Sexual dysfunction is common in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), regardless of the type of CP/CPPS they have.
That was the conclusion of two studies presented here at the 2007 AUA annual meeting. Although the rates of sexual dysfunction in these patients need to be compared with those of healthy men in a controlled study and compared with rates before patients developed CP/CPPS symptoms, the studies show that these patients need urologists' help in treating their sexual dysfunction.
One particular study lends support to the idea that distinguishing between "inflammatory" and "noninflammatory" prostatitis isn't useful clinically.
In a study of male CP/CPPS patients, investigators from the University of Science Malaysia, Penang, found that 72% of men (216 of 298) with CP/CPPS reported experiencing sexual dysfunction. Based on responses to the International Index of Erectile Function-5 (IIEF) questionnaire and selected questions from the University of Washington Symptom Score, 25% of the men with sexual dysfunction had erectile dysfunction only, 33% had ejaculatory dysfunction only, and 42% had both.
Men with sexual dysfunction had worse CP/CPPS symptoms, with a total NIH-Chronic Prostatitis Symptom Index (CPSI) score averaging 22.4+6.9 (vs. 20.4+7.8; p=.027), and worse quality of life scores, with an average subscore of 8.5+2.7 (vs. 7.7+2.7; p=.01) than did patients who did not have sexual dysfunction.
Men with both erectile and ejaculatory dysfunction experienced worse CP/ chronic prostatitis / chronic pelvic pain syndrome symptoms, with a statistically significant difference in their total (p=.042) and QoL CPSI score (p=.006).
"This brings us to suggest that in the future, sexual function should be used as a secondary outcome measure for future CP/CPPS studies," said first author Shaun W.H. Lee, PhD, from the school of pharmacy, University of Science Malaysia.
In a similar study of 134 men with CP/CPPS from Justus Liebig University in Giessen, Germany, 35 were identified as having type IIIA (inflammatory) prostatitis and 99 were identified as having type IIIB (non-inflammatory) prostatitis. Among all participants, 63 (47%) had erectile dysfunction on the basis of an IIEF score of 25 or more. Seven men had no sexual activity. The dysfunction typically was rated as moderate in 46% (26) of patients, although 25% (14) had severe dysfunction, 11% (six) had mild to moderate dysfunction, and 18% (10) had mild dysfunction, reported the authors, led by Wolfgang Weidner, MD.
Among the men with type IIIA prostatitis, 15 (24%) had erectile dysfunction, and among those with type IIIB prostatitis, 48 (76%) had erectile dysfunction. The distribution of severity of erectile dysfunction did not show a statistically significant difference.
Data shape clinical practice
Do the results pertain to men in North America? Probably.
"If you look at just erectile dysfunction, the results are almost identical [for American and Malaysian men with CP/CPPS]," said John N. Krieger, MD, professor of urology at the University of Washington, Seattle, and a co-investigator on the Malaysian study.
Interpreting these data is still a challenge, pointed out J. Curtis Nickel, MD, professor of urology, Queens University, Kingston, Ontario.
"There's no control data, and the control data are absolutely imperative because we know that on average, in men over 50, depending on the population-based study, 40% to 60% of those who fill out the IIEF will have at least mild to moderate erectile dysfunction," Dr. Nickel said.
Next year, he and his colleagues will be presenting results of a North American study that will answer that question.
Clinicians will want to know how to treat men with both CP/CPPS and sexual dysfunction. It remains to be seen whether resolving pain for these patients will improve their sexual function or whether they need directed therapy.
Some speculate that therapy for erectile dysfunction might improve CP/CPPS symptoms. So far, it's only speculation, but PDE-5 inhibitors might reduce prostatitis inflammation and ease symptoms by relaxing prostatic duct smooth muscle and increasing washout of prostatic reflux products (Med Hypotheses 2007; 69:25-6).
http://urologytimes.modernmedicine.com/ ... ail/454972