Sexual dysfunction in male LUTS. M. Gacci Department of Urology, University of Florence
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1 Sexual dysfunction in male LUTS M. Gacci Department of Urology, University of Florence Roma, June, 2015
2 Cross-sectional population-based study of 4800 men (40 79 yr of age) UK, Netherlands, France, Korea currently having ED consulted a doctor for this reason Boyle P, BJU Int 2003
3 Proportion of men with enlarged prostate and their spouses reporting specific relationship concerns Moderate-to-severe LUTS can adversely affect important areas of personal relationships Men with mild symptoms (n=216) Men with moderate-to-severe symptoms (n=203) Spouses of men with enlarged prostate (n=77) Lack of physical intimacy Anger or conflict Avoidance or withdrawal A feeling of distance or isolation Lack of communication Measured through questionnaire-based survey: EP in American Men Survey Roehrborn C, Prostate Can Prost. Dis
4 GENERAL population based studies BPH /ED population based studies 20 70% of men have ED 44 90% of men have LUTS % of men with LUTS have ED 8 26% of men with ED have LUTS Gacci M et al; Eur Urol 2011; ;60(4):809-25
5 % of men who have erections US and six European countries surveys were mailed out, were completed and returned, and analyzed Sexual dysfunction is strongly related to both age and severity of BPH symptoms 50% of men years with moderate LUTS have erectile dysfunction Age cohort No, I cannot get an erection Net reduction in stiffness years years years LUTS severity years years Adapted from Rosen R at al; Eur Urol. 2003; 44(6):637-49
6 Adapted from Rosen R at al; Eur Urol. 2003; 44(6):637-49
7 MetS & Prostate Hammarsten J et al; Prostate Can & Pros Dis, 1998; 1(3):
8 MetS & ED Multicenter, cross-sectional, study in 2238 men with T deficiency (1094 subjects with MetS) Garcia Cruz E et al; J Sex Med 2013; 10(10):
9 MetS & LUTS 271 consecutive men treated with OP in two tertiary referral centers for LUTS/BPH. Gacci M. at al; Prostate Can Prost Dis 2013; 16(1):101-6
10 MetS & LUTS 271 consecutive men treated with OP in two tertiary referral centers for LUTS/BPH. 60cc 45mm Gacci M. at al; Prostate Can Prost Dis 2013; 16(1):101-6
11 MetS, LUTS and Inflammation A multi-center cohort of BPH patients (n = 244) + effects of MetS insults on (hbph) Vignozzi L, Gacci M; Prostate Sep;73(13):
12 Inflammatory Score MetS, LUTS & ED: Inflammation 44 Pts treated with OP/TURP for persistent severe LUTS, refractory to medical treatment Placebo PDE5-I Placebo PDE5-I without MetS With MetS Vignozzi L, Gacci M; Prostate 2013; 73(8):
13 CDU: Color doppler ultrasound Lotti et al: Asian j Urol 2014
14 IPSS total score 171 infertile subjects, mean age 36.5±8.3 years Age-Adj.r= p< <22 (192) (30) (17) IIEF erectile function score Lotti A, Andrology, 2013
15 Prostate volume (ml) Lotti A, Andrology, infertile subjects, mean age 36.5±8.3 years p for trend at ANOVA < Waist ( 102 cm) Glycemia ( 6.1 mmol/l)/t HDL (<1.03 mmol/l)/t Triglycerides ( 1.7 mmol/l)/t Blood Pressure ( 130/85 mmhg)/t 0 (76) 1 (47) 2 (26) 3 (16) Number of MetS components 4 (6) Prostate volume (ml)
16 Cross-sectional multicenter survey on 3369 community-dwelling men (mean age 60y) Corona G et al et al; J Sex Med 2010; 7(4 Pt 1):
17 BPH /LUTS ED CVD Adapted from Gacci M et al. Eur Urol 2011; 60:
18 MetS & ED Liu, Int J Impot Res 2014
19 MetS & ED Overall RR: 1,60 (1,27-2,02) Liu, Int J Impot Res 2014
20 MetS & BPE Gacci M, Corona G, BJU Int 2015
21 MetS & BPE Total prostate volume mean differences (ml) 1.80 (> 30mL: 2.13) Gacci M, Corona G, BJU Int 2015
22 MetS & BPE AGE Waist HDL-C Gacci M, Corona G, BJU Int 2015
23 Peak systolic velocity (cm/sec) Increased WC is associated to more severe ED and worst PCDU parameters Corona G, Asian Journal of Andrology (2014) 16,
24 A multi-center cohort of BPH patients (n = 378), 238 with MetS Gacci M et al, BJU Int 2015
25 IPSS TOTAL IPSS irritative Gacci M et al, BJU Int 2015 A multi-center cohort of BPH patients (n = 378), 238 with MetS PRE POST 0 PRE POST WC < 102 cm WC 102 cm WC < 102 cm WC 102 cm
26 Wang C et al; Diabetes Care 2011;34(7):
27 Ferrario C, J Clin Hypert, 2002 Ferrario C, J Clin Hypert, 2002
28 Tacklind J, Cochrane Library, 2012
29 Tacklind J, Cochrane Library, 2012
30 Larson TR, Urology Apr;61(4):692-8.
31 Singh DV, J Sex Med,2013
32 Singh DV, J Sex Med,2013
33 Mean Prostate Volume: 50 ml Casabè A, J Urol 2014
34 IPSS Mean Prostate Volume: 50 ml IIEF Casabè A, J Urol 2014
35 Eur Urol 2011 Curr Bladde Dys Rep 2013
36 160 men (pla) vs. 160 men (tad) 5 mg once daily for 12 wk Porst H. Eur Urol. 2011
37 Run-in placebo Basale Total IPSS 25 Placebo Tad 2,5 Tad 5,0 Tad 10,0 Tad 20,0 Estensione in aperto In aperto fino a variazione endpoint media (DS) -2,2 (5,3) Tad 5,0 Tad 5,0 Tad 5,0 Tad 5,0 Tad 5,0-2,5 (5,1) 0,2 (5,4) -0,2 (5,8) 0,8 (6,4) 20 Endpoint n=416 (LOCF) Mean IPSS Weeks men (69.9%) completed the 1-year, open-label extension period Donatucci BJU Int 2011
38 Placebo Tadalafil Overall (N=92) 2,5 mg (N=96) 5 mg (N=83) 10 mg (N=85) 20 mg (N=71) (N=427) IPSS total (n) Change: Week 0 - E -4,1±6,8-5,7±5,4-5,0±7,2-5,7±6,4-4,6±7,7-5,0±6,7 Change: Week 12 E -2,2±5,3-2,5±5,1 0,2±5,4-0,2±5,8 0,8±6,4-0,9±5,7 IPSS irritative(n) Change: Week 0 E -1,6±3,2-2,1±2,6-2,1±3,1-1,9±2,7-1,8±3,3-1,9±3,0 Change: Week 12 E -0,9±2,4-1,0±2,7-0,0±2,4 0,2±2,7 0,3±2,8-0,3±2,6 IPSS obstructive (n) Change: Week 0 - E -2,5±4,2-3,6±3,6-3,0±4,8-3,8±4,3-2,8±4,9-3,1±4,4 Change: Week 12 - E -1,3±3,6-1,6±3,1 0,2±3,4-0,5±3,6 0,4±4,2-0,6±3,6 Donatucci BJU Int 2011
39 Gacci M et al, Research & Rep 2013 Gacci M et al, Eur Urol 2012
40 IPSS Mean difference in IPSS: -2,8 (ALL) - 1,6 to - 4,1 (TADALAFIL) Reduction of both irritative (storage) an obstructive (voiding) LUTS Timing: 4 weeks (3/4) 12 weeks (1/4): (lasting 12 months) Dose dependent
41 IIEF PDE5-Is alone: +5,5 IIEF Mean difference in IIEF: + 5,5 (ALL) + 4,0 PDE5-Is + α-blocker: +3,6 IIEF to 6,9 (TADALAFIL)
42 BPH + ED Placebo (N = 105), Tadalafil 5 mg (N = 106), Tamsulosin 0.4 mg (N = 99) International Index of Erectile Function - Orgasmic Function IIEF-Question 9 (IIEF-Q9) (ejaculatory frequency) IIEF-Question 10 (IIEFQ10) (orgasmic frequency) Giuliano F; J Sex Med 2013
43 Gacci M & Maggi M, j Sex Med, 2014
44 Alpha blocker vs. Placebo 5 ARI vs. Placebo OR 7.03 OR 2.90 Gacci M & Maggi M, j Sex Med, 2014
45 Combination Vs. Alpha blocker Combination Vs. 5 ARI OR: 4,7-3,3 Gacci M & Maggi M, j Sex Med, 2014
46 TAKE HOME MESSAGE: Epidemiology Trends in age-standardised BMI between 1980 and 2008 in adults 20 yr or older Finucane MM et al., Lancet. 2011;377:557-67
47 TAKE HOME MESSAGE: Pathophysiology LUTS /BPE Adapted from Gandaglia G et al; Eur Urol 2013; E-Pub ahead of print
48 TAKE HOME MESSAGE: Co-Diagnosis Kirby M et al; Int J Clin Prat 2013; 67(7):606-18
49 TAKE HOME MESSAGE: Treatments Drug Age ED LUTS Comorbidities Pool «American» billiard Five-pin «Italian» billiard
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