Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia

Sexual function

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), and sexual dysfunction, are common, highly bothersome conditions in older men, and the prevalence of both disorders increases with age. Sexual dysfunction manifests mainly as erectile dysfunction (ED), ejaculatory disorders, or decreased libido/hypoactive sexual desire (HSD). Whereas both reduced rigidity and reduced ejaculate volume are highly prevalent in ageing men, reduced rigidity and pain on ejaculation are considered to be most bothersome. Sexual dysfunction is much more prevalent in patients with LUTS/ BPH than in men with no LUTS/BPH, even after controlling for confounding variables such as age or comorbidities. Hence LUTS/BPH is considered an independent risk factor for sexual dysfunction. Whether this is because of a common underlying pathology, or whether the considerable bother associated with LUTS/ BPH leads to reduced sexual functioning, remains to be elucidated. Despite a decline in the frequency of sexual intercourse, as well as in overall sexual functioning, most ageing men report regular sexual activity and consider their sex life as an important dimension of their quality of life (QoL). However, most patients with LUTS/BPH experience a negative effect of their LUTS on their sex life. Hence, treatment of LUTS/BPH should aim to at least maintain or, if possible, improve sexual function. Current medical treatment of LUTS/BPH consists of monotherapy with α1-adrenoceptor (AR) antagonists, 5α-reductase inhibitors (RIs) or a combination of these. Whereas 5α-RIs increase the risk of ED, ejaculatory disorders and HSD, α1-AR antagonists can induce ejaculatory disorders, but do not provoke HSD or ED. Combined therapy carries the cumulative risk for sexual dysfunction associated with either type of drug. As already indicated, ED is generally perceived as more bothersome than ejaculatory disorders. In addition, α1-AR antagonists slightly improve overall sexual function, possibly by increasing blood flow in the penis through α1-AR blockade and/or to an increased overall QoL from the relief of LUTS. It can be concluded that α1-AR antagonists constitute a first-line therapy for LUTS/BPH because they combine good treatment efficacy with very few adverse effects on sexual function.

Original languageEnglish (US)
Pages (from-to)12-18
Number of pages7
JournalBJU International, Supplement
Volume95
Issue number4
DOIs
StatePublished - Jun 2005
Externally publishedYes

Fingerprint

Lower Urinary Tract Symptoms
Prostatic Hyperplasia
Adrenergic Receptors
Erectile Dysfunction
Therapeutics
Oxidoreductases
Quality of Life
Psychological Sexual Dysfunctions
Libido
Ejaculation
Confounding Factors (Epidemiology)
Coitus
Penis
Sexual Behavior
Comorbidity
Pathology
Pain
Pharmaceutical Preparations

Keywords

  • α-adrenoceptor antagonists
  • 5α-reductase inhibitors
  • BPH
  • Ejaculatory disorder
  • Erectile dysfunction
  • Hypoactive sexual desire
  • LUTS

ASJC Scopus subject areas

  • Urology

Cite this

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title = "Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: Sexual function",
abstract = "Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), and sexual dysfunction, are common, highly bothersome conditions in older men, and the prevalence of both disorders increases with age. Sexual dysfunction manifests mainly as erectile dysfunction (ED), ejaculatory disorders, or decreased libido/hypoactive sexual desire (HSD). Whereas both reduced rigidity and reduced ejaculate volume are highly prevalent in ageing men, reduced rigidity and pain on ejaculation are considered to be most bothersome. Sexual dysfunction is much more prevalent in patients with LUTS/ BPH than in men with no LUTS/BPH, even after controlling for confounding variables such as age or comorbidities. Hence LUTS/BPH is considered an independent risk factor for sexual dysfunction. Whether this is because of a common underlying pathology, or whether the considerable bother associated with LUTS/ BPH leads to reduced sexual functioning, remains to be elucidated. Despite a decline in the frequency of sexual intercourse, as well as in overall sexual functioning, most ageing men report regular sexual activity and consider their sex life as an important dimension of their quality of life (QoL). However, most patients with LUTS/BPH experience a negative effect of their LUTS on their sex life. Hence, treatment of LUTS/BPH should aim to at least maintain or, if possible, improve sexual function. Current medical treatment of LUTS/BPH consists of monotherapy with α1-adrenoceptor (AR) antagonists, 5α-reductase inhibitors (RIs) or a combination of these. Whereas 5α-RIs increase the risk of ED, ejaculatory disorders and HSD, α1-AR antagonists can induce ejaculatory disorders, but do not provoke HSD or ED. Combined therapy carries the cumulative risk for sexual dysfunction associated with either type of drug. As already indicated, ED is generally perceived as more bothersome than ejaculatory disorders. In addition, α1-AR antagonists slightly improve overall sexual function, possibly by increasing blood flow in the penis through α1-AR blockade and/or to an increased overall QoL from the relief of LUTS. It can be concluded that α1-AR antagonists constitute a first-line therapy for LUTS/BPH because they combine good treatment efficacy with very few adverse effects on sexual function.",
keywords = "α-adrenoceptor antagonists, 5α-reductase inhibitors, BPH, Ejaculatory disorder, Erectile dysfunction, Hypoactive sexual desire, LUTS",
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AU - Lowe, Franklin C.

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AB - Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), and sexual dysfunction, are common, highly bothersome conditions in older men, and the prevalence of both disorders increases with age. Sexual dysfunction manifests mainly as erectile dysfunction (ED), ejaculatory disorders, or decreased libido/hypoactive sexual desire (HSD). Whereas both reduced rigidity and reduced ejaculate volume are highly prevalent in ageing men, reduced rigidity and pain on ejaculation are considered to be most bothersome. Sexual dysfunction is much more prevalent in patients with LUTS/ BPH than in men with no LUTS/BPH, even after controlling for confounding variables such as age or comorbidities. Hence LUTS/BPH is considered an independent risk factor for sexual dysfunction. Whether this is because of a common underlying pathology, or whether the considerable bother associated with LUTS/ BPH leads to reduced sexual functioning, remains to be elucidated. Despite a decline in the frequency of sexual intercourse, as well as in overall sexual functioning, most ageing men report regular sexual activity and consider their sex life as an important dimension of their quality of life (QoL). However, most patients with LUTS/BPH experience a negative effect of their LUTS on their sex life. Hence, treatment of LUTS/BPH should aim to at least maintain or, if possible, improve sexual function. Current medical treatment of LUTS/BPH consists of monotherapy with α1-adrenoceptor (AR) antagonists, 5α-reductase inhibitors (RIs) or a combination of these. Whereas 5α-RIs increase the risk of ED, ejaculatory disorders and HSD, α1-AR antagonists can induce ejaculatory disorders, but do not provoke HSD or ED. Combined therapy carries the cumulative risk for sexual dysfunction associated with either type of drug. As already indicated, ED is generally perceived as more bothersome than ejaculatory disorders. In addition, α1-AR antagonists slightly improve overall sexual function, possibly by increasing blood flow in the penis through α1-AR blockade and/or to an increased overall QoL from the relief of LUTS. It can be concluded that α1-AR antagonists constitute a first-line therapy for LUTS/BPH because they combine good treatment efficacy with very few adverse effects on sexual function.

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KW - 5α-reductase inhibitors

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KW - Ejaculatory disorder

KW - Erectile dysfunction

KW - Hypoactive sexual desire

KW - LUTS

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