Treatments for BPH, LUTS Frequently Associated with Ejaculatory Dysfunction

Treatments for BPH, LUTS Frequently Associated with Ejaculatory Dysfunction

A new report published in the journal Translational Andrology and Urology explored previously published data to help clarify the impact of certain treatments for lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH), on ejaculatory function.

The study, by a trio of researchers from the Southern Illinois University School of Medicine, is titled “Ejaculatory Dysfunction In The Treatment Of Lower Urinary Tract Symptoms.

Several studies have documented the relationship between treatments for LUTS and sexual dysfunction, which can occur from erectile dysfunction (ED) or ejaculatory dysfunction (EjD). Ejaculatory dysfunction refers to any disturbance in ejaculation, each with a potentially different mechanism related to LUTS. It includes premature ejaculation, delayed ejaculation, retrograde ejaculation (the return of the semen into the urinary tract), anejaculation (absence of ejaculation), decreased force of ejaculation, and pain upon ejaculation.

“Treatment for LUTS includes observation, medical management, and surgical therapy,” the authors wrote in the report. “Either medical management or surgical therapy is recommended for those with moderate to severe LUTS both to improve quality of life and reduce the risk of disease progression. Unfortunately both options increase the risk of EjD”.

Medical treatments based on the use of α-blockers (action inhibitors of the hormone dihydrotestosterone produced in excess in BPH), which are commonly used to treat LUTS associated with BPH, frequently lead to anejaculation. Those included Flomax (tamsulosin) and Rapaflo (silodosin) which, although better tolerated, are more likely to be associated with EjD.

Studies testing the impact of other similar blockers, such as UroXatral (alfuzosin), Cardura (doxazosin), and Hytrin (terazosin), reported no significant differences among patients treated with these drugs or with a placebo, showing that they rarely induce EjD.

The use of drugs that inhibit the enzyme 5-alpha reductase (which produces dihydrotestosterone from testosterone), such as finasteride and dutasteride, can also be linked to the onset of EjD. According to the authors, BPH patients taking finasteride have a 4 percent adverse event rate of EjD compared to 1 percent in those taking placebo, which can increase with time. Dutasteride has been found to induce a rate of 2.2 percent in EjD.

Regarding finasteride, the U.S. Food and Drug Administration (FDA) ordered that all finasteride products should include information that advises patients of the risk of libido loss, erectile dysfunction, ejaculatory disorders, and other adverse sexual experiences. However, it is not clear whether treatment is indeed associated with EjD, and more studies are warranted to study this possible association.

For surgical treatments, the impact on ejaculation depends on which intervention is chosen, but surgery most often induces retrograde ejaculation. The most common surgical procedures — the transurethral resection of the prostate (TURP), the Holmium Laser Enucleation of the prostate (HoLEP) and photovaporization — have been associated with high rates of EjD in patients (65 percent or higher) despite the overall good quality of life of patients report after surgery. Other techniques, such as the Urolift and the recent Rezum System, are associated with lower or no rates of EjD.

Researchers believe “less invasive therapies may spare ejaculatory function but at the cost of reduced efficacy in relieving LUTS.”  They stress that patients should be thoroughly informed about the ejaculatory impact that certain BPH therapies may have.

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