Impact of treatment of BPH on sexuality

Abstract

Benign prostatic hyperplasia (BPH) can have a profound affect on a patient's quality of life and sexual function and is considered by patients to be one of the most important aspects affected by the disease. Different treatments can produce a variable response in terms of the patient's quality of life, including sexual activity and satisfaction. Varying rates of erectile dysfunction (ED) and retrograde ejaculation following surgery for BPH have been reported. In general, the incidence of these side-effects is less after minimally invasive therapies, such as interstitial laser coagulation and transurethral microwave therapy, but the data available are limited. The lowest rates of sexual dysfunction are reported with medical therapies. The 5a-reductase inhibitor, finasteride, can result in ED in 5 -9% of patients and ejaculation disorders in 0.8 -2.0%. With the exception of tamsulosin, a 1 blockers are associated with a low rate of sexual dysfunction. No cases of ED have been reported with alfuzosin and abnormal ejaculation with terazosin or alfuzosin is negligible. Indeed, early research suggests a beneficial effect of a 1 blockers on sexual function. In addition to information on the efficacy of a particular therapy, patients should be informed of side effects, in particular those relating to sexual function, in order that they can make informed treatment decisions. Prostate Cancer and Prostatic Diseases (2001) 4, Suppl 1, S12-S16.

Terazosin in the Treatment of Premature Ejaculation: A Short-term Follow-up

“…However, these have been observed in therapeutic doses rarely [22,23]. The other important side effect of a blockers is impaired ejaculation or retrograde ejaculation.…”

Association of lower urinary tract symptoms and erectile dysfunction: pathophysiological aspects and implications for clinical management

“…73 There has been some speculation that a-blocker therapy may result in improvements in sexual function as a result of improvements in LUTS. Again, as was explained above, it is difficult to determine whether this treatment improves LUTS and subsequently ED, or whether the treatment targets both processes by targeting a shared pathophysiology.…”

Measurement of benign prostatic hyperplasia treatment effects on male sexual function

“…Even early studies measuring treatment outcomes after transurethral resection of the prostate reported on impotence and the obvious ejaculatory deficits after surgery 55. As electrocautery disrupts the integrity of the bladder neck and potentially scars the ejaculatory ducts, declines in ejaculatory function are extremely common with this approach (>50%),56 whereas subsequent erectile dysfunction is now rare (<5%) 57. With increasing knowledge of other potential sexual function deficits after surgical treatment, decreased libido and worsened satisfaction with sexuality 1 year after transurethral resection have also been demonstrated 58…”

“…In this literature, minimally invasive therapies seem to be less frequently associated with erectile or ejaculatory dysfunction 56,59. The effects of surgical and minimally invasive therapies vary for different aspects of male sexual function (see Table 1).…”