[Sexual dysfunctions linked with prostatic diseases].
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.Current Bladder Dysfunction Reports