Treatment of lower urinary tract symptoms in benign prostatic hyperplasia and its impact on sexual function.
BACKGROUND
Benign prostatic hyperplasia (BPH) is a common disorder in older men and may be associated with lower urinary tract symptoms (LUTS) and sexual dysfunction. Men who present with symptomatic BPH and LUTS are at increased risk for sexual dysfunction, including erectile dysfunction (ED) and ejaculatory dysfunction (EjD).


OBJECTIVE
This review describes treatment options recommended by the 2003 American Urological Association (AUA) guideline panel for the relief of LUTS associated with BPH, with a focus on the effects of each treatment on ED and EjD.


METHODS
Relevant articles were identified via MEDLINE searches of all English-language articles published from January 1984 to January 2005 using the following search terms: benign prostatic hyperplasia and sexual dysfunction, lower urinary tract symptoms and sexual dysfunction, alfuzosin, doxazosin, terazosin, tamsulosin, dutasteride, finasteride, transurethral resection of prostate, erectile dysfunction, and ejaculatory dysfunction. Data on the effects of BPH treatments on sexual function were extracted from the articles and summarized. Because properly designed, adequately powered, direct-comparator studies have not yet been conducted, the AUA's report provides the most comprehensive analyses regarding the efficacy and safety of the current BPH treatment options.


RESULTS
LUTS are an independent risk factor for sexual dysfunction in aging men, even after controlling for age and comorbidities. Although surgery, minimally invasive therapies, and pharmacologic therapies can all improve LUTS and the peak urinary flow rate, some can cause or exacerbate ED (incidence rates: surgery, 10%; minimally invasive therapies, 1%-3%; pharmacologic monotherapy or combination therapy, 3%-10%) and EjD (incidence rates: surgery, 65%; minimally invasive therapies, 4%-16%; pharmacologic monotherapy or combination therapy, 0%-10%). Among pharmacologic therapies for BPH, the frequency of EjD appears to be greater with tamsulosin (10%) than with other alpha(1)-blockers (0%-1%) or the 5alpha-reductase inhibitor finasteride (4%), based on data from a single-arm meta-analysis conducted by the AUA.


CONCLUSIONS
Sexual function should be assessed and discussed with the patient when contemplating the appropriate management strategy for LUTS associated with BPH, as well as when evaluating the patient's response to treatment.
Brown University, Swansea Family Practice Group, Swansea, Massachusetts 02777, USA. martin_miner@brown.edu
Martin
M
Miner
Matt T
MT
Rosenberg
Michael A
MA
Perelman
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D007172:Erectile Dysfunction / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome; D014555:Urination Disorders / Q000150:complications / Q000628:therapy*
D000317:Adrenergic alpha-Antagonists