The Challenge of Erectile Dysfunction in the Man with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk Q10-1, Cleveland, OH 44195, USA.
Current Urology Reports (Impact Factor: 1.51). 05/2012; 13(4):263-7. DOI: 10.1007/s11934-012-0254-0
Source: PubMed


Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), also known as NIH category III prostatitis, is common and has significant impact on quality of life through pain and lower urinary tract symptoms. A high proportion of men with CP/CPPS suffer from some form of sexual dysfunction including erectile dysfunction, premature ejaculation, and painful ejaculation. While well described, the pathophysiology of these sexual symptoms has not been well studied. This review will focus on what we know regarding the incidence and potential mechanisms for sexual dysfunction in CP/CPPS and discuss diagnostic and therapeutic options.

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    • "From a study that evaluated the prevalence, relevant factors, and effects of sexual dysfunction in primary care referral populations, sexual disorders (selfreported ED or ejaculatory difficulty or both) were reported by 72% of patients with CP/CPPS [11]. Similarly, in another questionnaire-based study (í µí±› = 1,765), Vienna men reported that NIH-CPSI score was the risk factor of ED (odds = 8.3) [10]. Unfortunately, while the NIH-CPSI contains items on pain, urination, and quality of life, it totally omits questions with regard to sexual dysfunction [12]. "
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    ABSTRACT: The purpose of the study is to evaluate the relationship between NIH-CPSI and IIEF-5 in Chinese men with CP/CPPS. A large cross-sectional and multicenter survey was conducted from July 2012 to January 2014. Men were recruited from urology clinics which were located at the five cities in China. All men participated in the survey by completing a verbal questionnaire (consisted of sociodemographics, past medical history, sexual history, and self-estimated scales). The results showed that 1,280 men completed the survey. Based on the CP/CPPS definition, a total of 801 men were diagnosed as having CP/CPPS. Men with CP/CPPS reported higher scores of NIH-CPSI and lower scores of IIEF-5 than men without CP/CPPS. NIH-CPSI scores were significantly negatively correlated with IIEF-5 scores. The total scores of NIH-CPSI were significantly more strongly correlated with question 5 than other questions of IIEF-5. The total scores of IIEF-5 were significantly more strongly correlated with pain symptoms scores of NIH-CPSI. Strongest correlation was found between QoL impact and question 5 of IIEF-5. The findings suggested that NIH-CPSI scores were significantly negatively correlated with IIEF-5 scores. Strongest correlation was found between QoL impact and question 5 of IIEF-5.
    08/2015; 2015(4):560239. DOI:10.1155/2015/560239
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    • "In the study, we found that three of the six domains, psychosocial, organ specific and tenderness of skeletal muscle, did exert a significant effect on the IIEF-5 score, suggesting that both organic and extraprostatic factors are all associated with the development of ED in CP/CPPS patients. Although the underlying mechanisms that exist between CP/CPPS and ED remains unclear, many factors can impact erectile functioning, including vascular deficiency, neuromuscular damage, and psychosocial difficulties [24], [25]. It has been suggested that CP/CPPS impairs patients' quality of life and causes mental distress, such as depression, that may be in turn the trigger for ED [26], [27]. "
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    ABSTRACT: Recent data showed that a six-domain UPOINT is a flexible and responsive new classification system that has the clinical applicability in CP/CPPS. However, the utility of UPOINT algorithm in men in China with CP/CPPS has not been comprehensively studied. For international validation and adoption, we evaluated this clinical phenotype system for a large cohort of Chinese CP/CPPS patients and correlated it with patient symptoms and erectile dysfunction (ED). We also investigated the addition of an ED domain in regard to symptom correlation. A total of 389 Chinese males with CP/CPPS were prospectively collected and classified in each domain of the UPOINT system. Symptom severity was measured using the NIH-CPSI and IPSS. The erectile function was evaluated using the IIEF-5. Clinically relevant associations were calculated. The percentage of patients positive for each domain was 54.0%, 42.1%, 41.9%, 20.8%, 26.7%, and 40.4% for the Urinary, Psychosocial, Organ-specific, Infection, Neurological/systemic, and Tenderness, respectively. There were significant correlations between the number of positive UPOINT domains and total NIH-CPSI (r = 0.706, p<0.001), IPSS (r = 0.682, p<0.001) and IIEF-5 scores (r = 0.631, P = 0.007) in Chinese cohort. Except for patients age, symptom duration was associated with a significantly greater number of positive domains (r = 0.638, P = 0.005). After adding an ED domain to create a modified UPOINT system, the correlation between the number of phenotypic domains and symptom severity was improved (0.706 to 0.844, p<0.001). The clinical applicability of using UPOINT phenotyping system has been validated in the Chinese patients with CP/CPPS. In our cohort, the number of positive domains was also correlated with ED symptoms and the significant association between the number of UPOINT domains and NIH-CPSI scores was further refined by adding a domain for ED. Our findings presented here support the utility of using ED as a stand-alone item in the UPOINT domain.
    PLoS ONE 01/2013; 8(1):e52044. DOI:10.1371/journal.pone.0052044 · 3.23 Impact Factor
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    ABSTRACT: Prostatitis is a spectrum of disorders that impacts a significant number of men. Acute bacterial prostatitis may be a life-threatening event requiring prompt recognition and treatment with antibiotic therapy. Chronic bacterial prostatitis has a more indolent course and also requires antibiotic therapy for resolution. Chronic prostatitis/chronic pelvic pain syndrome is the most common manifestation of prostatitis and may be the most difficult to treat. Asymptomatic inflammatory prostatitis is an incidental finding of unclear significance. Understanding the diagnostic and management strategies for each of these entities is critical for general practitioners in caring for their male patients.
    Australian family physician 04/2013; 42(4):216-9. · 0.71 Impact Factor
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