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.     

Medical management of benign prostatic hypertrophy

Benign prostatic hyperplasia (BPH) is a common condition of the aging male. The bladder outlet obstruction caused by this condition occurs despite variations in prostate size. Symptoms of BPH include the irritative and obstructive voiding symptoms termed lower urinary tract symptoms (LUTS). While transurethral surgery has long been the gold standard for treatment of LUTS, medical treatment has emerged as the first line of treatment for those men who fail expectant or watchful waiting treatment. Medical options include: alpha blockers, 5alpha-reductase inhibitors and newly identified PDE 5 inhibitors, drugs for erectile dysfunction that have a relieving effect on the symptoms of LUTS. Newer prostate selective alpha blockers have replaced older nonselective agents as first choice in treatment of most men, especially those with smaller prostates and in whom preservation of sexual function is important. While tamsulosin has the effect of an ejaculation, alfuzosin preserves ejaculatory function. 5alpha-reductase inhibitors may decrease ejaculate volume, libido and sexual function. While this effect is frequently a self limited, it can be a compliance issue for many men. PDE 5 inhibitors, while effective in relieving LUTS symptoms, have not shown effectiveness in reducing post void residual volumes or increasing urinary flow rates.     

The Link Between Benign Prostatic Hyperplasia and Sexual Dysfunction

Benign prostate hyperplasia (BPH) occurs in up to 50 % of men by age 50, and the incidence increases with age. The rate of erectile dysfunction (ED) in patients with BPH ranges from 30 to 70 %, but can be as high as 90.5 % in males aged over 50 years. BPH/lower urinary tract symptoms (LUTS) and sexual dysfunction (SD) can have a substantial negative impact on a man’s quality of life (QoL). Symptom severity and impact on QoL in each condition increase when LUTS and ED coexist. Age and erection change in patients with LUTS could also correlate with ejaculation dysfunction. However, urologists and primary care physicians appear to under-recognize SD in men with BPH/LUTS. We review the mechanisms of action, association, and effect of treatment between BPH and ED.     

Minimally Invasive Treatment for Male Lower Urinary Tract Symptoms: the Prostatic Urethral Lift

Male lower urinary tract symptoms (LUTS) are one of the most common non-malignant conditions afflicting quality of life in aging men. Treatment modalities for bothersome LUTS consist of pharmacotherapeutic and surgical options. There is particular interest in the development of minimally invasive procedures showing good efficacy with a favorable safety profile. An innovative technique offering rapid and durable relief without compromising sexual function is in great demand. The prostatic urethral lift represents a promising minimally invasive approach for the relief of bladder outlet obstruction (BOO) with few adverse events. The principle includes the application of retracting implants under cystoscopic guidance to unobstruct encroaching lateral lobes of the prostate. Clinical trials have confirmed improvement in LUTS with preservation of sexual function. The prostatic urethral lift appears to be a promising addition to the current repertoire of minimally invasive treatments for the management of LUTS.     

PDE5-Is for the Treatment of Concomitant ED and LUTS/BPH

Epidemiologic data in adult men exhibit a strong relationship between erectile dysfunction (ED) and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), indicating that men affected by ED should also be investigated for LUTS/BPH and those presenting with storage or voiding LUTS should be investigated for co-morbid ED. Common pathophysiolgical mechanisms underlying both LUTS/BPH and ED, including alteration of NO/cGMP or RhoA/Rho-kinase signaling and/or vascular or neurogenic dysfunction, are potential targets for proposed phosphodiesterase type 5 inhibitors (PDE5-Is). Several randomized controlled trials and only a few reviews including all commercially available PDE5-Is demonstrated the safety and efficacy of these drugs in the improvement of erectile function and urinary symptoms, in patients affected either by ED, LUTS, or both conditions.     

Statin Medications and Development and Progression of Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms

Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are common among aging men and impact quality of life. Recently, there has been an interest in alternative mechanisms of BPH and LUTS, specifically the role of chronic prostatic inflammation. Statin medications, known for their cholesterol-lowering properties, also possess certain anti-inflammatory effects, which may be of interest in the treatment and/or prevention of BPH and LUTS. Prior studies of statins have yielded conflicting results. These were limited by cross-sectional designs or limited follow-up, small sample sizes, and inability to control for confounding. One prior randomized control trial found no difference between atorvastatin vs. placebo in the treatment of BPH and LUTS after 6 months. Additional randomized trials with longer follow-up time evaluating the impact of statins on incident BPH and LUTS are required to assess the therapeutic potential of statins and develop a better understanding of alternative mechanisms for BPH and LUTS.     

The relationship between erectile dysfunction and lower urinary tract symptoms: Epidemiological, clinical, and basic science evidence

Lower urinary tract symptoms (LUTS) and sexual dysfunction are highly prevalent in aging men. Both conditions also are significant contributors to overall quality of life. New data have emerged to indicate potential links in epidemiological, physiologic, pathophysiologic, and treatment aspects of these two entities. There are numerous publications based on sophisticated community and clinical-based data, suggesting a strong and consistent association between LUTS and erectile dysfunction (ED). The association is supported by the consistent linear relationship of more severe LUTS with more severe ED. The link between ED and LUTS has biologic plausibility given the four leading theories of how these diseases inter-relate.     

Anticholinergics in men: Does the evidence support combination therapy?

Benign prostatic hyperplasia (BPH) is common in men older than age 50, and the symptoms occurring from bladder outlet obstruction (BOO) commonly overlap with lower urinary tract symptoms (LUTS) experienced in overactive bladder (OAB). Anticholinergics are often withheld from men with BOO. This article reviews seven randomized controlled trials (RCTs) and a meta-analysis study examining anticholinergic use in men with LUTS associated with OAB and BPH. There is growing evidence that anticholinergics are a suitable, safe treatment in men with persistent LUTS associated with BOO, refractory to α-blockers. Only four of 750 men treated with anticholinergics in the seven RCTs reviewed had acute urinary retention. Further well-designed, placebo-controlled RCTs are required to assess the efficacy and long-term safety outcomes of combination therapy. However, it appears feasible to effectively use adjunctive anticholinergic therapy in men with LUTS/BPH and no significant increase in postvoid residual volume.     

甲磺酸多沙唑嗪控释片治疗良性前列腺增生及改善勃起功能的研究

目的 研究甲磺酸多沙唑嗪控释片对良性前列腺增生(BPH)患者下尿路症状(LUTS)及性功能的影响.方法 101例典型的伴有LUTS的BPH患者治疗前进行国际前列腺症状评分(IPSS)、勃起功能障碍国际问卷5(IIEF2-5)调查,给甲磺酸多沙唑嗪控释片4 mg,1次/d,疗程8周.分析治疗后LUTS及性功能改善情况.结果 治疗前IPSS评分(19.9±6.5)分,治疗后(14.3±4.0)分(t=7.534,P＜0.001);治疗前IIEF-5评分(9.5±8.5)分,治疗后(14.9±8.8)分(t=5.335,P＜0.001),治疗后各项指标较治疗前有明显改善.IPSS和IIEF2-5呈负相关(r=-0.33,P＜0.001).结论 LUTS是性功能障碍的危险因素,LUTS的严重程度与性功能障碍的发展密切相关.甲磺酸多沙唑嗪控释片在改善LUTS的同时可明显改善患者的性功能状况.

Abstract：

Objective To study the therapeutic effect of cardura on lower urinary tract symptoms (LUTS) and ejectile dystunction(ED) in men with benign prostatic hyperplasia (BPH).Methods One hundred and one cases with BPH and typical LUTS were investigated using the International Prostate Symptom Score (IPSS) and International Index of Erectile Function 5 (IIEF-5)before and after treatment. The patients were given cardura 4 mg, once a day for 8 weeks. The LUTS and ED were was analyzed after treatment. Results The IPSS was scores ( 14.3 ± 4.0) after treatment, and it was lower than before (mean scores: 19.9±6.5, t= 7.534, P＜0.001). The IIEF2-5 was(14.9±8.8)scores after treatment, and it was higher than before (mean scores: 9.5±8. 5, t = 5. 335, P＜ 0. 001 ), respectively. There was statistically significant correlation between IIEF2-5 and IPSS score (r= -0. 327, P＜0. 001 ). Various indexes were significantly improved after cardura treatment as compared with pretreatment (P＜0.001). Conclusions LUTS is dangerous factor for sexual dysdysfunction, and the severity of LUTS is closely related to the development of sexual dysfunction. Cardura can at once improve the sexual function and LUTS of BPH patients.     

Evaluation and Management of Lower Urinary Tract Symptoms After Outlet Surgery for Benign Prostatic Hyperplasia

There are many options available in the surgical treatment of outlet obstruction secondary to benign prostatic hyperplasia (BPH). While most patients exhibit improvement in their lower urinary tract symptoms (LUTS) following intervention, up to 35 % of patients may exhibit persistent or recurrent LUTS. In the present review, we discuss the pathophysiology of LUTS after bladder outlet surgery and discuss considerations in evaluating and managing such patients. We highlight the crucial role of thorough evaluation with complete urodynamics testing, as pure obstruction only accounts for a minority of post-operative LUTS. Hence, detrusor contractility, detrusor overactivity, urethral sphincter function, and urinary incontinence must be assessed to appropriately guide subsequent therapy and improve patients’ quality of life.     

Nocturia Potentially Influences Maintenance of Sexual Function in Elderly Men with Benign Prostatic Hyperplasia

Objective: This study examined the relationship between bothersome symptoms of nocturia and erectile function. Methods: Subjects comprised patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Patients were prospectively followed on treatment with the alpha‐1 blocker naftopidil for 8 weeks. Patient backgrounds and efficacy of naftopidil associated with LUTS and sexual activity were evaluated. Results: The percentage of patients who identified nocturia as the most bothersome symptom was 30.2% (n = 135), representing the highest percentage among International Prostate Symptom Score (IPSS) items. The number of patients with nocturia as the most bothersome symptom plateaued at an IPSS for nocturia of two or three points. In contrast, the number of patients with slow stream as the most bothersome symptom increased with symptom severity according to IPSS for slow stream. Logistic regression analysis on association between nocturia and erectile function confirmed that the odds ratio was 1.41 (P < 0.05). Naftopidil showed excellent efficacy related to male LUTS, but International Index of Erectile Function 5 (IIEF5) total score was almost unchanged. Among patients with nocturia improved by naftopidil, IIEF5 total score was significantly changed in the group with IPSS nocturia score ≤1 as compared to the group with IPSS nocturia score ≥2 per night (P = 0.038). Conclusion: Nocturia the most bothersome symptom correlated with aging. Nocturia could associate erectile dysfunction, and keeping the frequency of nocturia at ≤1 episode might be meaningful for maintaining quality of life in elderly men.     

Molecular Basis of α1-AR and its Clinical Application in Male LUTS Medical Therapy

Alpha1-adrenoceptor (??₁-AR) antagonists are now considered to be the first-line agents for the management for men with lower urinary tract symptoms associated with benign prostate hyperplasia (LUTS/BPH). A number of ??₁-AR antagonists are currently approved in the United States, Europe and Asia, all of which are generally well tolerated; however, there are differences in the efficacy and adverse effect profiles among the various ??₁-AR antagonists and patients. Recent molecular approaches have provided not only new knowledge about ??₁-AR subtypes (??_1a-, ??_1b- and ??_1d-AR) but also new strategies to improve the efficacy and reduce the adverse effects of LUTS medical therapy. Precious understanding of the subtype-specific roles of ??₁-AR provides a better strategy for LUTS medical treatment. Additionally, in the future, molecular approaches may enable personalized medicine for LUTS based on individual differences in the genetic background.     

Current Understanding of the Interplay between Oab & Bph

Lower urinary tract symptoms (LUTS) are very common and bothersome to men. For many years all male LUTS, even the storage ones, were attributed to the prostate, which was the target of therapeutic approaches. Increasing knowledge of the contribution of bladder dysfunction to LUTS pathophysiology has brought into focus detrusor overactivity (DO) and its treatments. Available data indicate that in many cases DO and overactive bladder (OAB) symptoms are secondary to bladder outlet obstruction (BOO), due to prostatic disease. Accumulating evidence also suggests that the two pathologies may coexist because they share etiologic factors. Despite the prevalence of storage symptoms in men with benign prostatic hyperplasia (BPH), antimuscarinics, the main treatment for OAB, were infrequently used because of fear of urinary retention. Available clinical trials indicate that the addition of an antimuscarinic to prostate-targeted treatments, or treatment initiation with a combination regimen, is safe in terms of urinary retention and offers improvements in storage symptoms. Nevertheless, the improvement in overall quality of life is modest. Criteria for the selection of patients likely to benefit most from the addition of antimuscarinics to common BPH treatments are lacking.     

Tadalafil Administered Once Daily for Treatment of Lower Urinary Tract Symptoms in Korean men with Benign Prostatic Hyperplasia: Results from a Placebo‐Controlled Pilot Study Using Tamsulosin as an Active Control

Objectives: Assess the efficacy and safety of once‐daily tadalafil or tamsulosin versus placebo during 12 weeks on lower urinary tract symptoms (LUTS) in Korean men with benign prostatic hyperplasia (BPH). Methods: Following a 4‐week placebo run‐in period, 151 Korean men were randomly assigned to receive once‐daily tadalafil 5 mg, tamsulosin 0.2 mg, or placebo for 12 weeks. Results: The International Prostate Symptom Score (IPSS) least squares mean changes from baseline to endpoint were numerically but not significantly improved in the tadalafil (?5.8) and tamsulosin (?5.4) groups compared with placebo (?4.2, P > 0.05). Decreases in IPSS obstructive and irritative subscores, IPSS Quality of Life score, and BPH Impact Index from baseline to endpoint were largest in the tadalafil group followed by tamsulosin, though none separated significantly from placebo. Increases in maximum urinary flow rate were small and not significantly different than placebo; the increase was largest in the tadalafil group (2.5 mL/sec), followed by the placebo (2.3 mL/sec) and tamsulosin (2.1 mL/sec) groups. The percentage of subjects reporting at least one treatment‐emergent adverse event was 26.5, 13.7 and 3.9% in the tamsulosin, tadalafil and placebo groups, respectively. Conclusions: In this pilot study in Korean men, those with BPH and treated with tadalafil 5 mg or tamsulosin 0.2 mg once daily experienced a reduction in LUTS, which was numerically (but not statistically) significant compared with the placebo. Tadalafil was well tolerated and few subjects discontinued the study due to treatment‐emergent adverse events. Larger studies in Asian men with BPH and LUTS treated with phosphodiesterase type 5 inhibitors are needed.     

Lower urinary tract symptoms, benign prostatic hyperplasia, and sexual dysfunction

Previously viewed as independent processes, sexual dysfunction (SD) and lower urinary tract symptoms (LUTS) frequently associate and significantly detract from overall quality of life for men. Analysis of historic and emerging literature using some of the Bradford-Hill criteria argues causality between the two disease processes, with most data focusing on the interplay between LUTS and erectile dysfunction. Understanding of the relationship between SD and LUTS is crucial given the current societal age demographics leading to an increased pool of affected patients. Additional information on risk factors for either disease could potentially improve patient screening, and many currently available treatments (medical and surgical) for SD impact LUTS and vice versa.     

Sildenafil in the treatment of erectile dysfunction: an overview of the clinical evidence

Erectile dysfunction (ED) is a highly prevalent disease associated with aging as well as with several risk factors including hypertension, heart disease, obesity, dyslipidemia, diabetes, hypogonadism, drugs-related, and pelvic surgery. Many of these factors are components of the metabolic syndrome, a multiplex risk factor for cardiovascular disease (CVD). ED shares common risk factors with CVD. Endothelial dysfunction seems to be the early underlying pathophysiology across both conditions. The efficacy, tolerability and cardiovascular safety of sildenafil has been evaluated in numerous large, randomized, double-blind, placebo-controlled clinical studies in the broad population of men with ED including men with several co-morbid conditions. Sildenafil is effective in several specific patient populations including the difficult-to-treat subpopulations such as diabetes mellitus and after radical prostatectomy. It is associated with rapid onset of action – within 14 minutes for some men – and an extended duration of action for up to 12 hours. Sildenafil improves quality of life and satisfaction for treated men and is well tolerated with a favorable safety profile. New data suggest that sildenafil has beneficial effects in several chronic conditions. It has been approved for the treatment of idiopathic pulmonary hypertension. Numerous articles have suggested that it improves endothelial function and a possible role on premature ejaculation or treatment of lower urinary tract symptoms has been suggested.     

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.     

Role of angiogenesis in bladder response to partial outlet obstruction

Benign prostatic hyperplasia (BPH) is a disease that has its etiology in the abnormal growth of the adult human prostate gland that accompanies the aging process in men. The symptomatic presentation of this disease, however, is related largely to degenerative changes in the bladder that occur as a result of the increasing urethral resistance and partial bladder outlet obstruction (PBOO) caused by the growing prostate gland. BPH is characterized by bladder hypertrophy, significant decreases in urinary flow and compliance, presence of residual urine after voiding, voiding urgency and incontinence (). Obstructed bladder dysfunction secondary to BPH is a slow, progressive disease that is so strongly associated with human aging that it is an expected occurrence of the male aging process. Although the symptoms of BPH are usually not life threatening, they effect an extremely negative quality of life for men who suffer from them. However, many men delay seeking medical treatment for early BPH since bladder function can remain relatively normal as the hypertrophying bladder initially compensates for the progressive increase in urethral resistance caused by prostatic obstruction. The limited changes in micturition pressure and flow characteristics that occur during compensated function are not usually disabling enough to motivate seeking medical attention, which, often, is not sought until the symptoms become typical of advanced disease. Recent advances in detection methods enable identification of patients with significant BPH during compensation before the bladder becomes dysfunctional (decompensated). A more complete understanding of the disease processes that underlie the loss of bladder function associated with BPH might enable the development of treatments that better protect these early-stage BPH patients from the more debilitating aspects of the disease. This review updates the understanding of obstructive bladder dysfunction via the use of animal models.     

180例离退休干部下尿路症状与尿流率的相关性探讨

目的 探讨离退休干部良性前列腺增生(BPH)患者下尿路症状(LUTS)与前列腺体积(PV)、最大尿流率(QMAX)的关系. 方法 随机选取180例经直肠指诊及经直肠前列腺超声(TRUS)确诊的离退休干部BPH患者,计算其国际前列腺症状评分(IPSS),记录PV及QMAX值,分析其相关性. 结果 (1)60～69岁、70～79岁、≥80岁3组离退休干部BPH患者IPSS评分分别为(9.1±0.7)分、(12.1±0.7)分、(14.0±1.3)分,PV分别为(40.6±1.9)ml、(42.4±1.9)ml、(48.7±2.8)ml,随年龄增加而增加(F值分别为5.705,2.983,P＜0.05).QMAX分别为(14.7±0.6)ml/s、(14.0±0.5)ml/s、(12.6±0.9)ml/s,随年龄增加而降低,但差异无统计学意义(F=2.131,P＞0.05),组间分析,60～69岁组与≥80岁组间差异有统计学意义(P=0.048).(2)随着LUTS加重,在IPSS评分＜7分、8～17分、＞20分组中,PV增加[分别为(39.2±18.1)ml、(45.7±16.9)ml、(47.9±16.5)ml],QMAX下降[(15.0±4.8)ml/s、(13.5±5.0)ml/s、(11.5±4.7)ml/s](F值分别为3.427,4.742,P＜0.05). 结论 离退休干部BPH患者LUTS不仅随年龄增加而加重,而且其严重程度随PV增加,随QMAX下降.对于PV增大的老年患者积极给予缩小体积的药物治疗有可能改善LUTS.