prostatitis in Chinese men

OBJECTIVES

Chronic pelvic pain syndrome is a common and serious health problem affecting the quality of life of men. We evaluated the prevalence of premature ejaculation (PE) in Chinese men with chronic pelvic pain syndrome and studied its correlation to chronic prostatitis.

METHODS

A total of 15,000 men (aged 15-60 years) were randomly recruited to take part in a survey to provide questionnaire-elicited information for sociodemographics, sexual function, National Institutes of Health-Chronic Prostatitis Symptom Index, and International Index of Erectile Function 5-item questionnaire. The eligible subjects of the present investigation were married with sexual activity.

RESULTS

Responses were collected from 12 743 men (84.95%). Of these men, 1071 (8.4%) reported having prostatitis-like symptoms. The incidence of chronic prostatitis was 4.5% (n = 571) for the entire group. Of the 7372 eligible men, the incidence of prostatitis-like symptoms, chronic prostatitis, and PE was 10.5% (n = 771), 5.0% (n = 370), and 15.3% (n = 1127), respectively. The group with PE had worse National Institutes of Health-Chronic Prostatitis Symptom Index scores (P < .05) and lower International Index of Erectile Function 5-item questionnaire scores (P < .05) than the patients without PE. Also, the percentage of prostatitis-like symptoms in the PE group was greater than that in the non-PE group (P < .05). The prevalence of PE was 64.1% and 36.9% in the prostatitis-like symptom and chronic prostatitis group, respectively, of the 7372 eligible men.

CONCLUSIONS

The results of our study showed a high prevalence of PE in patients with chronic prostatitis. An examination of the prostate, physically and microbiologically, should be considered during the assessment of patients with PE.

Botulinum neurotoxin A for benign prostatic hyperplasia

PURPOSE OF REVIEW

The injection of botulinum neurotoxin A (BoNT-A) into the prostate represents an alternative, minimal invasive treatment for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH), which gained the interest of urologists during the last years, although it is not yet licensed. The purpose of this review is to summarize the mechanisms through which BoNT-A could inhibit the progression of BPH and eliminate the lower urinary tract symptoms according to the findings of animal studies. Furthermore, we review clinical studies to report the efficacy and safety of intraprostatic BoNT-A injection according to various injection protocols.

RECENT FINDINGS

The experimental studies report induced relaxation of the prostate, atrophy, and reduction in its size through inhibition of the trophic effect of the autonomic system on the prostate gland. Also, a possible mechanism of reduction in lower urinary tract symptoms might take place through inhibition of sensory afferents from the prostate to the spinal cord. Clinical studies report symptomatic relief and improvement in the measured parameters during the follow-up period, whereas local or systematic side-effects are rare.

SUMMARY

We should recognize that, at present, this therapy is still experimental. Although the results of the clinical studies are encouraging, the level of evidence is low. Clearly, we need large-scale, clinical, placebo-controlled, randomized studies, including long-term surveillance to document the evidence of this therapy and, eventually, to register BoNT-A for this indication.

Painful Ejaculation: A Review

Background

Pain at ejaculation/orgasm perceived in perineum, urethra and/or urethral meatus, has a profound impact on the quality of life of the affected man. Although underestimated, this condition is reported to have a 1–9.7% prevalence over the general population.

Methods

Structured review of the relevant available literature.

Results

Among the main causes of pain experienced at ejaculation/orgasm are: prostatevesicular causes (LUTS/BPH, prostatitis, ejaculatory duct obstruction, vesicular stone), postsurgical causes (radical prostatectomy, inguinal hernioplasty), pharmacologic causes (antidepressants), psychogenic causes (psychosexual conflicts, sexual abuse), rare causes. For these pathologies, diagnostic and therapeutic strategies have been proposed.

Conclusions

Ejaculatory pain is associated with a high level of personal distress, and represents a possible request for help within the andrologic/urologic area. Each field specialist should be competent in correctly interpreting every single case, in order to manage it appropriately.

[Prevalence of ejaculatory dysfunction secondary to alpha-blocker therapy in patients with benign prostatic hyperplasia]

INTRODUCTION

Benign prostatic hyperplasia (BPH) is characterized by lower urinary tract symptoms (LUTS) that may cause ejaculatory disorders, although they could be also a consequence of alpha-blocker treatment.

OBJECTIVES

To determine the prevalence of ejaculatory dysfunction in patients with HBP undergoing alpha-blocker therapy. Secondary objectives were to evaluate the effect of different drugs on normal ejaculation and the relationship of dysfunction degree to prognostic factors and BPH severity.

MATERIALS AND METHODS

Epidemiologic, transversal, uncontrolled and open-label study in 1.177 patients older than 40, who had been diagnosed of BPH/LUTS with more than 6 months of evolution and treated with the same alpha-blocker for at least the last 3 months. Severity of ejaculatory dysfunction was determined by the domain on ejaculation of the Male Sexual Health Questionnaire (MSHQ). Results were stratified by age and BPH severity, determined by the International Prostate Symptoms Score (IPSS).

RESULTS

The prevalence of ejaculatory dysfunction has been estimated to be 82.6% in patients with BPH/LUTS treated with alpha-blockers. Although usually mild, the dysfunction is considered as bothersome by a high percentage of those who suffer it. Advanced age is the most influential factor in the severity of both ejaculatory abnormalities and prostate symptoms. Moreover, a solid correlation between these two parameters has been established. Finally, among the analyzed alpha-blockers, alfuzosin has been associated with the best sexual function.

CONCLUSIONS

More than 80% of patients with BPH suffer ejaculatory abnormalities, which are closely related to the severity of prostate symptoms and increased age. When initiating alpha-blocker treatment, we should consider that alfuzosin is the one with less negative impact on ejaculatory function.

Common approach to managing lower urinary tract symptoms and erectile dysfunction

The present paper serves as a review of the associations between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), with a focus on common and combined pathways for treatment. LUTS and ED are common conditions seen in general urologic practice. Research has started to establish epidemiologic and pathophysiologic links between the two conditions and a strong association confirmed across multiple studies. Men seeking care for one condition should always be interviewed for complaints of the other condition. Proposed common pathways include alpha-1 adrenergic receptor imbalance, Rho-kinase overactivity, endothelial cell dysfunction and atherosclerosis-induced ischemia. Medical therapy has replaced surgery as the first-line treatment for LUTS in most patients, with the incorporation of alpha-adrenergic receptor antagonists (alpha-ARAs) and 5-alpha-reductase inhibitors (5-ARIs) into everyday practice. Treatment with alpha-ARAs contributes to some improvement in ED, whereas use of 5-ARIs results in worsened sexual function in some patients. Phosphodiesterase-5 (PDE-5) inhibitors have revolutionized the treatment of ED with a simple oral regimen, and new insights demonstrate a benefit of combined use of PDE-5 inhibitors and alpha-ARAs. The mechanisms of action of these medications support these observed benefits, and they are being studied in the basic science and clinical settings. In addition, novel mechanisms for therapy have been proposed based on clinical and research observations. The minimally invasive and surgical treatments for LUTS are known to have adverse effects on ejaculatory function, while their effects on erectile function are still debated. Much remains to be investigated, but it is clear that the associations between LUTS and ED lay the foundation for future therapies and possible preventative strategies.

The Influence of Alpha1-Adrenoreceptors on Neuropeptide Release from Primary Sensory Neurons of the Lower Urinary Tract

OBJECTIVES

Adrenergic alpha(1)-receptors agonists and antagonists have been reported to increase and reduce, respectively, neurogenic inflammatory responses mediated by capsaicin-sensitive sensory neurons. However, the precise role and localization of the alpha(1)-adrenoceptors involved in these effects are not known.

METHODS

We have studied in the rat whether functional alpha(1)-adrenoreceptors are expressed in primary sensory neurons, and whether they regulate neurogenic inflammation and nociceptive responses in the urinary bladder.

RESULTS

The alpha(1)-adrenoreceptor agonist phenylephrine (1 micromol/l) (1) mobilized intracellular Ca(2+) in cultured lumbar and sacral dorsal root ganglia neurons, (2) caused the release of substance P (SP) from terminals of capsaicin-sensitive sensory neurons from the lumbar enlargement of the dorsal spinal cord and urinary bladder, and (3) increased plasma protein extravasation in the urinary bladder. All these effects were abolished by the alpha(1)-adrenoceptor antagonist alfuzosin (10 micromol/l). Furthermore, alfuzosin (30 microg/kg, i.v.) partially, but significantly, inhibited cyclophosphamide-induced plasma protein extravasation in the rat urinary bladder. Phenylephrine-induced Ca(2+) mobilization in cultured dorsal root ganglia neurons was exaggerated by pretreating the rats in vivo with cyclophosphamide. Finally, cyclophosphamide increased c-fos expression in the rat lumbar spinal cord. Also these in vitro and in vivo effects were inhibited by pretreatment with alfuzosin.

CONCLUSIONS

Alpha(1)-adrenoceptors are functionally expressed by capsaicin-sensitive, nociceptive, primary sensory neurons of the rat urinary tract, and their activation may contribute to signal irritative and nociceptive responses arising from the urinary tract. It is possible that, at least, part of the beneficial effects of alpha(1)-adrenoceptor antagonists in the amelioration of storage symptoms in the lower urinary tract derives from their inhibitory effect on neurogenic inflammatory responses.

Sexual function after transurethral resection of the prostate (TURP): results of an independent prospective multicentre assessment of outcome

OBJECTIVES

The influence of surgical treatment of bladder outlet obstruction on sexual function is uncertain and available evidence is conflicting. Transurethral resection of the prostate (TURP) causes retrograde ejaculation, but its effect on erectile function is controversial. We have prospectively investigated the influence of TURP on erectile and ejaculatory function.

METHODS

Between January 2000 and January 2005, 11 hospitals in Switzerland informed the Verein Outcome (VO), an independent institution specialising in outcome measurements in the Swiss health care system, about patients scheduled for TURP. VO obtained the Danish Prostate Symptom Score (DAN-PSS) including the sexual function domain (DAN-PSSsex) before and 4 mo after surgery and compared the respective scores.

RESULTS

Data from 1014 patients were evaluated. Mean patient age was 69 yr. DAN-PSSsex questionnaires were returned by 988 patients before and 642 patients after TURP; 722 (73.1%) and 474 (73.8%) of the patients, respectively, stated that they were still sexually active. The mean erectile function score improved insignificantly from 1.66 to 1.47 (p=0.11), the mean ejaculatory function score worsened from 1.27 to 2.34 (p<0.00) and the mean discomfort on ejaculation score improved from 0.37 to 0.29 (p=0.10) before and after TURP, respectively.

CONCLUSION

The results confirm that TURP has no negative influence on the quality of erections measured by self-assessment questionnaires. The loss of ejaculatory function is significant and is associated with considerable bother. However, three of four patients undergoing TURP are still sexually active and the surgery has no influence on this ratio.

Sexual dysfunction and prostatitis

Despite a large number of reports exploring the links between diseases of the prostate and effects on sexuality, the relationship between prostatitis and sexual dysfunction has not been as thoroughly investigated. A number of reports have focused on the adverse effects of prostatitis on quality of life, with resultant indirect effects on sexuality. More detailed studies are available on the links between ejaculation and the chronic prostatitis/chronic pelvic pain syndrome subgroup of prostatitis. Improvement of sexual dysfunction following treatment of prostatitis has been reported in a few studies, most notably in association with alpha-blocker therapy. This review addresses some of the more relevant reported links between prostatitis and sexual function.