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

ABSTRACT 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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    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 · 3.53 Impact Factor
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    ABSTRACT: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), or NIH category III prostatitis, is a common clinical syndrome characterized by genital/pelvic pain and lower urinary tract symptoms in the absence of urinary tract infection. There is also growing recognition of the association of sexual dysfunction with CP/CPPS including erectile dysfunction, ejaculatory pain, and premature ejaculation. In this review, we discuss the association between CP/CPPS and sexual dysfunction, potential mechanisms for sexual dysfunction, and treatment strategies for erectile dysfunction in CP/CPPS.
    World Journal of Urology 04/2013; 31(4). DOI:10.1007/s00345-013-1076-5 · 3.42 Impact Factor
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    ABSTRACT: ContextErectile dysfunction (ED) has progressively emerged as an important sentinel marker of cardiovascular and overall health among men. A timely and accurate diagnosis of ED may thus represent a significant opportunity both to diagnose the dysfunction per se and to identify comorbid and potentially life-threatening conditions.Objective To summarise the diagnostic evaluation of the man presenting with ED.Evidence acquisitionThe most recently developed European Association of Urology guidelines, International Society for Sexual Medicine recommendations, and standard operating procedures were analysed.Evidence summaryThe basic work-up for a man seeking help for ED should begin by considering that ED may share several modifiable and nonmodifiable common risk factors with cardiovascular disorders and other potentially life-threatening conditions. In this context, a comprehensive medical history should be taken for each patient including the assessment of current medications. A thorough sexual history should also be noted including information about age, sexual orientation, marital status, and sexual experience to gain a better understanding of the man's sexual ecology. Physical examination and laboratory tests for patients with ED are highly recommended but not always necessary. Recommended laboratory tests for men with ED typically include a fasting glucose and lipids profile if not assessed in the previous 12 mo. Hormonal tests must include a morning sample of total testosterone. Some patients may need specific diagnostic tests including the Rigiscan assessment of nocturnal penile tumescence and rigidity, a dynamic duplex ultrasound penile blood flow evaluation, a dynamic infusion cavernosometry or cavernosography, or an internal pudendal arteriography.Conclusions Most patients with ED can be adequately managed with a basic diagnostic work-up that includes a comprehensive medical and sexual history, along with a physical examination and some laboratory tests. Some selected patients may also need specific diagnostic tests.
    European Urology Supplements 06/2013; 12(2):7–12. DOI:10.1016/j.eursup.2013.03.001 · 3.37 Impact Factor