Current Urology Reports

, Volume 11, Issue 4, pp 228–235 | Cite as

Sexual Impact of Treatment of Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia



Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) and the treatment of these conditions are commonly associated with sexual dysfunction. The effects on sexual function of common medical and surgical therapies used in the treatment of LUTS/BPH are reviewed. Also discussed is the emerging use of phosphodiesterase inhibitors in the treatment of LUTS/BPH.


Lower urinary tract symptoms Benign prostatic hyperplasia Retrograde ejaculation Erectile dysfunction Alpha-1-adrenergic antagonist 5-alpha-reductase inhibitor Phosphodiesterase inhibitor Prostate photovaporization Holmium laser enucleation of the prostate Transurethral resection of the prostate Open prostatectomy 


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

  1. 1.
    American Urological Association: AUA Guidelines on Management of Benign Prostatic Hyperplasia, 2003, revision 2006. Chapter 3. Available at Accessed February 2010.
  2. 2.
    Price DT, Schwinn DA, Lomasney JW, et al.: Identification, quantification, and localization of mRNA for three distinct alpha 1 adrenergic receptor subtypes in human prostate. J Urol 1993, 150:546–551.PubMedGoogle Scholar
  3. 3.
    Roehrborn CG: Efficacy of alpha-adrenergic receptor blockers in the treatment of male lower urinary tract symptoms. Rev Urol 2009, 11(Suppl 1):S1–S8.PubMedGoogle Scholar
  4. 4.
    Hellstrom WJ, Sikka SC: Effects of acute treatment with tamsulosin versus alfuzosin on ejaculatory function in normal volunteers. J Urol 2006, 176:1529–1533.CrossRefPubMedGoogle Scholar
  5. 5.
    Nagai A, Hara R, Yokoyama T, et al.: Ejaculatory dysfunction caused by the new α-blocker silodosin: A preliminary study to analyze human ejaculation using color Doppler ultrasonography. Int J Urol 2008, 15:915–918.CrossRefPubMedGoogle Scholar
  6. 6.
    Hisasue S, Furuya R, Itoh N, et al.: Ejaculatory disorder caused by α-1 adrenoceptor antagonists is not retrograde ejaculation but a loss of seminal emission. Int J Urol 2006, 13:1311–1316.CrossRefPubMedGoogle Scholar
  7. 7.
    Kobayashi K, Masumori N, Hisasue S, et al.: Inhibition of seminal emission is the main cause of anejaculation induced by a new highly selective α1A-blocker in normal volunteers. J Sex Med 2008, 5:2185–2190.CrossRefPubMedGoogle Scholar
  8. 8.
    Goldstein I: Oral phentolamine: an alpha-1, alpha-2 adrenergic antagonist for the treatment of erectile dysfunction. Int J Impot Res 2000, 12(Suppl 1):S75–S80.CrossRefGoogle Scholar
  9. 9.
    Kirby RS, Roehrborn C, Boyle P, et al.: Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology 2003, 61:119–126.CrossRefPubMedGoogle Scholar
  10. 10.
    Lepor H, Williford WO, Barry MJ, et al.: The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N Engl J Med 1996, 335:533–539.CrossRefPubMedGoogle Scholar
  11. 11.
    van Kerrebroeck P, Jardin A, Laval KU, van Cangh P: Efficacy and safety of a new prolonged release formulation of alfuzosin 10 mg once daily versus alfuzosin 2.5 mg thrice daily and placebo in patients with symptomatic benign prostatic hyperplasia. ALFORTI Study Group. Eur Urol 2000, 37:306–313.CrossRefPubMedGoogle Scholar
  12. 12.
    Van Kerrebroeck P, Jardin A, van Cangh P, et al.: Long-term safety and efficacy of a once-daily formulation of alfuzosin 10 mg in patients with symptomatic benign prostatic hyperplasia: Open-label extension study. Eur Urol 2002, 41:54–60.CrossRefGoogle Scholar
  13. 13.
    Elhilali M, Emberton M, Matzkin H, et al.: Long-term efficacy and safety of alfuzosin 10 mg once-daily: A 2-year experience in “real-life” practice. BJU Int 2006, 97:513–519.CrossRefPubMedGoogle Scholar
  14. 14.
    Narayan P, Tewari A: A second phase III multicenter placebo controlled study of 2 dosages of modified release tamsulosin in patients with symptoms of benign prostatic hyperplasia. United States 93-01 Study Group. J Urol 1998, 160:1701–1706.CrossRefPubMedGoogle Scholar
  15. 15.
    Narayan P, Lepor H: Long-term, open-label, phase III multicenter study of tamsulosin in benign prostatic hyperplasia. Urology 2001, 57:466–470.CrossRefPubMedGoogle Scholar
  16. 16.
    Höfner K, Claes H, De Reijke TM, et al.: Tamsulosin 0.4 mg once daily: effect on sexual function in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. Eur Urol 1999, 36:335–341.CrossRefPubMedGoogle Scholar
  17. 17.
    Marks LS, Gittelman MC, Hill LA, et al.: Rapid efficacy of the highly selective alpha1A-adrenoceptor antagonist silodosin in men with signs and symptoms of benign prostatic hyperplasia: pooled results of 2 phase 3 studies.. J Urol 2009, 181:2634–2640.CrossRefPubMedGoogle Scholar
  18. 18.
    Kawabe K, Yoshida M, Homma Y: Silodosin, a new alpha1A-adrenoceptor-selective antagonist for treating benign prostatic hyperplasia: results of a phase III randomized, placebo-controlled, double-blind study in Japanese men. BJU Int 2006, 98:1019–1024.CrossRefPubMedGoogle Scholar
  19. 19.
    Andriole G, Bruchovsky N, Chung LW, et al.: Dihydrotestosterone and the prostate: the scientific rationale for 5alpha-reductase inhibitors in the treatment of benign prostatic hyperplasia. J Urol 2004, 172:1399–1403.CrossRefPubMedGoogle Scholar
  20. 20.
    Marberger MJ: Long-term effects of finasteride in patients with benign prostatic hyperplasia: a double-blind, placebo-controlled, multicenter study. PROWESS Study Group. Urology 1998, 51:677–686.Google Scholar
  21. 21.
    Roehrborn CG, Boyle P, Nickel JC, et al.: Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 2002, 60:431–441.CrossRefGoogle Scholar
  22. 22.
    Roehrborn CG, Marks LS, Fenter T, et al.: Efficacy and safety of dutasteride in the four-year treatment of men with benign prostatic hyperplasia. Urology 2004, 63:709–715.CrossRefPubMedGoogle Scholar
  23. 23.
    McVary KT, Roehrborn CG, Kaminetsky JC, et al.: Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology 2007, 177:1401–1407.CrossRefGoogle Scholar
  24. 24.
    • Roehrborn CG, McVary KT, Elion-Mboussa A, Viktrup L: Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a dose finding study. J Urol 2008, 180:1228–1234. This excellent follow-up study to McVary et al. 2007 redemonstrates the efficacy of PDE5Is over placebo and provides useful clinical information regarding appropriate dosing.CrossRefPubMedGoogle Scholar
  25. 25.
    Bechara A, Romano S, Casabé A, et al.: Comparative efficacy assessment of tamsulosin vs. tamsulosin plus tadalafil in the treatment of LUTS/BPH. Pilot study. J Sex Med 2008, 5:2170–2178.CrossRefPubMedGoogle Scholar
  26. 26.
    Liguori G, Trombetta C, De Giorgi G, et al.: Efficacy and safety of combined oral therapy with tadalafil and alfuzosin: an integrated approach to the management of patients with lower urinary tract symptoms and erectile dysfunction. Preliminary report. J Sex Med 2009, 6:544–552.CrossRefPubMedGoogle Scholar
  27. 27.
    Kaplan SA, Roehrborn CG, Rovner ES, et al.: Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. JAMA 2006, 296:2319–2328. (Published erratums appear in JAMA 2007, 297:1195 and JAMA 2007, 298:1864.)CrossRefPubMedGoogle Scholar
  28. 28.
    Bent S, Kane C, Shinohara K, et al.: Saw palmetto for benign prostatic hyperplasia. N Engl J Med 2006, 354:557–566.CrossRefPubMedGoogle Scholar
  29. 29.
    Debruyne F, Koch G, Boyle P, et al.: Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study.. European Urology 2002, 41:497–506.CrossRefPubMedGoogle Scholar
  30. 30.
    Muntener M, Aellig S, Kuettel R, et al.: Sexual function after transurethral resection of the prostate (TURP): results of an independent prospective multicentre assessment of outcome. Eur Urol 2007, 52:510–515. (Published erratum appears in Eur Urol 2008, 53:456.)CrossRefPubMedGoogle Scholar
  31. 31.
    Poulakis V, Ferakis N, Witzsch U, et al.: Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms: results from a center with over 500 patients. Asian J Androl 2006, 8:69–74.CrossRefPubMedGoogle Scholar
  32. 32.
    • Jaidane M, Arfa NB, Hmida W, et al.: Effect of transurethral resection of the prostate on erectile function: a prospective comparative study. Int J Impot Res 2010, 22:146–151. This unusual and useful study used TURBT as a sham study for comparison with TURP and its effects on erectile function.CrossRefPubMedGoogle Scholar
  33. 33.
    Arai Y, Aoki Y, Okubo K, et al.: Impact of interventional therapy for benign prostatic hypertrophy on quality of life and sexual function: a prospective study. J Urol 2000, 164:1206–1211.CrossRefPubMedGoogle Scholar
  34. 34.
    Kavoussi PK, Hermans MR: Maintenance of erectile function after photoselective vaporization of the prostate for obstructive benign prostatic hypertrophy. J Sex Med 2008, 5:2669–2671.CrossRefPubMedGoogle Scholar
  35. 35.
    Paick JS, Um JM, Kim SW, Ku JH: Influence of high-power potassium-titanyl-phosphate photoselective vaporization of the prostate on erectile function: a short-term follow-up study. J Sex Med 2007, 4:1701–1707.CrossRefPubMedGoogle Scholar
  36. 36.
    Wilson LC, Gilling PJ, Williams A, et al.: A randomized trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol 2006, 50:569–573.CrossRefPubMedGoogle Scholar
  37. 37.
    Briganti A, Naspro R, Gallina A, et al.: Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. J Urol 2006, 175:1817–1821.CrossRefPubMedGoogle Scholar
  38. 38.
    Serretta V, Morgia G, Fondacaro L, et al.: Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990 s: A contemporary series of 1800 interventions. Urology 2002, 60:623–627.CrossRefPubMedGoogle Scholar
  39. 39.
    Gacci M, Bartoletti R, Figlioli S, et al.: Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study. BJU Int 2003, 91:196–200.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of UrologySouthern Illinois University School of MedicineSpringfieldUSA

Personalised recommendations