Prostate disease is a major disease that affects men’s health. It mainly includes prostate enlargement and prostatitis. In terms of men’s health, both of these diseases are closely related to sexual dysfunction, which is a major concern for men. Now we will talk about the relationship between these two diseases and male sexual dysfunction respectively.
The relationship between prostate enlargement and sexual dysfunction
Prostatic hyperplasia and sexual dysfunction are both common diseases in aging men. In the previous view prostatic hyperplasia was not directly related to sexual function, but in recent years many epidemiological studies have confirmed the close relationship between benign prostatic hyperplasia and lower urinary tract symptoms (bladder irritation symptoms and bladder obstruction symptoms) and sexual function, including erectile dysfunction (ED) and ejaculatory dysfunction (EjD).
Ejaculatory dysfunction, decreased ejaculation volume and painful ejaculation were found to be closely associated with BPH/lower urinary tract symptoms. A study in the United States and Europe showed that 49% of men aged 50 to 80 years with lower urinary tract symptoms had a combination of ED. lower urinary tract symptoms were the strongest risk factor for ED compared to diabetes, hypertension, and heart disease. The study also suggested that ED, abnormal ejaculation and painful ejaculation are highly prevalent in patients with BPH with lower urinary tract symptoms, and these prevent patients from having a satisfactory sex life.
Thus, in the management of prostate disease and lower urinary tract symptoms, attention should be paid to the patient’s sexual dysfunction.
Several national and international studies have confirmed that there is a significant correlation between baseline prostate symptom indices and various aspects of sexual function, including libido, erectile function, ejaculatory status, and total sexual satisfaction; the maximum urinary flow rate is also correlated with male sexual function.
Patients with BPH often have a combination of prostate inflammation or ejaculatory duct obstruction, which may be the main cause of ejaculatory pain or discomfort. In addition, the above problems may also result from hypogonadism in older men, which reduces the production of androgen-dependent seminal fluid and significantly reduces semen volume.
Possible mechanisms
The sympathetic and parasympathetic nerves that innervate the bladder and prostate and the cavernous nerves that control penile erection both come from the pelvic plexus. Patients with BPH have manifestations of increased systemic or local sympathetic excitability: the systemic manifestation is mainly BPH with hypertension; the local manifestation is the dynamics that cause bladder outlet obstruction and lower urinary tract symptoms. The sympathetic nerve excitability that controls erection and ejaculation is also increased due to neurological homeostasis, leading to erectile difficulties and rapid ejaculation.
It has also been shown that there is a common pathophysiological basis between male prostate disease and sexual dysfunction: the disease may be caused by a combination of multiple factors such as decreased nitric oxide synthase (NOS)/nitric oxide (NO) release, and expression of Rho-kinase, which regulates the contractile signaling pathway in the smooth muscle cells of the penile corpus cavernosum.
Treatment principles
Nearly 90% of patients with benign prostatic hyperplasia require pharmacological treatment. The application of different drugs should follow the principles of clinical treatment of BPH. The short-term goal of drug therapy for BPH patients is to relieve the lower urinary tract symptoms, and the long-term goal is to delay the clinical progression of the disease and prevent comorbidities.
Surgical treatment should be chosen when there is.
1. intractable urinary retention ;
2. recurrent episodes of hematuria of the naked eye;
3. renal insufficiency;
4.Bladder stones;
5.Large bladder diverticulum;
6, recurrent urinary tract infections.
Prostatitis and sexual dysfunction relationship
Chronic prostatitis is a common disease in young and middle-aged men. In recent years there has been more epidemiological investigation literature on the onset of sexual dysfunction in patients with prostatitis, and the data shows that the erectile function and ejaculatory function of patients with prostatitis are significantly reduced.
This is a very good idea. The incidence of sexual dysfunction in patients with prostatitis combined with ED and ejaculatory dysfunction was significantly higher than in healthy people, and the sexual function of patients with prostatitis combined with sexual dysfunction improved significantly after treatment of prostatitis symptoms.
Possible mechanisms
Sexual dysfunction is closely related to psychological factors. The chronic inflammation in prostatitis can cause psycho-psychiatric disorders, and plant nerve dysfunction may also be closely related to sexual dysfunction.
The specific mechanism by which prostatitis leads to decreased sexual function is not well understood and needs to be further studied.
Treatment principles
The symptoms of prostatitis are the main factor affecting the sexual function of patients and also the quality of life and sex life of patients.
Since prostatitis is difficult to heal and there is a lack of effective treatment methods, measures to treat prostatitis should focus on the relief of patients’ clinical symptoms, including relief of pain and urinary symptoms, improvement of patients’ sexual function status and psychological status, in order to improve the quality of sexual life and quality of life of patients with prostatitis.
Pharmacological treatment of prostate disease combined with sexual dysfunction
So, can one drug be used to treat both diseases, or is a combination therapy used?
A receptor blocker for ED: One study reported that in patients with lower urinary tract symptoms due to benign prostatic hyperplasia, the use of alfuzosin 10 mg once daily for a total of 1 year resulted in significant improvement in those with pre-existing ED and EjD (decreased ejaculation volume and painful ejaculation), with particularly significant improvement in those with severe lower urinary tract symptoms.
PDE inhibitors and lower urinary tract symptoms: Some studies have reported that oral sildenafil improves the International Prostate Symptom Score (IPSS) and trouble scores in ED patients. Nitric oxide (NO) and phosphodiesterase type 5 (PDE-5) isoenzymes have now been detected in the human prostate, and lower urinary tract symptom symptoms may be improved by a mechanism that increases NO activity and promotes smooth muscle cell relaxation after sildenafil administration.
Combination of а receptor blockers and PDE inhibitors for lower urinary tract symptoms and ED: Given the close association between lower urinary tract symptoms and sexual dysfunction, the use of both drugs in the treatment of lower urinary tract symptoms with ED is increasing. Since both a-blockers and PDE-5 blockers have an effect on blood pressure, hemodynamic additive effects may occur when using them, and clinical use should be cautious.