[Sexual dysfunctions linked with prostatic diseases].

Service d'Urologie de l'Hôpital Pitié-Salpêtrière, AP-HP, Université Paris VI, Faculté de médecine Pierre et Marie Curie, France, 83 Boulevard de l'Hôpital, 75013 Paris, France.
Progrès en Urologie (Impact Factor: 0.77). 06/2012; 22 Suppl 1:S14-20.
Source: PubMed

ABSTRACT The lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) and the treatment of prostate cancer (PCa) are linked to erectile dysfunction (ED). The objective of this work was to evaluate the influence of prostatic diseases on ED.
Data on the influence of BPH and PCa on ED have been explored in Medline and Embase using the MeSH keywords: benign prostatic hyperplasia, prostate cancer, prostatectomy, external beam radiotherapy; androgen deprivation therapy; erectile dysfunction. The articles were selected based on their methodology, relevance, date and language of publication.
The rate of ED in patients with BPH ranged from 30 to 70 %. The LUTS were an independent risk factor of ED. The pathophysiology linking BPH to ED has not been elucidated but seems to involve the path of Nitric Oxide - cyclic Guanosine Monophosphate (cGMP-No.), the RhoA - Rho - Kinase (ROCK) signal, the sympathetic autonomic nervous system and pelvic atherosclerosis. The rate of ED after radical prostatectomy (RP) ranged from 60 to 89 %. The bilateral preservation of neurovascular bundels improved these results. Risk factors of ED after RP were age, PSA levels, pretreatment erectile function and surgical technique. The rate of ED after prostate external beam radiotherapy ranged from 6 to 84 %. Risk factors of ED after external beam radiotherapy were age, pretreatment erectile function and association of androgen deprivation therapy. The rate of ED with androgen deprivation therapy was 85 %. Risk factors of ED with androgen deprivation therapy were age > 70 years, diabetes and pretreatment erectile function. Intermittent androgen deprivation therapy was associated with better results on erectile function than continue androgen deprivation therapy.
ED is responsible for a decrease of elderly patients life quality already affected by urinary symptoms and prostate disease progression. The development of drugs effective on both ED and BPH or PCa symptoms is then full of meaning.

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    ABSTRACT: Benign prostate hyperplasia (BPH) occurs in up to 50 % of men by age 50, and the incidence increases with age. The rate of erectile dysfunction (ED) in patients with BPH ranges from 30 to 70 %, but can be as high as 90.5 % in males aged over 50 years. BPH/lower urinary tract symptoms (LUTS) and sexual dysfunction (SD) can have a substantial negative impact on a man’s quality of life (QoL). Symptom severity and impact on QoL in each condition increase when LUTS and ED coexist. Age and erection change in patients with LUTS could also correlate with ejaculation dysfunction. However, urologists and primary care physicians appear to under-recognize SD in men with BPH/LUTS. We review the mechanisms of action, association, and effect of treatment between BPH and ED.
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    ABSTRACT: To investigate the correlation of histological prostatitis with sexual function (erectile dysfunction [ED]) and lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). A retrospective analysis of patients with BPH who received surgical treatment (from May 1, 2012 to November 30, 2012) was conducted, consisting of 80 patients with uncomplicated BPH and 80 patients with BPH plus histological prostatitis. The International Index of Erectile Function (IIEF-5) symptom score and the International Prostate Symptom Score (IPSS) before surgery were calculated. Preoperative sexual functions were compared between the 2 groups. Differences between both groups in age (72.56 ± 7.36 vs 71.98 ± 7.33) and IPSS score (18.65 ± 5.72 vs 20.50 ± 7.12) were not statistically significant (P >.05). Meanwhile, comparison in erectile function symptom score (14.80 ± 5.93 vs 7.35 ± 4.38) demonstrated significant differences (P <.001). According to the IIEF-5 score, 52 patients had normal erectile function or mild ED, 16 had moderate ED, and 12 had severe ED in the uncomplicated BPH group, whereas 10 patients had mild ED, 32 had moderate ED, 38 had severe ED, and no patients were found normal in BPH within the histological group. Further analysis using the chi-square test demonstrated significant differences between both groups (P <.001). BPH combined with histological prostatitis had a serious impact on sexual function of the patients. Histological prostatitis may serve as a major risk factor for sexual dysfunction while having little effects on LUTS in patients with BPH.
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    ABSTRACT: Erectile dysfunction (ED) is a common consequence of radical prostatectomy (RP) and can affect a man's long-term quality of life. Intraoperative manipulation of the neurovascular bundle causes neuropraxia with resultant fibrosis and trabecular smooth-muscle damage. Pioglitazone is an anti-diabetic agent with recognized antifibrotic and vasculoprotective properties, which can protect smooth muscle function. We hypothesize that post-RP pioglitazone therapy can help preserve erectile function.
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