Correlation of Subjective Symptoms in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction

Diabetes mellitus-induced lower urinary tract symptoms and hepatic steatosis in an older male

Summary

Diabetes mellitus type 2 (DM-2) is one of the important causes of low-grade chronic inflammation (meta inflammation) seen in almost all tissues in the body. Other possible mechanisms involved in the development of lower urinary tract symptoms (LUTS) with DM-2 are the hypertonicity of the peripheral sympathetic nerves and hyperinsulinemia effects on the autonomous nervous system activity. These further suggests that abnormalities in glucose homeostasis influence the hyperproliferation of the prostate cells resulting in benign prostatic hyperplasia (BPH). Similarly, hepatic steatosis, a form of non-alcoholic fatty liver disease (NAFLD) prevalence among patients with DM-2, is as high as 75%. NAFLD has no symptoms in most diabetic patients. In this study, we present a case of a 64-year-old Black male who had worsening urinary urgency and hesitancy for 4 months, with increasing abdominal girth. Patient was found to have symptoms, diagnostic studies, and physical exam findings indicative of BPH and fatty liver disease. He was treated with hepato-protective medications, tighter control of his blood glucose levels, and blood pressure meds for 13 months. Upon follow-up, most of his symptoms were resolved. Timeline of BPH resolution and decrease in liver size following treatment suggest that DM-2 has a strong correlation with the development of BPH and fatty liver disease in most patients living with diabetes.

Learning points

Men with type 2 diabetes mellitus (DM-2) tend to have significantly lower serum PSA level, lower testosterone levels, and larger prostate volume compared to non-diabetic male patients. Patients with DM-2 have higher prevalence of hepatic steatosis, liver cirrhosis, and end-stage liver failure. The role of metformin in reducing hepatic steatosis as stated by several studies is yet to be validated as our patient has been on metformin for 22 years for the management of DM-2 with fatty liver disease.

One-year Functional Outcomes after Holmium Laser Enucleation of the Prostate (HoLEP): Introduction of a Composite Score (Hexafecta)

OBJECTIVE

To compare the efficiency (micturition symptoms, continence, erection) and safety of Holmium Laser Enucleation of the Prostate (HoLEP) with a single composite score (the Hexafecta score) one year postprocedure.

PATIENTS AND METHODS

We conducted a single-center retrospective study including all patients who had undergone HoLEP for the treatment of benign prostate hyperplasia (BPH) between May 2013 and August 2017. Data were obtained preoperatively and at the 6- and 12-month visits. We also reported all 90-day complications. The Hexafecta score included 6 criteria: peak urine flow of at least 15ml/s, 30% reduction in International Prostate Symptoms Score (IPSS) score, quality of life via the IPSS less than 2, no incontinence (International Consultation Incontinence Questionnaire), no significant change in erectile function (International Index of Erectile Function), and no grade III or more complications according to the Clavien-Dindo classification.

RESULTS

Two hundred thirty-five patients were included, of whom 197 (83.8%) completed the 12-month visit. Complete data were available to assess the Hexafecta score for 178 of them (75.7%). Most of the missing data were for uroflowmetry and the erectile function assessment. Hundred three patients (58%) met all 6 criteria, while 45 (25%) met 5 of them. None were retreated for BPH in the follow-up period. The de novo incontinence rate was 4.1%.

CONCLUSION

The Hexafecta score is a simple, transversal method for comprehensively evaluating functional outcomes after HoLEP surgery. Such an evaluation could be used to compare other types of procedures for BPH treatment.

LEVEL OF EVIDENCE

3.

Lower Urinary Tract Symptoms and Sexual Dysfunction in Male: A Systematic Review and Meta-Analysis

Background: An association between lower urinary tract symptoms (LUTS) and risk of sexual dysfunction in male remains controversial in recent decades. Materials and Methods: PubMed and Web of Science were searched up to October 28, 2020, for articles reporting the prevalence of sexual dysfunction in men with LUTS. The main outcomes were results from sexual dysfunction assessments. Pooled odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) were calculated. The quality assessment of the included studies was performed by using The Newcastle-Ottawa Scale (NOS) or JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Results: A total of 24 full-manuscript papers met the inclusion criteria. The pooled OR for 21 studies suggested that patients with severer LUTS had a higher risk of sexual dysfunction (OR = 3.31, 95% CI: 2.43 to 4.49, p < 0.001, I ² = 90%). A significant decrease in scores of assessment tools for sexual dysfunction was observed in the patients with higher severity of LUTS compared with those patients with lower severity (WMD = -5.49, 95%CI: -7.25 to -3.27, P < 0.001, I ² = 96%). Similar outcomes were also found in subgroup analyses. In a detailed analysis of specific sexual function domains, the severity of LUTS was associated with erectile dysfunction, intercourse satisfaction, and overall satisfaction, except for sexual desire. Conclusion: The study demonstrates an association between exposure of lower urinary tract symptoms and risk of sexual dysfunction in male. Assessment of sexual function is necessary for patients with lower urinary tract symptoms. Systematic Review Registration: http://www.crd.york.ac.uk/prospero, identifier: CRD42020208747.

Erectile Dysfunction and Lower Urinary Tract Symptoms

PURPOSE OF REVIEW

In the past years, the relationship between lower urinary tract symptoms and erectile dysfunction has been widely explored. The aim of our systematic review is to summarize the published evidence over the past year on lower urinary tract symptoms (LUTS) and erectile dysfunction (ED).

RECENT FINDINGS

Recent data support the relationship between LUTS and ED in Eastern Europe and in Asia. The role of phosphodiesterase inhibitors alone or in combination with alpha blockers to treat LUTS and ED, especially in younger patients, is strongly supported by high level of evidence. LUTS and ED are prevalent conditions in men over 50; epidemiologically, the relationship between both conditions has been confirmed all over the world. PDE5i alone or in combination with alpha blockers can be considered the gold standard for the treatment of young patients with storage symptoms and concomitant ED. In clinical research, a better understanding of the molecular pathways behind this association may also help to identify new possible targets and develop novel therapeutic approaches to manage both disorders; the identification of new biomarkers of both disorders is also compulsory in this area.