Lower Urinary Tract Symptoms (LUTS) and Sexual Dysfunction (SD): New Targets for New Combination Therapies?

Abstract

Lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) and sexual dysfunction (SD) are highly prevalent in men over the age of 50 yr [1]. Both conditions have a significant impact on overall quality of life. Several recent analyses [1–4] strongly suggest that although age is an independent risk factor for both LUTS and SD, LUTS is also an independent risk factor for SD. In this field, it is more correct to answer the question in terms of SD rather than only in terms of erectile dysfunction (ED): male SD may manifest as decreased libido, ejaculation dysfunction, ED, or a combination of all three conditions. Moreover, treatment of LUTS and BPH includes pharmacologic, minimally invasive, and surgical therapies that could have an impact on sexual function. In particular, a1-adrenergic receptor antagonists are used for the treatment of LUTS; they may affect sexual function and for some of these drugs a positive effect on SD has been reported [5–7]. Combination therapy with 5a-reductase inhibitors and a1-adrenergic receptor antagonists has been considered the best pharmacologic therapy to reduce the risk of BPH progression, either in terms of prostate growth, or LUTS progression, or complication development. BPH and related LUTS are a complex problem where different factors influence their development and progression. Therefore, the