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: kaplans@med.cornell.edu

International Journal of Impotence Research (2008) 20, S1& 2008 Nature Publishing Group All rights reserved 0955-9930/08 $30.00

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