BPH and Sexual Dysfunction – Recommendations for the Primary Care Physician and Urologist
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Introduction: BPH and sexual dysfunction – recommendations for the primary care physician and urologist SA Kaplan Institute for Bladder and Prostate Health, Weill Cornell Medical College, Cornell University, New York, NY, USA International Journal of Impotence Research (2008) 20, S1; doi:10.1038/ijir.2008.50 The paradigm for the medical management of benign prostatic hyperplasia (BPH) has undergone significant changes over the past two decades. What was once a two-option field, that is do nothing or perform a transurethral resection of the prostate, has exploded into a virtual smorgasbord of therapies. With the advent of cutting-edge research, the approval of novel pharmaceutical and minimally invasive therapies and the economics of health-care financing, physicians have altered their approach to patient care in distinct ways. This evolution in thinking continues today. Moreover, as novel ther- apeutic modalities become available, as new con- nections between symptoms, sexual function and metabolic dysfunction become identified, and as we learn which baseline parameters best predict treat- ment response in particular patient populations, the therapeutic paradigm is likely to evolve and pro- gress still further. In addition to emerging treatment paradigms, BPH has now become a more universal disease, with primary care physicians increasingly involved in developing and sustaining treatment strategies. It is, therefore, a good time to coalesce many of these new diagnostic and therapeutic algorithms into a cohesive series of articles that has been titled ‘BPH and Sexual Dysfunction for the Primary care Physician.’ The objective of this supplement to The International Journal of Impotence Research is to provide an update for the primary care physicians and other interested health-care providers on new perspectives in the management of BPH and the strong association with sexual dysfunction. Specifically, the goals of this supplement are to (1) differentiate the safety and efficacy of a-blockers to treat BPH; (2) increase the primary care physician’s knowledge and expertise in the management of BPH through interaction with the urologist; (3) clarification of new treatment regimens and combination medical therapies; and (4) distin- guish between the numerous overlapping syn- dromes/comorbidities with lower urinary tract symptoms and the ensuing challenges in diagnosis and treatment. I am grateful to all of the authors for their scholarly contributions to this project and I am sure you will agree after reading this supplement that all these objectives have been met. To understand the best therapeutic strategies for BPH, one must have a thorough understanding of normal voiding function as well as risk factors for the development of BPH. Stacy Scofield and Steven A Kaplan provide a review of normal voiding function as well as risk factors for the development of BPH. We have come to understand that there are many pathophysiological mechanisms associated with the development of BPH as well as voiding dysfunction. Claus Roehrborn provides two papers to help explain the role of stromal and glandular elements of the prostate as well as how prostate volume, and an increasingly recognized surrogate, prostate-specific antigen, can be used to help select which agent or agents in combination can be used to treat both lower urinary tract symptoms and BPH. How should we assess both voiding dysfunction in the context of significant sexual dysfunction? Raymond Rosen and Allen Seftel provide insight into the increasing use of patient-related outcomes and questionnaires to assess both baseline status as well as response to treatments. Over the past decade, clinical studies have focused on examining the effectiveness of medical therapy either as single agents or in combination to relieve lower urinary tract symptoms and bladder outlet obstruction. Kevin T McVary reviews all the currently approved medical treatments including a-blockers, 5a-reduct- ase inhibitors and antimuscarinic agents and de- scribes the particular niches for each agent. We hope that this supplement can be used as both a learning tool and as a future reference guide for the diagnosis and treatment of men with BPH, lower urinary tract symptoms and sexual dysfunction. Disclosure Steven Kaplan has received lecture and consulting fees from sanofi-aventis as well as grant support from NIDDK. Correspondence: Professor SA Kaplan, Institute for Bladder and Prostate Health, Weill Cornell Medical College, Cornell University, F9 West-Box 261, 525 East 68th Street, New York, NY 10065, USA. E-mail: [email protected] International Journal of Impotence Research (2008) 20, S1 & 2008 Nature Publishing Group All rights reserved 0955-9930/08 $30.00 www.nature.com/ijir
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Introduction: BPH and sexual dysfunction recommendationsfor the primary care physician and urologist
SA Kaplan
Institute for Bladder and Prostate Health, Weill Cornell Medical College, Cornell University, New York, NY, USAInternational Journal of Impotence Research (2008) 20, S1; doi:10.1038/ijir.2008.50
The paradigm for the medical management ofbenign prostatic hyperplasia (BPH) has undergonesignificant changes over the past two decades. Whatwas once a two-option field, that is do nothing orperform a transurethral resection of the prostate, hasexploded into a virtual smorgasbord of therapies.With the advent of cutting-edge research, theapproval of novel pharmaceutical and minimallyinvasive therapies and the economics of health-carefinancing, physicians have altered their approach topatient care in distinct ways. This evolution inthinking continues today. Moreover, as novel ther-apeutic modalities become available, as new con-nections between symptoms, sexual function andmetabolic dysfunction become identified, and as welearn which baseline parameters best predict treat-ment response in particular patient populations, thetherapeutic paradigm is likely to evolve and pro-gress still further.
In addition to emerging treatment paradigms, BPHhas now become a more universal disease, withprimary care physicians increasingly involved indeveloping and sustaining treatment strategies. It is,therefore, a good time to coalesce many of these newdiagnostic and therapeutic algorithms into a cohesiveseries of articles that has been titled BPH and SexualDysfunction for the Primary care Physician. Theobjective of this supplement to The InternationalJournal of Impotence Research is to provide anupdate for the primary care physicians and otherinterested health-care providers on new perspectivesin the management of BPH and the strong associationwith sexual dysfunction. Specifically, the goals ofthis supplement are to (1) differentiate the safety andefficacy of a-blockers to treat BPH; (2) increase theprimary care physicians knowledge and expertise inthe management of BPH through interaction with theurologist; (3) clarification of new treatment regimensand combination medical therapies; and (4) distin-guish between the numerous overlapping syn-
dromes/comorbidities with lower urinary tractsymptoms and the ensuing challenges in diagnosisand treatment. I am grateful to all of the authors fortheir scholarly contributions to this project and I amsure you will agree after reading this supplement thatall these objectives have been met.
To understand the best therapeutic strategiesfor BPH, one must have a thorough understandingof normal voiding function as well as risk factors forthe development of BPH. Stacy Scofield and StevenA Kaplan provide a review of normal voidingfunction as well as risk factors for the developmentof BPH. We have come to understand that there aremany pathophysiological mechanisms associatedwith the development of BPH as well as voidingdysfunction. Claus Roehrborn provides two papersto help explain the role of stromal and glandularelements of the prostate as well as how prostatevolume, and an increasingly recognized surrogate,prostate-specific antigen, can be used to help selectwhich agent or agents in combination can be used totreat both lower urinary tract symptoms and BPH.How should we assess both voiding dysfunction inthe context of significant sexual dysfunction?Raymond Rosen and Allen Seftel provide insightinto the increasing use of patient-related outcomesand questionnaires to assess both baseline status aswell as response to treatments. Over the past decade,clinical studies have focused on examining theeffectiveness of medical therapy either as singleagents or in combination to relieve lower urinarytract symptoms and bladder outlet obstruction.Kevin T McVary reviews all the currently approvedmedical treatments including a-blockers, 5a-reduct-ase inhibitors and antimuscarinic agents and de-scribes the particular niches for each agent.
We hope that this supplement can be used as botha learning tool and as a future reference guide for thediagnosis and treatment of men with BPH, lowerurinary tract symptoms and sexual dysfunction.
Disclosure
Steven Kaplan has received lecture and consultingfees from sanofi-aventis as well as grant supportfrom NIDDK.
Correspondence: Professor SA Kaplan, Institute forBladder and Prostate Health, Weill Cornell MedicalCollege, Cornell University, F9 West-Box 261, 525 East 68thStreet, New York, NY 10065, USA.E-mail: [email protected]
International Journal of Impotence Research (2008) 20, S1& 2008 Nature Publishing Group All rights reserved 0955-9930/08 $30.00
www.nature.com/ijir
Introduction: BPH and sexual dysfunction - recommendations for the primary care physician and urologistDisclosure
