LUTS and ED a new interest of urological andrology0_9.doc
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LUTS and ED: a new interest of urological andrology
Run Wang, MD, FACS
Associate Professor
Departments of Urology, University of Texas Medical School at Houston and University of Texas MD Anderson Cancer Center, 6431 Fannin Street, MSB 6.018,Houston, Texas 77030, USA
Tel: 713-500-7337, Fax: 713-500-7319
E-mail. Run.Wang@uth.tmc.edu
Abstract
The relationship of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) is a new interest in urological-andrology practice.Recent epidemiology studies have clearly shown the close relationship between LUTS and male ED. LUTS and ED are both para-aging phenomena. The international prostate symptom score (IPSS) and the international index of erectile function (IIEF) are inversely related in each age group. Studies also show that LUTS maybe an age-independent predictor of ED and the presence of LUTS not only increases the likelihood of developing ED, but the severity of LUTS is also associated with the intensity of ED.Proposed common pathophysiologic links between these two conditions include α-1 adrenergic receptor imbalance, Rho-kinase overactivity, endothelial cell dysfunction, and atherosclerosis-induced ischemia. Medical therapy has replaced surgery as the first-line treatment for LUTS in most patients, with the incorporation of α-adrenergic receptor antagonists (α-ARAs) and 5-alpha-reductase inhibitors (5-ARIs) into everyday practice; treatment with α-ARAs has shown some improvement in ED, while use of 5-ARIs results in worsened sexual function in some patients.Phosphodiesterase-5 (PDE-5) inhibitors have revolutionized the treatment of ED with a simple oral regimen, and new insights demonstrate a benefit of combined use of PDE5 inhibitors and α-ARAs.The mechanisms of action of these medications support these observed benefits, and they are being studied in the basic science and clinical settings.The minimally invasive and surgical treatments for LUTS are known to have adverse effects on ejaculatory function, while their effects on erectile function are still debated. In addition, novel mechanisms for therapy have been proposed based on clinical and research observations.Much remains to be investigated, but it is clear that the associations between LUTS and ED lay the foundation for future treatment and possible prevention of both conditions. This presentation will review current available evidences related to the optimal management of ED and LUTS with minimal side-effects.
LUTS and ED: a new interest of urological andrology
Run Wang, MD, FACS
Associate Professor
Departments of Urology, University of Texas Medical School at Houston and University of Texas MD Anderson Cancer Center, 6431 Fannin Street, MSB 6.018,Houston, Texas 77030, USA
Tel: 713-500-7337, Fax: 713-500-7319
E-mail. Run.Wang@uth.tmc.edu
Abstract
The relationship of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) is a new interest in urological-andrology practice.Recent epidemiology studies have clearly shown the close relationship between LUTS and male ED. LUTS and ED are both para-aging phenomena. The international prostate symptom score (IPSS) and the international index of erectile function (IIEF) are inversely related in each age group. Studies also show that LUTS maybe an age-independent predictor of ED and the presence of LUTS not only increases the likelihood of developing ED, but the severity of LUTS is also associated with the intensity of ED.Proposed common pathophysiologic links between these two conditions include α-1 adrenergic receptor imbalance, Rho-kinase overactivity, endothelial cell dysfunction, and atherosclerosis-induced ischemia. Medical therapy has replaced surgery as the first-line treatment for LUTS in most patients, with the incorporation of α-adrenergic receptor antagonists (α-ARAs) and 5-alpha-reductase inhibitors (5-ARIs) into everyday practice; treatment with α-ARAs has shown some improvement in ED, while use of 5-ARIs results in worsened sexual function in some patients.Phosphodiesterase-5 (PDE-5) inhibitors have revolutionized the treatment of ED with a simple oral regimen, and new insights demonstrate a benefit of combined use of PDE5 inhibitors and α-ARAs.The mechanisms of action of these medications support these observed benefits, and they are being studied in the basic science and clinical settings.The minimally invasive and surgical treatments for LUTS are known to have adverse effects on ejaculatory function, while their effects on erectile function are still debated. In addition, novel mechanisms for therapy have been proposed based on clinical and research observations.Much remains to be investigated, but it is clear that the associations between LUTS and ED lay the foundation for future treatment and possible prevention of both conditions. This presentation will review current available evidences related to the optimal management of ED and LUTS with minimal side-effects.