Physician perceptions of sexual dysfunction related to benign prostatic hyperplasia (BPH) symptoms and sexual side effects related to BPH medications

Abstract

In a large-scale epidemiology study, 50% of aging men reported erectile dysfunction (ED) or ejaculatory dysfunction (EjD), with lower urinary tract symptoms (LUTS) an independent risk factor for each of these conditions. In light of the shift from urologists (UROs) to primary care/ internal medicine physicians (PCPs) for the initial management of men with LUTS associated with benign prostatic hyperplasia (BPH), a survey was conducted to assess the perceptions of UROs and PCPs regarding sexual dysfunction (SD) in men with LUTS/BPH and the effects of BPH treatments (a 1 -adrenergic receptor antagonists (a-blockers) and 5a-reductase inhibitors (5ARIs)) on sexual function. The survey was mailed to 7500 UROs and 2500 PCPs, with 1275 (13%) surveys returned (1087 by UROs, 177 by PCPs and 11 by other specialty). a-Blocker monotherapy was the most common medication prescribed by both UROs (56%) and PCPs (47%). UROs estimated that 19% of their patients with LUTS/BPH experienced SD owing to their symptoms compared with the estimate of 27% by PCPs. UROs estimated that 19% of their patients experienced SD owing to their BPH medication compared with the PCP estimate of 24%. The incidence of EjD owing to BPH medications estimated by UROs (32%) was higher than that estimated by PCPs (22%); the rate of ED estimated by PCPs (34%) was higher than that estimated by UROs (23%). UROs were more aware than PCPs of the specific sexual side effects caused by a-blockers versus 5ARIs. These results suggest that physicians are underestimating the prevalence of SD in men with LUTS/BPH. As men with LUTS/ BPH are at increased risk for SD, physicians should be especially cognizant of BPH treatmentrelated sexual side effects.

Beneficial effects of testosterone administration on symptoms of the lower urinary tract in men with late-onset hypogonadism: A pilot study

“…The results of pilot studies [21,22] also showed positive effects of testosterone undecanoate therapy on LUTS in men with LOH. If indeed testosterone treatment improves Table I symptoms of LUTS, this would benefit patients since pharmacological treatment of LUTS (a1-adrenergic receptor antagonists and 5a-reductase inhibitors) often leads to sexual complaints [23]. And testosterone appears to have a wide range of effects in hypogonadal elderly men, such as on features of metabolic syndrome, mood, erectile function and anabolic effects on muscle and bone.…”

Male lower urinary tract symptoms: how do symptoms guide our choice of treatment?

“…In addition, IPSS has no ability to identify symptoms related to erectile dysfunction. Recently, a survey revealed that physicians underestimate the prevalence of sexual dysfunction in men with LUTS/BPH [32]. Urologists should inquire about possible coexistence of erectile dysfunction in men seeking treatment for LUTS.…”

Benign prostatic hyperplasia evaluation, association with sexual dysfunction, treatment, and practice patterns according to physician specialty

“…Several studies have examined the practice patterns of PCPs in the management of BPH and indicate that a signifi cant percentage were not following published guidelines prior to the most recent AUA guidelines, differing from urologists [36][37][38]. This discrepancy continued after the release of the AUA guidelines, with urologists being twice as likely to use AUASI (81% to 41%) as part of their initial evaluation [39,40].…”