Sexuality is an important component of an individual’s sense of well-being and quality of life (QOL). In particular, male patients who present with urinary tract symptoms should be carefully evaluated for the presence of sexual disorders. All patients with lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) should be asked questions about sexual activity. Currently available questionnaires can assess this. The Male Sexual Health Questionnaire (MSHQ) was specifically developed and validated to assess the dimensions of male sexual function and is the only questionnaire that assesses in detail the components of ejaculation, namely delay, volume and force of ejaculation. This assessment will improve our knowledge about sexual symptoms associated with LUTS due to BPO. When choosing appropriate pharmacotherapy, the clinician must consider not only effective relief of the presenting symptoms but also the patient’s QOL, including sexual function and potential long-term outcomes, such as acute urinary retention and the need for surgical intervention. For men with LUTS and sexual dysfunction, an appropriate integrated management approach based on each patient’s symptoms and outcome objectives is warranted.

Although future research is required to determine the exact relationship between the association of LUTS and male sexual dysfunction, various mechanisms have been proposed based on current knowledge of the pathophysiology of these conditions.

Future endeavours should include consideration of the following:

  * The development of new uroselective α1-antagonists and agents that modify the NOS/cGMP/protein kinase G signalling pathway in the prostate, similar to current ED therapy. These drugs will reduce prostatic tone and increase smooth muscle relaxation. The influence of the NO/cGMP pathway in the bladder needs further exploration.

  * The effect of PDE-5 inhibitors, alone or in combination with other medications, on the severity of LUTS/BPO needs further study.

  * There is a need for long-term observational studies evaluating the benefit of selective and nonselective ET receptor antagonists on the contractile activity of the bladder, prostate and erectile tissues.

  * Further investigation of the suppressive effect of Rho-kinase inhibitors on contractile activity in LUTS, BPH and ED.

  * The hypothesis that both atherosclerosis-induced ischaemia and sympathetic nervous system over activity may act in a synergistic manner to increase the incidence of LUTS/BPO symptoms and its relationship to ED.

  * Further study of the pathophysiological mechanisms that are observed in the pathogenesis of LUTS, will likely open up new awareness of treatment.

  * It is recognized that men with BPH with reduced NOS activity to have increased Rho-kinase activity and autonomic hyperactivity. This needs further investigation.

  * Additionally, multidisciplinary studies are needed to confirm the association of LUTS/BPO and sexual dysfunction, as well as other common co-morbidities in aging men. The results of such studies provide valuable information on prevention of treatment options.

  * Combination therapy is likely to become the norm in LUTS/BPO associated with ED.

  * Assessment of benefits to sexual function and the monitoring of medication-related adverse effects in patients undergoing treatment for LUTS associated with BPO are important.

In summary, potentially important targets in LUTS/BPO-linked ED research include the vasculature, hormones, contractile and relaxant properties of smooth muscle, and NO bioavailability. Further molecular forms will be needed for genes, enzymes and receptors. Therapies that can inhibit proliferation of prostate stromal and glandular tissues and reduce the tone of prostatic smooth muscle are in need of further investigation. New therapies for BPH/LUTS may benefit men with ED. Overall, there still remains much basic research through to transitional clinical practice, in men’s health.

###

Written by
Serap Gur, MD, as part of Beyond the Abstract on http://UroToday.com.

Drugs. 68(2):209-229, 2008