Impact of Management of Lower Urinary Tract Symptoms (LUTS) on Men Sexual Function

Objectives: Troublesome lower urinary tract symptoms (LUTS) and sexual dysfunction are common and often problematic in older men. We prospectively evaluated the effect of treatment of LUTS on sexual function. Material and Methods: In all, 167 men aged between 48 and 77 years with LUTS suggestive of benign prostatic hyperplasia (BPH) were enrolled in this study. In addition to routine diagnostic work up of BPH, only 136 patients were selected and assessed at baseline and three months after treatment by means of ICS sex questionnaire items concerned with erectile stiffness, ejaculatory volume, pain or discomfort on ejaculation and whether sex life was spoilt by urinary symptoms. Treatment modalities included surgical [Transure¬thral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), or open prostatectomy] and medical treatment (aj- blocker, doxazosin). Results: At the baseline assessment before BPH treatment, erectile dysfunction, abnormal ejaculatory volume, pain or discomfort on ejaculation and sex life spoilt by LUTS were observed in 63%, 60%, 31% and 50% patients respectively. Following treatment, erectile dysfunction was significantly improved (29.4%) after both surgical and medical treatment, with no significant difference between both treatment modal¬ities. All patients who underwent surgical treatment suffered from retrograde ejaculation except 50% of those treated by TUIP. Meanwhile, reduced ejaculation was reported in 32.8% of patients on medical treatment. Pain or discomfort on ejaculation and sex life spoilt by LUTS were observed after treatment in 12.5% and 32.4% of patients respectively. The overall sexual satisfaction was better in patients who were on medical treatment (78.1%) compared to those on surgical treatment (58.3%). Conclusion: Sexual dysfunction is strongly associated with LUTS. Therefore, sexual function should be carefully assessed in the initial evaluation of patients with LUTS and in deciding the appropriate treatment modality as it may have a negative impact on sexual life. However, a large scale multicenter randomized controlled study is now required to evaluate the different invasive and non- invasive surgical modalities and different medical treatment options on sexual function or patients complaining of BPH.