Tuesday, September 18, 2012

Medical Management of Comorbid BPH/LUTS and ED: Defining the Current Treatment Algorithm part 1


Numerous epidemiologic studies have reported a strong association between benign prostatic hyperplasia–associated lower urinary tract symptoms (BPH/LUTS) and erectile dysfunction (ED) that is independent of age and other comorbidities.
LUTS and ED share common elements, including a multifactorial etiology and a possible biological link. Although a direct causal relationship is not yet established and the pathogenesis has not been completely elucidated, 4 pathophysiologic mechanisms potentially explain the relationship:
1- an alteration in nitric oxide bioavailability
2- α1-adrenergic receptor hyperactivity
3- pelvic atherosclerosis
4- sex hormones.
These pathophysiologic pathways have various clinical implications for the management of ED and LUTS. Clinicians should recognize that all men seeking care for ED should be screened for complaints of BPH/LUTS and vice versa. Furthermore, sexual function should be assessed and discussed with the patient when choosing the appropriate management strategy for BPH/LUTS as well as when evaluating the patient's response to treatment.
Clinicians need to be aware of the potential positive and negative effects on sexual function of all medical therapies for BPH/LUTS. No single therapy for BPH/LUTS is superior to another; physicians should consider individual patient factors, efficacy, tolerability, treatment-related AEs (eg, retrograde ejaculation, diminished libido, ED), cost, and patient preference. Furthermore, men seeking help for BPH/LUTS should be assessed for various aspects of sexual dysfunction and informed about the impact of medication and surgery on sexual health.
Upon completion of this activity, participants should be able to:
  1. Screen all men seeking care for benign prostatic hyperplasia–associated lower urinary tract symptoms (BPH/LUTS) for erectile dysfunction (ED) and vice versa
  2. Examine with patients the adverse effect (AE) profile of each therapy when deciding the appropriate management strategy for BPH/LUTS and evaluating the patient's treatment response
  3. Select therapeutic modalities with minimal AEs, particularly sexual AEs
  4. Integrate BPH/LUTS and ED treatment goals to improve quality of life and optimize health outcomes                                                                                                                                

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