Enlarging the scope of managing benign prostatic hyperplasia: addressing sexual function and quality of life

Abstract

Benign prostatic hyperplasia is a common genitourinary disorder that increases in incidence with age. Symptoms of this condition include a weak urinary stream, hesitancy, intermittency and sensations of incomplete emptying, as well as frequency, urgency, urge incontinence and nocturia. These symptoms can be ameliorated successfully by a variety of medical treatments - such as alpha(1)-adrenergic blockade and 5-alpha-reductase inhibition - and surgical therapies - including transurethral resection of the prostate and less-invasive procedures. However, many of the treatments are known to result in sexual dysfunction, which can have a negative impact on the patient's quality of life. This must be considered when the physician seeks to determine the appropriate treatment for an individual patient. Current reports suggest that alpha(1)-adrenergic blockade is most likely to improve lower urinary tract symptoms while resulting in the fewest sexual side-effects; 5-alpha-reductase inhibitors appear to be particularly appropriate in men with large prostates. Among surgical therapies, transurethral resection of the prostate remains the gold standard, but is associated with a high incidence of sexual side-effects, especially retrograde ejaculation. Transurethral incision of the prostate, which is an endoscopic procedure, may be as effective as transurethral resection, but results in fewer side-effects. Minimally invasive procedures, including laser ablation or resection of the prostate, transurethral microwave thermotherapy and transurethral needle ablation, are rapidly evolving technologies that have demonstrated promising results, at least in the short term.

Preservation of Sexual Function with the Prostatic Urethral Lift: A Novel Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

“…The link between severity of LUTS and sexual dysfunction has been well established [8,19–22]. To explore that relationship in this cohort, we performed regression analysis between SHIM and IPSS and between MSHQ‐EjD and IPSS.…”

“…Thus, the severity of EjD was significantly associated with the deterioration of sexual activity ( P < 0.0001) [10]. While EjD has been shown to affect sexual life, an even broader effect has been linked to ED: men with ED have a decreased likelihood of physical, emotional, and general happiness [8]. As ED contributes to anxiety, depression, loss of self‐esteem, and diminished quality of life [11,12], it follows that preserving erectile function after treatment for LUTS is important in maintaining or improving quality of life for patients.…”

“…Surgical treatments for BPH are also associated with an increased rate of sexual dysfunction. In its many manifestations, transurethral resection of the prostate (TURP) has an incidence of de novo postoperative ED ranging from 3.9% to 30% and de novo retrograde ejaculation of 7.7–89% [8,9]. Minimally invasive LUTS/BPH therapies also lead to compromised sexual function; transurethral microwave therapy and transurethral needle ablation result in a 3.1–7.5% ED rate and a 0–22% retrograde ejaculation rate [9].…”

“…Sexual function after treatment of LUTS is an important measure of patient satisfaction and is considered when evaluating treatment options [12]. Treatments that adversely affect sexual function, even with LUTS improvement, may negatively affect a patient's quality of life overall [8]. With so many aging men facing LUTS secondary to BPH who place a high value on an active sex life, a therapy that does not degrade sexual function would be a valuable addition to the LUTS treatment armamentarium.…”

Treatment satisfaction after 1 year high-power potassium-titanyl-phosphate photoselective vaporization of the prostate

“…In addition, the degree to which a patient is bothered by his symptoms becomes a factor in the treatment decision [22]. Therefore, measuring satisfaction with the therapy provides important outcome information from the patient's perspective, related to his or her experience with the therapy [7].…”