Metabolic syndrome and lower urinary tract symptoms

Recently,clinical and epidemiologic data indicating the involvement of metabolic syndrome(Met S)in the pathogenesis and progression of lower urinary tract symptom(LUTS)/benign prostatic hyperplasia(BPH)are reported.This review evaluates the reports on the influence of MetS in the development and progression of LUTS/BPH,and discusses possible clinical implications for the management and treatment of this disease.Recent studies on the epidemiological relationship between MetS and LUTS hypothesize that MetS may be associated with an overactivity of the autonomic nervous system for which hyperinsulinemia,a key element of the Met S,might be responsible.An alternative explanation is that LUTS are associated with chronic ischemia of pelvis resulting from atherosclerotic changes in blood vessels,which leads the production of reactive oxygen species,which can damage the bladder detrusor.Control of autonomic nervous system overactivity and control of chronic bladder ischemia have potential as new targets for LUTS treatment.Studies suggest an association of Met S with LUTS/BPH,although further research is needed to understand how MetS influences LUTS/BPH.Met S should be considered a new domain in basic and clinical research in patients with LUTS/BPH and as a target for treatment.     

Phosphodiesterase inhibitors for treatment of voiding dysfunction: An overview of experimental and clinical evidence

Recently,the focus of the origin of lower urinary tract symptoms(LUTS)has change from the prostate to the bladder.Regardless of the underlying mechanism associated with the origin of LUTS,alpha-blockers continue to be the most common medicine prescribed to treat LUTS due to benign prostatic obstruction(BPO).The newest class of drug introduced to treat LUTS/BPO is phosphodiesterase inhibitors(PDEi)and the aim of this study was to review the role of PDEi in the treatment of LUTS/BPO.In this review,the first evidence was evaluated based on epidemiological studies followed by randomized clinical trials which provide evidence on the administration of PDEi in patients with LUTS/BPO.Experimental studies were also assessed to tentatively elucidate the association between LUTS and erectile dysfunction,and to elucidate the underlying mechanism.There is still controversy regarding the administration of PDEi due to the fear of detrusorimpairment,response to acute administration,and the effects of PDEi combined with alpha-blockers.Following this review,we conclude that treatment of BPO/LUTS with PDEi is beneficial,based on experimental studies,strong evidence and the large number of randomized clinical trials confirming their efficiency.     

《EAU男性下尿路症状诊治指南(2012年版)》解读

欧洲泌尿外科学会(The European Association of Urology,EAU)2012年发表了新的《EAU男性下尿路症状诊治指南(2012年版)》(以下简称《指南》)。在下尿路症(Male Lower Urinary Tract Symptoms,LUTS)的评估、治疗、随访等方面做了论述。本文对《指南》的解读,旨在帮助全科医生和不熟悉LUTS治疗的医生正确诊断和治疗该病。     

妇女性健康相关因素的探讨

目的:妇女性健康是医疗专业人员所关注的课题,因为性健康若受损害,对生活满足感和生活质量都有不良影响。本研究探讨与性健康相关的因素,调查香港妇女性健康的一般状况。方法:采用橫向研究法,通过问卷调查搜集数据,参与者人口特征广泛多样。结果:香港妇女性功能尚属健康,仅性欲方面稍为偏低。不利性健康的因素包括高龄、受教育程度低、离婚、停经、曾接受盆腔手术等。性健康较差的妇女,性活动较少,意味性生活质量较差。结论:医疗专业人员可根据掌握的风险因素,针对性的推广性健康咨询和教育讲座,提高妇女的性健康。     

Sexual behaviour of lesbians and bisexual women

OBJECTIVES: To provide data about the sexual histories of a large sample of lesbians and bisexual women, to inform those who provide health care or carry out research with women who may be sexually active with other women. DESIGN: Cross sectional survey. Setting/subjects: 803 lesbians and bisexual women attending, as new patients, lesbian sexual health clinics, and 415 lesbians and bisexual women from a community sample. MAIN OUTCOME MEASURES: Self reported sexual history and sexual practice with both male and female partners. RESULTS: 98% of the whole sample gave a history of sexual activity with women, 83% within the past year, with a median of one female partner in that year. 85% of the sample reported sexual activity with men; for most (70%) this was 4 or more years ago. First sexual experience tended to be with a man (median 18 years old), with first sexual experience with a woman a few years later (median 21 years). Oral sex, vaginal penetration with fingers, and mutual masturbation were the most commonly reported sexual practices between women. Vaginal penetration with penis or fingers and mutual masturbation were the most commonly reported sexual activities with men. CONCLUSIONS: These data from the largest UK survey of sexual behaviour between women to date demonstrate that lesbians and bisexual women may have varied sexual histories with both male and female partners. A non-judgmental manner and careful sexual history taking without making assumptions should help clinicians to avoid misunderstandings, and to offer appropriate sexual health advice to lesbians and bisexual women.     

The evolving relationship of erectile dysfunction and lower urinary tract symptoms

Previously viewed as independent processes, erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) frequently co-associate and significantly influence the overall quality of life of men. Analysis of historical and emerging literature, using some of the Bradford Hill criteria, argues for a causal link between the two disease processes. Four mechanisms are proposed to explain the relationship between ED and LUTS. Understanding this relationship is crucial for several reasons: 1) additional information on risk factors for either disease could be important for patient screening; 2) the pool of affected men is increasing, given the age demographics in many societies; 3) sexual problems related to LUTS are not necessarily limited to ED; and 4) many medical or surgical treatments for one disorder affect the other.     

Consistency of self-reported sexual behavior and condom use among current sex partners

OBJECTIVE: The objective of this study was to determine concordance in sex partner reports of frequency of vaginal and oral intercourse and condom use. STUDY DESIGN: Self-reported behaviors among 112 women treated for urinary tract infection (UTI), sore throats, or receiving birth control at a student health service were compared with that of their current sex partner. RESULTS: Correlation was excellent for frequencies of vaginal intercourse (r = 0.88), cunnilingus (r = 0.72), fellatio (r = 0.76), and condom use (r = 0.86), but women with UTI compared with women without UTI reported greater frequency of sexual activity than their sex partner. This effect overwhelmed the modest increases in correlation associated with duration of relationship and marital status. CONCLUSIONS: Women with genitourinary symptoms may over-recall frequency of sexual behavior compared to women without these symptoms. Knowing the extent of this recall bias will assist in the interpretation of data and appropriate correction of parameters when included in prediction models.     

疏肝益阳胶囊联合盐酸坦索罗辛治疗BPH/LUTS合并ED的临床观察

目的:探讨疏肝益阳胶囊联合盐酸坦索罗辛缓释胶囊治疗肝郁肾虚兼血瘀型前列腺良性增生/下尿路症状(BPH/LUTS)合并勃起功能障碍(ED)的临床疗效。方法:将60例确诊为肝郁肾虚兼血瘀型BPH/LUTS合并ED的患者,随机分为试验组和对照组,每组各30例。试验组采用疏肝益阳胶囊联合盐酸坦索罗辛进行治疗,对照组用盐酸坦索罗辛进行治疗。治疗时间均为8周。采用国际前列腺症状评分(IPSS)、生活质量评价(QOL)、国际勃起功能指数(IIEF-5)、综合医院焦虑抑郁表(HAD)、每月的成功性交频率及停药3个月后复发率来比较两组的疗效。结果:两组患者治疗4周后的IPSS、QOL均比治疗前提高(P0.01);试验组治疗4周后IPSS、QOL、HAD、IIEF-5及性交频率优于对照组(P0.01);试验组停药3月后的复发率低于对照组(P0.05)。结论:疏肝益阳胶囊联合盐酸坦索罗辛可以有效治疗肝郁肾虚兼血瘀型BPH/LUTS合并ED患者,提高下尿路症状的疗效,改善焦虑症状,减少复发率。     

Childhood sexual abuse: Effects on female sexual function and its treatment

For many woman survivors of childhood sexual abuse, there are long-term sexual sequelae, such as hypersexual activity and avoidance, although the trajectory to each type of response remains unclear. Female survivors of childhood sexual abuse have problems with intimate relationships and some survivors may also complain of multiple health problems and use emergency room services at a higher rate than women who were not sexually abused. Although the health care provider is in a position to screen for childhood sexual abuse, care must be taken to maintain trust if referring the survivor for psychotherapy, specifically sex therapy, which can be the treatment of choice. This article reviews the effect of childhood sexual abuse in female sexual function and provides general treatment recommendations.     

Risk factors for hepatitis B virus infection in black female attendees of a sexually transmitted disease clinic

Although recent data have supported the role of heterosexual activity in the transmission of hepatitis B virus infection in women, studies generating these data have enrolled few black women. We therefore examined black female participants attending our local health department's sexually transmitted disease clinic for the treatment of presumed uncomplicated gonorrhea in serologic and risk-factor surveys of hepatitis B virus infection. Twenty-four (17.6%) of 136 subjects tested had evidence of prior hepatitis B infection. Serologic evidence of hepatitis B infection was significantly associated with three different barometers of sexual activity that included: (1) years of sexual activity (P less than 0.005); (2) history of sexually transmitted disease (P less than 0.02); and (3) number of lifetime heterosexual partners (P less than 0.001). These data provide further support that the quantity of sexual exposure seems to be an important risk factor for hepatitis B infection in heterosexually active females.     

索利那新联合坦索罗辛治疗前列腺增生伴下尿路症状患者的疗效观察

目的:研究索利那新联合坦索罗辛治疗前列腺增生伴下尿路症状患者的有效性及安全性。方法:采用随机数字表法将64例患者随机分为两组,每组32例,实验组服用索利那新5mg/qd+坦索罗辛0.2mg/qd,对照组仅服用坦索罗辛0.2mg/qd,持续4周。比较两组治疗前后平均I-PSS、SSS、QOL评分以及最大尿流率(Q_(max))和膀胱残余尿量。结果:两种治疗方案均对缓解前列腺增生伴下尿路症状有效,且联合用药疗效优于单独用药(P<0.05)。结论:索利那新联合坦索罗辛治疗前列腺增生伴下尿路症状疗效优于单独使用坦索罗辛,且安全性好。     

Female Sexual Dysfunction Management After Pubovaginal/Midurethral Sling Surgery

The complexity of female sexual dysfunction (FSD) in women with stress urinary incontinence makes the diagnosis and treatment difficult. While the prevalence is high for both conditions, they are often underreported. Although the impact of sling surgery on sexual outcomes remains controversial, this type of procedure is known to cause sexual dysfunction in a subset of women. In this article, we review the prevalence of FSD, its intricate relationship with incontinence, the pathophysiology linking sling placement to sexual dysfunction, and the outcomes of treatment directed at FSD arising from sling surgery.     

Contemporary Review of BPH Medical and Surgical Treatments on Sexual Function

Purpose of Review

Contemporary urologists have myriad options to offer patients when discussing treatments for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). While the primary goal of managing BPH is to improve LUTS, many treatments cause adverse effects on sexual function including erectile and ejaculatory function and libido. In the past 5 years, new literature has continued to evaluate the impact that medical, minimally invasive, and surgical BPH therapies have on sexual function.

Recent Findings

Research on medical treatment continues to show high rates of erectile and ejaculatory dysfunction in addition to low libido. Minimally invasive procedures had the lowest risk of developing both ejaculatory and erectile dysfunction. Invasive procedures such as transurethral resection of the prostate (TURP) caused significant ejaculatory dysfunction, while holmium laser enucleation of the prostate (HoLEP) caused significant erectile dysfunction.

Summary

Not all existing studies are comprehensive in their analysis of sexual function with impacts on libido being the least reported. Sexual function remains at a high level of patient concern and can be a significant source of procedural dissatisfaction. Appropriate preoperative counseling and further comparison studies are of paramount importance.

     

Effects of Hysterectomy on Sexual Function

Hysterectomy remains the most common major gynecological surgery. Postoperative sexual function is a concern for many women and their partners. In this respect, a beneficial effect of hysterectomy for benign disease independent of surgical techniques or removal of the cervix has been demonstrated in the past decade by the majority of studies. For about 20 % of women, deteriorated sexual function has been reported and current research is attempting to identify mechanisms and predictive factors explaining these postoperative changes. Alternative treatments of benign uterine disorders or uterus preserving surgery for genital prolapse appeared to have similar outcomes in terms of sexual function. Concomitant oophorectomy had negative effects on sexual function and long-term health, particularly in premenopausal women. This may not be reversed by estrogen replacement. Hysterectomy performed for malignancy had a detrimental effect on sexual function. Individualized risk assessment and information should be aimed at during preoperative decision making.     

Are phosphodiesterase type 5 inhibitors effective for the management of lower urinary symptoms suggestive of benign prostatic hyperplasia?

AIM: To review the efficacy of phosphodiesterase type 5 inhibitors(PDE5-Is) in lower urinary tract symptoms(LUTS) suggestive of benign prostate hyperplasia(LUTS/BPH). METHODS: A comprehensive research was conducted to identify all publications relating to benign prostate hyperplasia and treatment with sildenafil, vardenafil and tadalafil. To assess the efficacy, the changes in total international prostate symptom score(IPSS), IPSS subscore including voiding, storage and quality of life(Qo L), Benign prostatic hyperplasia Impact Index(BII), maximum urinary flow rate(Qmax) and the International Index of Erectile Function(IIEF) were extracted. A meta-analytical technique was used for the analysis of integrated data from the included studies to evaluate the mean difference in the results. RESULTS: Total IPSS score, IIEF and BII showed a significant improvement in trials in which LUTS/BPH with or without erectile dysfunction(ED) were compared with the placebo. For LUTS/BPH, the mean differences of total IPSS score, IIEF and BII are-2.17, 4.88 and-0.43, P 0.00001, respectively. For LUTS/BPH with comorbid ED, the mean difference are-1.97, 4.54 and-0.52, P 0.00001, respectively. PDE5-Is appear to improve IPSS storage, voiding and Qo L subscore(mean difference =-0.71,-1.23 and-0.33, P 0.00001, respectively). Although four doses of tadalafil(2.5, 5, 10 and 20 mg) failed to reach significance in Qmax(mean difference = 0.22, P = 0.10), the 5 mg dose of tadalafil significantly improved the Qmax(mean difference = 0.33, P = 0.03).CONCLUSION: PED5-Is demonstrated efficacy for improving LUTS in BPH patients with or without ED and could be considered to be the first line treatment for LUTS/BPH.     

Ejaculatory disorders and lower urinary tract symptoms

A growing body of literature supports the observed association between lower urinary tract symptoms and sexual dysfunction. The causal relationship between these two conditions has not been determined. Ejaculatory function is an important aspect of sexual functioning, and recent studies have shown a high prevalence of this ejaculatory dysfunction in men with lower urinary tract symptoms. Furthermore, the degree of bother associated with ejaculatory dysfunction is quite high, making it an important problem for patients. Thus, health care providers should have a heightened sense of awareness for the presence of ejaculatory dysfunction and appropriate patient counseling should be undertaken before initiation of specific treatments for lower urinary tract symptoms.     

Ejaculatory disorders and lower urinary tract symptoms

A growing body of literature supports the observed association between lower urinary tract symptoms and sexual dysfunction. The causal relationship between these two conditions has not been determined. Ejaculatory function is an important aspect of sexual functioning, and recent studies have shown a high prevalence of this ejaculatory dysfunction in men with lower urinary tract symptoms. Furthermore, the degree of bother associated with ejaculatory dysfunction is quite high, making it an important problem for patients. Thus, health care providers should have a heightened sense of awareness for the presence of ejaculatory dysfunction and appropriate patient counseling should be undertaken before initiation of specific treatments for lower urinary tract symptoms.     

性满意度影响因素的相关研究

性满意度不仅是性健康的重要内容,也是衡量生活质量的主要指标之一。经文献回顾发现,性满意度的相关研究在国内并未得以广泛和深入的探讨,而国外学者对其进行了诸多研究,并针对社会人口学因素、生理因素和心理因素对性满意度的影响进行了探讨。本文对相关研究结果进行了梳理,旨在为目前国内进一步开展性满意度的研究提供建设性的思考。     

Accessing sexual and reproductive health care and information: Perspectives and recommendations from young Asian American women

ObjectivesUnderstanding the influence of culture on how sexual and reproductive health is perceived and addressed in Asian American communities is important for the effective provision of care and health information. This study aimed to explore how and when sexual and reproductive health information is shared within Asian American families and communities, barriers and facilitators to accessing sexual and reproductive health care and information for young Asian American women, and their recommendations to improve access.MethodsQualitative data were collected through six focus groups conducted with a total of 33 young Asian American women.ResultsThe majority of participants reported that stigma created a barrier to discussing these topics within their families and communities, and discussed ways in which they confidentially seek out care and information. Responses varied with respect to participants' preferred means of increasing access to care and information; some recommended strategies that would increase communication about these issues in their families and communities, while others expressed a desire to maintain confidentiality.ConclusionsThese findings suggest that diversified strategies are needed to connect Asian American women with sexual and reproductive health care and information in order to meet their varied preferences, including strategies that are community-driven and culturally appropriate.     

Marital violence and sexually transmitted infections among women in post-revolution Egypt

ObjectivesTo explore the relationship between past year physical or sexual partner violence against women and women’s self-report of sexually transmitted infection (STI) symptoms in post-revolution Egypt; and to examine the effects of men’s and women’s risky sexual behavioural characteristics and structural dimensions of poverty and gender inequality on this relationship.Study designThis study uses the nationally representative cross-sectional demographic and health survey data conducted in 2014. Multivariate logistic regression was used to assess the relationship between past year partner violence and self-report of STI symptoms among currently married women.Main outcome measureswomen’s self-report of STI was based on their responses to three questions; whether in the past year they had: got a disease through sexual contact?, a genital sore or ulcer?, or a bad smelling abnormal genital discharge? Women who gave an affirmative response to one or more of these questions were assumed to self-report STI.ResultsAlmost one-third of women self-reported symptoms of STI. Fourteen percent of women reported they had experienced physical or sexual violence by a male partner in the past 12 months. Abused women had a 2.76 times higher odds of self-reported STI symptoms (95% CI 2.25–3.38). The significant relationship between self-reported STI and past year partner violence against women did not alter when adjusting for men’s and women’s behavioural characteristics and factors related to poverty and gender inequality.ConclusionsPublic health interventions that address women’s sexual and reproductive health need to consider violence response and prevention strategies.