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The Effect of LUTS/BPH and Treatments on Ejaculatory Function

  • Benign Prostatic Hyperplasia (K McVary, Section Editor)
  • Published:
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Abstract

As men age, there is an increased incidence of lower urinary tract symptoms (LUTS), often from benign prostatic hyperplasia (BPH) which can adversely affect sexual function. There are many different treatments for these symptoms; however, many of the treatments also affect sexual quality of life, specifically in the realm of ejaculation. Our paper will review the medications, surgical procedures, minimally invasive procedures, and even investigational procedures used to treat LUTS/BPH and the effect they have on ejaculation. The aim of this paper is to help practitioners counsel patients more effectively on treatment options when ejaculation is a concern.

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Abbreviations

BPH:

Benign prostatic hyperplasia

LUTS:

Lower urinary tract symptoms

5-AR:

5-Alpha reductase

PDE-5:

Phosphosiesterase 5

QOL:

Quality of life

IPSS:

International Prostate Symptom Score

IIEF:

International Index of Erectile Function

DHT:

Dihydrotestosterone

TURP:

Transurethral resection of the prostate

TUMT:

Transurethral microwave thermotherapy

TUNA:

Transurethral needle ablation

HoLAP:

Holmium laser ablation of the prostate

HoLEP:

Holmium laser enucleation of the prostate

RALP:

Robot-assisted laparoscopic prostatectomy

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Woo HH et al. Preservation of sexual function with the prostatic urethral lift: a novel treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Sex Med. 2012;9(2):568–75.

    Article  PubMed  Google Scholar 

  2. Erdemir F, Harbin A, Hellstrom WJ. 5-alpha reductase inhibitors and erectile dysfunction: the connection. J Sex Med. 2008;5(12):2917–24.

    Article  PubMed  Google Scholar 

  3. Radomski SB. Update on medical therapy for male LUTS. Can Urol Assoc J. 2014;8:S148–50. Canada.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sun J, Zhang X. Pharmacotherapy and herbal treatment of benign prostatic hyperplasia. Front Biosci (Landmark Ed). 2014;19:789–97. United States.

    Article  Google Scholar 

  5. Wein AJ et al. The impact of lower urinary tract symptoms on male sexual health: EpiLUTS. BJU Int. 2009;103 Suppl 3:33–41.

    Article  PubMed  Google Scholar 

  6. Li MK et al. An Asian multinational prospective observational registry of patients with benign prostatic hyperplasia, with a focus on comorbidities, lower urinary tract symptoms and sexual function. BJU Int. 2008;101(2):197–202.

    PubMed  Google Scholar 

  7. Martin DJ, Mulhall JP. Enlarging the scope of managing benign prostatic hyperplasia: addressing sexual function and quality of life. Int J Clin Pract. 2005;59(5):579–90.

    Article  CAS  PubMed  Google Scholar 

  8. Rosen R, Seftel A, Roehrborn CG. Effects of alfuzosin 10 mg once daily on sexual function in men treated for symptomatic benign prostatic hyperplasia. Int J Impot Res. 2007;19(5):480–5.

    Article  CAS  PubMed  Google Scholar 

  9. van Dijk MM, de la Rosette JJ, Michel MC. Effects of alpha(1)-adrenoceptor antagonists on male sexual function. Drugs. 2006;66:287–301. New Zealand.

    Article  PubMed  Google Scholar 

  10. Lowe FC. Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: sexual function. BJU Int. 2005;95 Suppl 4:12–8.

    Article  CAS  PubMed  Google Scholar 

  11. Giuliano F, Clement P. Pharmacology for the treatment of premature ejaculation. Pharmacol Rev. 2012;64(3):621–44.

    Article  CAS  PubMed  Google Scholar 

  12. Hellstrom WJ, Giuliano F, Rosen RC. Ejaculatory dysfunction and its association with lower urinary tract symptoms of benign prostatic hyperplasia and BPH treatment. Urology. 2009;74(1):15–21.

    Article  PubMed  Google Scholar 

  13. Kim MK et al. An open, non-comparative, multicentre study on the impact of alfuzosin on sexual function using the Male Sexual Health Questionnaire in patients with benign prostate hyperplasia. Int J Clin Pract. 2010;64:345–50. England.

    Article  CAS  PubMed  Google Scholar 

  14. Gacci M et al. Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis. J Sex Med. 2014;11(6):1554–66. This is a great article that covers many of the side effects and concerns with the medications dealing with ejaculatory dysfunction in LUTS/BPH.

    Article  CAS  PubMed  Google Scholar 

  15. Rosen RC, Fitzpatrick JM. Ejaculatory dysfunction in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. BJU Int. 2009;104(7):974–83.

    Article  PubMed  Google Scholar 

  16. Corona G et al. Perceived ejaculate volume reduction in patients with erectile dysfunction: psychobiologic correlates. J Androl. 2011;32(3):333–9.

    Article  CAS  PubMed  Google Scholar 

  17. Gacci M et al. Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2011;60(4):809–25.

    Article  PubMed  Google Scholar 

  18. Nix JW, Carson CC. Medical management of benign prostatic hypertrophy. Can J Urol. 2007;14 Suppl 1:53–7.

    PubMed  Google Scholar 

  19. Chapple CR. Pharmacological therapy of benign prostatic hyperplasia/lower urinary tract symptoms: an overview for the practising clinician. BJU Int. 2004;94:738–44. England.

    Article  PubMed  Google Scholar 

  20. Thiyagarajan M. alpha-Adrenoceptor antagonists in the treatment of benign prostate hyperplasia. Pharmacology. 2002;65:119–28. 2002 S. Karger AG, Basel: Switzerland.

    Article  CAS  PubMed  Google Scholar 

  21. Yoshimura K et al. A survey of the FAERS database concerning the adverse event profiles of alpha1-adrenoreceptor blockers for lower urinary tract symptoms. Int J Med Sci. 2013;10(7):864–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Welliver C et al. Impact of alpha blockers, 5-alpha reductase inhibitors and combination therapy on sexual function. Curr Urol Rep. 2014;15(10):441. This is another great paper dealing with all different types of sexual side effects of LUTS/BPH.

    Article  PubMed  Google Scholar 

  23. Yokoyama T et al. Effects of three types of alpha-1 adrenoceptor blocker on lower urinary tract symptoms and sexual function in males with benign prostatic hyperplasia. Int J Urol. 2011;18(3):225–30.

    Article  CAS  PubMed  Google Scholar 

  24. Sakata K, Morita T. Investigation of ejaculatory disorder by silodosin in the treatment of prostatic hyperplasia. BMC Urol. 2012;12:29.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Giuliano F. Impact of medical treatments for benign prostatic hyperplasia on sexual function. BJU Int. 2006;97 Suppl 2:34–8. discussion 44-5.

    Article  PubMed  Google Scholar 

  26. Kaplan SA et al. A 5-year retrospective analysis of 5alpha-reductase inhibitors in men with benign prostatic hyperplasia: finasteride has comparable urinary symptom efficacy and prostate volume reduction, but less sexual side effects and breast complications than dutasteride. Int J Clin Pract. 2012;66(11):1052–5.

    Article  CAS  PubMed  Google Scholar 

  27. Uckert S, Kuczyk MA, Oelke M. Phosphodiesterase inhibitors in clinical urology. Expert Rev Clin Pharmacol. 2013;6(3):323–32.

    Article  PubMed  Google Scholar 

  28. Giuliano F et al. Tadalafil once daily improves ejaculatory function, erectile function, and sexual satisfaction in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia and erectile dysfunction: results from a randomized, placebo- and tamsulosin-controlled, 12-week double-blind study. J Sex Med. 2013;10(3):857–65.

    Article  CAS  PubMed  Google Scholar 

  29. Suarez O et al. Mirabegron for male lower urinary tract symptoms. Curr Urol Rep. 2013;14(6):580–4.

    Article  PubMed  Google Scholar 

  30. Chung DE, Sandhu JS. Overactive bladder and outlet obstruction in men. Curr Urol Rep. 2011;12(1):77–85.

    Article  PubMed  Google Scholar 

  31. Otsuki H et al. Beta3-adrenoceptor agonist mirabegron is effective for overactive bladder that is unresponsive to antimuscarinic treatment or is related to benign prostatic hyperplasia in men. Int Urol Nephrol. 2013;45(1):53–60.

    Article  CAS  PubMed  Google Scholar 

  32. Calmasini FB et al. The beta-3 adrenoceptor agonist, mirabegron relaxes isolated prostate from human and rabbit: new therapeutic indication? Prostate. 2015;75(4):440–7. As new medications are being used to treat LUTS, it is helpful to know how they may affect sexual function and this article addresses that with mirabegron.

    Article  CAS  PubMed  Google Scholar 

  33. Cirino G et al. Involvement of beta 3-adrenergic receptor activation via cyclic GMP- but not NO-dependent mechanisms in human corpus cavernosum function. Proc Natl Acad Sci U S A. 2003;100:5531–6. United States.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Matsumoto R et al. Expression and functional role of beta3 -adrenoceptors in the human ureter. Int J Urol. 2013;20(10):1007–14.

    CAS  PubMed  Google Scholar 

  35. Nomiya M, Yamaguchi O. A quantitative analysis of mRNA expression of alpha 1 and beta-adrenoceptor subtypes and their functional roles in human normal and obstructed bladders. J Urol. 2003;170(2 Pt 1):649–53.

    Article  CAS  PubMed  Google Scholar 

  36. Liao CH, Kuo YC, Kuo HC. Predictors of successful first-line antimuscarinic monotherapy in men with enlarged prostate and predominant storage symptoms. Urology. 2013;81(5):1030–3.

    Article  PubMed  Google Scholar 

  37. Hofner K et al. Symptomatic and quality of life response to tolterodine in subgroups of men with overactive bladder symptoms and presumed non-obstructive benign prostatic hyperplasia. World J Urol. 2010;28(3):353–7.

    Article  CAS  PubMed  Google Scholar 

  38. Kaplan SA, Walmsley K, Te AE. Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol. 2005;174:2273–5. discussion 2275-6.

    Article  PubMed  Google Scholar 

  39. McVary KT et al. Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift. J Sex Med. 2014;11(1):279–87. This article looks at how anticholinergics effect sexual function in men while still helping to treat irratative symptoms of LUTS/BPH.

    Article  PubMed  Google Scholar 

  40. Barry MJ et al. Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of medicare-age men. J Clin Oncol. 2012;30:513–8. United States.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Zong HT et al. The impact of transurethral procedures for benign prostate hyperplasia on male sexual function: a meta-analysis. J Androl. 2012;33(3):427–34.

    Article  PubMed  Google Scholar 

  42. Spaliviero M et al. Does Greenlight HPS(™) laser photoselective vaporization prostatectomy affect sexual function? J Endourol. 2010;24(12):2051–7.

    Article  PubMed  Google Scholar 

  43. Mamoulakis C et al. Bipolar vs monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting. BJU Int. 2013;112(1):109–20.

    Article  PubMed  Google Scholar 

  44. Bruyere F. The relationship between photoselective vaporization of the prostate and sexual function. Curr Urol Rep. 2011;12(4):261–4.

    Article  PubMed  Google Scholar 

  45. Terrasa JB et al. Prospective, multidimensional evaluation of sexual disorders in men after laser photovaporization of the prostate. J Sex Med. 2013;10(5):1363–71.

    Article  PubMed  Google Scholar 

  46. Elshal AM et al. Male sexual function outcome after three laser prostate surgical techniques: a single center perspective. Urology. 2012;80(5):1098–104.

    Article  PubMed  Google Scholar 

  47. Meng F et al. Change of sexual function in patients before and after Ho:YAG laser enucleation of the prostate. J Androl. 2007;28(2):259–61.

    Article  PubMed  Google Scholar 

  48. Ponholzer A, Madersbacher S. Lower urinary tract symptoms and erectile dysfunction; links for diagnosis, management and treatment. Int J Impot Res. 2007;19(6):544–50.

    Article  CAS  PubMed  Google Scholar 

  49. Frieben RW et al. The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function: a systematic review. Asian J Androl. 2010;12:500–8. China.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Elhilali MM et al. Prospective, randomized, double-blind, vehicle controlled, multicenter phase IIb clinical trial of the pore forming protein PRX302 for targeted treatment of symptomatic benign prostatic hyperplasia. J Urol. 2013;189(4):1421–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Dixon CM et al. Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezum® system: evaluation of acute ablative capabilities in the human prostate. Res Rep Urol. 2015;7:13–8. This article gave a nice review of some newer therapies with steam that seems to be promising at this point.

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Urology, Southern Illinois University School of Medicine, 301 N 8th St—4th Floor, PO Box 19665, Springfield, IL, 62794-9665, USA

    Michelle Herberts & Tobias Köhler

  2. Park Nicollet Urology, Minneapolis, MN, USA

    Michael Butcher

Authors
  1. Michelle Herberts
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  2. Michael Butcher
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  3. Tobias Köhler
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Correspondence to Tobias Köhler.

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Conflict of Interest

Michelle Herberts and Michael Butcher each declare no potential conflicts of interest.

Tobias Köhler reports grants and personal fees from Boston Scientific.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Benign Prostatic Hyperplasia

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Herberts, M., Butcher, M. & Köhler, T. The Effect of LUTS/BPH and Treatments on Ejaculatory Function. Curr Urol Rep 17, 48 (2016). https://doi.org/10.1007/s11934-016-0604-4

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  • DOI: https://doi.org/10.1007/s11934-016-0604-4

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