Effects of three types of alpha‐1 adrenoceptor blocker on lower urinary tract symptoms and sexual function in males with benign prostatic hyperplasia

Abstract

Objectives:The aim of the present study was to explore the effects of three different types of alpha-1 adrenoceptor blockers (a1-blocker) on lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and ejaculatory dysfunction (EjD) in patients with benign prostatic hyperplasia. Methods: A total of 136 male LUTS patients aged 50-80 years with International Prostate Symptom Score (IPSS) Ն8 were enrolled. They were divided into three groups. Group S received silodosin at 4 mg twice a day; group T received tamsulosin at 0.2 mg once a day; and group N received naftopidil at 50 mg once a day. Assessment included IPSS, quality of life indexes (QOL), International Index of Erectile Function (IIEF-5), an ejaculation questionnaire, Qmax and post-void residual urine volume (PVR). These parameters were recorded at baseline, and at 1 and 3 months after treatment had ended. Results: Mean IPSS and Qmax significantly improved after treatment in all groups without any significant difference among them. As for the IIEF-5 score, only group N significantly improved at 1 and 3 months. After treatment, 2.6 and 2.4% of patients complained of a de novo reduced volume of ejaculation in both groups T and N, respectively. Ten out of 41 patients (24.4%) complained of a total absence of antegrade ejaculation in group S after treatment. Conclusions: All three types of a1-blockers provided an objective and subjective improvement of LUTS in the present study population. However, erectile function only improved in patients treated with naftopidil and a higher rate of EjD was observed in those receiving silodosin. Because of their variable effects, we should consider the sexual dimension when prescribing a1-blockers for LUTS.

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

“…Silodosin 4 mg BD was associated with inability to have antegrade ejaculation in 7.2-28.1% of men with LUTS [Miyakita et al 2010;Marks et al 2009aMarks et al , 2009bYokoyama et al 2011]. More patients receiving de novo (7.5%) versus continuing treatment (1.9%) discontinued study participation because of retrograde ejaculation [Marks et al 2009b].…”

“…Retrograde ejaculation associated with tamsulosin 0.4 mg daily treatment for LUTS was reversed by intermittent tamsulosin treatment in 63.3% of affected men [Goktas et al 2006]. Lowering the dose to tamsulosin 0.2 mg daily treatment for LUTS had less adverse effects on ejaculation [Song et al 2011;Yokoyama et al 2011]. Other α-blockers for the treatment of LUTS were not associated with significant EjD [Roehrborn et al 2003].…”

“…Incidences of decreased frequency, delay, dryness, decreased strength/force, decreased volume, decreased pleasure and pain at ejaculation were 2.4%, 3.1%, 3.9%, 3.9%, 6.3%, 7.1% and 3.1%, respectively. In another study comparing tamsulosin 0.2 mg with other α-adrenergic blockers for the treatment of LUTS, de novo decreased volume of ejaculation developed in 2.6% of patients [Yokoyama et al 2011]. A prospective study of the more widely used dose of tamsulosin 0.4 mg daily was carried out involving men above 50 with LUTS [Goktas et al 2006].…”

“…Similarly, identification of the separate events of ejaculation and orgasm is omitted in many studies, although they might affect each other or occur in dissociation [Kobayashi et al 2009;Yokoyama et al 2011]. If sexual activity and erection do not occur, it is less likely that ejaculation and orgasm can occur.…”

“…In a clinical setting, however, these precise pathophysiologic events are overlapping and blurred by the absence of a detailed history, overlapping nonspecific terminology, lack of diagnostic tools and the presence of confounding and interacting factors. The terms EjD and orgasmic dysfunction have been used interchangeably in many studies to describe the whole spectrum of EjD.Similarly, identification of the separate events of ejaculation and orgasm is omitted in many studies, although they might affect each other or occur in dissociation [Kobayashi et al 2009;Yokoyama et al 2011]. If sexual activity and erection do not occur, it is less likely that ejaculation and orgasm can occur.…”