Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life

Carbone, DJ; Hodges, Steve J.

doi:10.1038/sj.ijir.3901017

Cited by 78 publications

(54 citation statements)

References 63 publications

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“…The main treatment options -besides prostatic surgery -are a-blockers and 5-a reductase inhibitors. 76,77 PDE activity in human prostate tissues was first reported in 1970. 78 Later studies demonstrated that various PDE isoenzymes, including PDE5, are expressed in the prostate.…”

Section: Benign Prostate Syndrome and Lower Urinary Tract Symptoms (Bmentioning

confidence: 99%

PDE5 inhibitors beyond erectile dysfunction

et al. 2007

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The phosphodiesterase type-5 (PDE5) inhibitors sildenafil, vardenafil and tadalafil are widely used first-line therapy for erectile dysfunction (ED). Since the advent of sildenafil in 1998, more than 40 million men worldwide have been successfully treated with these compounds. The safety and high tolerability of PDE5 inhibitors make them an attractive tool to investigate further physiological functions of PDE5, for example the modulation of intracellular cyclic GMP (cGMP) pools. As cGMP is a key component of intracellular signaling this may provide novel therapeutic opportunities beyond ED even for indications in which chronic administration is necessary. The approval of sildenafil for the treatment of pulmonary hypertension in 2005 was a notable success in this area of research. A number of other potential new indications are currently in various phases of preclinical research and development. In recent years, extensive but very heterogeneous information has been published in this field. The aim of this review is to summarize existing preclinical and clinical knowledge and critically discuss the evidence to support potential future indications for PDE5 inhibitors.

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Section: Benign Prostate Syndrome and Lower Urinary Tract Symptoms (Bmentioning

confidence: 99%

PDE5 inhibitors beyond erectile dysfunction

et al. 2007

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“…4,[6][7][8][9] The current analysis from the PCAW program provides one of the largest known studies, which adjusted for the apparent effect of other known risk factors on sexual health including age, comorbidities, smoking and testosterone level. Further to our knowledge, it is the first analysis to address the effect of race on the overall sexual health in a large cohort of men in the USA.…”

Section: Correlation Between Luts and Edmentioning

confidence: 99%

Correlation between LUTS (AUA-SS) and erectile dysfunction (SHIM) in an age-matched racially diverse male population: data from the Prostate Cancer Awareness Week (PCAW)

et al. 2005

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The relationship between lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia and sexual health in men participating in a national multicenter screening program was studied. A total of 12 679 men were screened for prostate cancer in the year 2003. Of these, 6641 men had completed both the American Urological Association Symptom Score (AUA-SS) and the Sexual Health Inventory for Men (SHIM) questionnaires. We assessed the apparent effect of comorbidities (ischemic heart disease, hypertension, hypercholesteremia and diabetes), smoking habits and testosterone level on the overall sexual health. Age and race were also assessed as factors affecting the SHIM score. We used a general linear multivariable regression analysis to express the effect of these variables on the sexual health in these men adjusting for the apparent effect of LUTS. The mean and median age of the population was 58.479.8 and 58 y, respectively. The median AUA-SS was 4/25 (mean ¼ 5.775.3) and SHIM score was 19/25 (mean ¼ 16.375.9). Of the men, 4948 (75%) were Caucasian and 1154 (17%) were from African-American racial origin. A high AUA-SS appears to have a negative effect on the overall sexual health (Po0.05) after adjusting for all other confounding factors. As expected, age showed a significant inverse correlation with SHIM score (Po0.05). Caucasian men on average appear to have a significantly higher SHIM score by 6.5 points when compared to African-American men after adjusting for age, comorbidities, smoking habits, and AUA-SS (Po0.05). However, with increasing age, the difference in SHIM score diminishes between the two groups. Further, smoking and comorbidities were strong predictors of poor sexual health performance. Interestingly, hypogonadism (testosterone o300 ng/dl) was not a significant risk factor (P ¼ 0.104) when adjusting for all other variables. Nonetheless, in a univariate analysis, testosterone levels significantly correlated with reported SHIM scores (Po0.05). The overall sexual health in aging men is substantially affected not only by age, but by the severity of their urinary symptoms after adjusting for the most common known risk factors, suggesting perhaps a common underlying pathophysiology. Moreover, race appears to constitute another neglected potential risk factor, which should be investigated further in future studies.

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“…Unfortunately, some pharmacological treatments for LUTS/BPH (i.e., a 1 -adrenergic receptor antagonists (a-blockers) and 5a-reductase inhibitors (5ARIs)) are associated with sexual side effects (i.e., ED, EjD and hypoactive sexual desire [HSD]). 18,19 For example, in two US clinical trials in men with LUTS/BPH, treatment with tamsulosin resulted in a higher incidence of EjD (8.4% for tamsulosin 0.4 mg; 18.1% for tamsulosin 0.8 mg) than placebo (0.2%). 20 Furthermore, treatment with a 5ARI, finasteride or dutasteride, is associated with higher incidences of ED, EjD and HSD in men with LUTS/BPH than placebo.…”

Section: Introductionmentioning

confidence: 99%

Physician perceptions of sexual dysfunction related to benign prostatic hyperplasia (BPH) symptoms and sexual side effects related to BPH medications

2007

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In a large-scale epidemiology study, 50% of aging men reported erectile dysfunction (ED) or ejaculatory dysfunction (EjD), with lower urinary tract symptoms (LUTS) an independent risk factor for each of these conditions. In light of the shift from urologists (UROs) to primary care/ internal medicine physicians (PCPs) for the initial management of men with LUTS associated with benign prostatic hyperplasia (BPH), a survey was conducted to assess the perceptions of UROs and PCPs regarding sexual dysfunction (SD) in men with LUTS/BPH and the effects of BPH treatments (a 1 -adrenergic receptor antagonists (a-blockers) and 5a-reductase inhibitors (5ARIs)) on sexual function. The survey was mailed to 7500 UROs and 2500 PCPs, with 1275 (13%) surveys returned (1087 by UROs, 177 by PCPs and 11 by other specialty). a-Blocker monotherapy was the most common medication prescribed by both UROs (56%) and PCPs (47%). UROs estimated that 19% of their patients with LUTS/BPH experienced SD owing to their symptoms compared with the estimate of 27% by PCPs. UROs estimated that 19% of their patients experienced SD owing to their BPH medication compared with the PCP estimate of 24%. The incidence of EjD owing to BPH medications estimated by UROs (32%) was higher than that estimated by PCPs (22%); the rate of ED estimated by PCPs (34%) was higher than that estimated by UROs (23%). UROs were more aware than PCPs of the specific sexual side effects caused by a-blockers versus 5ARIs. These results suggest that physicians are underestimating the prevalence of SD in men with LUTS/BPH. As men with LUTS/ BPH are at increased risk for SD, physicians should be especially cognizant of BPH treatmentrelated sexual side effects.

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Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life

Cited by 78 publications

References 63 publications

PDE5 inhibitors beyond erectile dysfunction

PDE5 inhibitors beyond erectile dysfunction

Correlation between LUTS (AUA-SS) and erectile dysfunction (SHIM) in an age-matched racially diverse male population: data from the Prostate Cancer Awareness Week (PCAW)

Physician perceptions of sexual dysfunction related to benign prostatic hyperplasia (BPH) symptoms and sexual side effects related to BPH medications

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