Tuesday, September 18, 2012

Medical Management of Comorbid BPH/LUTS and ED: Defining the Current Treatment Algorithm part 7


DIFFICULT CASE OF TREATMENT CONSIDERATIONS FOR CONCOMITANT BPH/LUTS, ED, AND HYPOGONADISM

Jacob, a 74-year-old retiree, comes into the office for his routine physical and to ask about travel immunization; he and his wife are planning a 2-month cruise.
During the physical examination, the patient mentions "prostate trouble" and, upon further inquiry, reveals that he also has ED. He describes his energy level and his libido as low but attributes that to the aging process. Although his wife does not seem as interested in sexual activity as he is, he states, "We're not having sex now, but I was hoping to rekindle the old fire on this cruise."

This patient should be evaluated for what condition(s)?
ED
LUTS
Hypogonadism
All of the above

































A strong association between LUTS and ED that is independent of age and other comorbidities has been reported in numerous studies. Also well-recognized is the relationship between ED and hypogonadism, and evidence suggests that testosterone levels inversely correlate with ED severity.

Diagnosis

BPH/LUTS, ED, and hypogonadism

There is not total agreement on the threshold of testosterone value below which a man would be considered hypogonadal. (Currently there are no standards as to when to treat women.) Testosterone can be measured as "free" (that is, bioavailable and unbound) or more commonly, "total" (including the percentage which is chemically bound and unavailable). In the United States, male total testosterone levels below 300 ng/dL from a morning serum sample are generally considered low. Identification of inadequate testosterone in an aging male by symptoms alone can be difficult.



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