Prostatitis and Sexual dysfunction

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Prostatitis and Sexual dysfunction

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Introduction CP/CPPS

• Most common clinical presentation
• Recurrent, episodic symptoms
• One of pain
• (pelvic, perineal, penile, ejaculatory, lower
  abdomen)
• Variable irritative obstructive symptoms
• Sexual dysfunction
• (usually ejaculatory disturbance)
• A seriuos impact on quality of life

Krieger JN, et al. Urology 2002 Wenniger K, et
al. J Urol 1996
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CP/CPPS (past)
Prostate
infection/ inflmmation
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CP/CPPS (present)
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EAU classification (2003)
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Pathogenesis of prostatitis

• Poorly understand
• Proposed theories
• Infection bacterial, viral, fungal,etc
• Chemical irritation d/t urine reflux
• Autoimmune theory
• Cytokine or leukotriene driven or influenced
• Aberration of people growth factors
• Biochemical aberration citrate
• Multi-factorial etilogy

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Psychological factor to prostatitis

• An important role in the development or
  exacerbation in both of the chronic prostatitis
  syndromes
• Berghius JP, et al. J Pshchom Res 1996
• 51 CP/CPPS patients group vs 34 control group
• depression and pyschological disturbance are
  common among CP/CPPS
• Krieger JN, et al. Clin J Pain 1994
• Common chronic back pain in CP/CPPS patients
• Chronic back pain caused more somatically focused
  depression and anxiety, resulted in exacerbation
  of the prostatitis

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Sexual Dysfunction(S.D.)

• ED
• Ejaculation
• Libido
• Orgasm
• Cause
• Many factors exist...
• But, this condition is usually result of a
  combination several factors coming together

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MSAM-7 LUTS have a negative impacton sexual
function
Rosen R et al. Eur Urol 2003
IC.ALF.04.06.03
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Relations between prostatitis and sexual
dysfunction ?

• Only a few reports of study
• Not clear and dont know about
• Suspicous evidence of relations
• The neurovascular bundles responsible for the
  erectile intimately related to the prostate.
• The mechanism of urination is similar to erectile
  mechanism of penis related of nerve stimulation.
• Function of ejaculation is associated with the
  prostate.
• Androgen affect on sexual function and prostate
  both.

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S.D. and CP/CPPS There is a coincidence?

• Blanker MH, et al. J Am Geriatr Soc 2001
• Surveyed 1600 men in a multivariate logistic
  regression analysis
• The most correlated factor of E.D.
• age, LUTS, obesity
• Diseases of the prostate, prostatitis,
  prostatodynia, BPH, and PCa interfere with E. D.
• Screponi E, et al Urology 2001
• Supposes a role for chronic prostate inflammation
  in the pathogenesis of some cases of premature
  ejaculation (Plt0.05)

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• Cho IR, et al. Kor J Androl 2007
• 303 patients with CPPS and 83 healthy control
• 3 questionnaire demographic data, Korean version
  of NIH-CPSI, IIEF
• The prevalence rate of Premature ejaculatioin
• P.E. vs control 217 (71.6) vs 19 (22.9)
• Significant higher rate in CP/CPPS (P lt0.01)
• Each mean IIEF domain score is lower than control
• No difference in the patients with CPPS
  categorized in IIIa and IIIb
• The rate of premature ejaculation is higher in
  CP/CPPS

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• Liang CZ, et al. BJU Int 2004
• 1786 patients with chronic prostatitis completed
  the survey using the NIH-CPSI and five-question
  version of the IIEF
• The overall prevalence of sexual dysfunction
• 49
• The prevalence of premature ejaculation 26
  erectile dysfunction 15
• both P.E. and E.D. 7.7
• The prevalence of S.D. in patients with chronic
  prostatitis was high

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Higher appearance of chronic prostatitis in men
with infertility

• Li HJ, et al. Zhonghua Yi Xue Za Zhi 2004
• 534 patients with male infertility were diagnosed
  with chronic prostatitis at a prevalence rate of
  39.1
• The prevalence rate of liquefaction dysfunction
  was much higher
• (22.7 vs 14.3, Plt0.05)
• however, little influence on the quality of
  semen, pH value, sperm density, and sperm motility

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Is E.D. a Sx. of CP/CPPS?

• Krieger JN, et al. Urology 1996
• Pain symptoms were the predominant urologic
  manifestations of CP/CPPS
• Ejaculatory pain was also more common among men
  with prostatitis than among men with BPH(P0.07)
  or among men with sexual dysfunction(Plt0.01)
• Beutel ME, et al. Urologe A 2004
• In a clinical study of 770 men surveyed in
  Germany SD (ED Libido) was more frequently
  reported by men with pelvic pain than without
  pain syndrome.

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• Nickel JC, et al. BJU Int 2005
• Of 3700 sexually active men with LUTS suggestive
  of BPH,
• specific prostatitis-like Sx. of pain/discomfort
  on ejaculation
• -gt 20, clearly differed from LUTS only
• Of men with painful ejacuation,
• E.D.72 -gt 91 considered it a problem
• reduced ejaculation 75 -gt 81 considered it a
  problem
• BPH and painful ejaculation had more severe LUTS
  and higher prevalence of E.D. and reduced
  ejaculation, than men with LUTS only

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• Lutz MC, et al. J Urol 2005
• The cross-sectional study of associations with
  urogenital pain and sexual function
• 1764 white men with a median age of 60years
  completed a questionnaire that included questions
  from the NIH-CPSI to evaluate urogenital pain and
  from the Brief Male Sexual Function Inventory to
  evaluate five domains of sexual function.
• Significant associations of testicular pain with
  impaired sexual drive and sexual satisfaction

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QoL has a great influence on E.D and CP/CPPS ?

• Tan JK, et al. 2004
• across-sectional study to determine the
  prevalence of prostatitis-like symptoms, LUTS,
  and E.D.
• 1087 men aged 21-70 years
• Average age of patients with prostatitis-like Sx.
• -gt 43 years
• Participants with prostatitis-like Sx. had worse
  E.D. (Plt0.003) and a worse QoL (Plt0.001) than
  those without prostatitis-like Sx.
• Aspect of QoL seems to be the strongest relation
  between E.D. and CP/CPPS.

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• Burber B, et al. Eur Urol 1999
• The study of men from four different countries
• Worsening urinary function seen as
  prostatitis-like Sx. causes a global decrease in
  the QoL, thereby negatively affecting sexual
  function
• E.D. is also strongly associated with a negative
  impact on the QoL

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• Mehik A, et al. BJU Int 2001
• To determine the occurrence of mental distress
  related to prostatitis
• population-based cross-sectional survey
• men with symptomatic prostatitis
• E.D 43, decreased libido 24
• Psychological stress is common in men with
  prostatitis
• Tripp DA, et al. BJU Int 2004
• 463 men were enrolled in the NIH-Chronic
  Prostatitis Cohort Study
• Depressive Sx. And pain intensity significantly
  predict a poorer QoL in patients with CP/CPPS
• QoL has a great influence on E.D

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Conclusions

• LUTS and BPH are definitely related to SD, but
  there is a little study which influnce of CP/CPPS
  on the incidence of SD
• Any kind of pain is likely to be the most
  significant Sx. in men with CP/CPPS as it relates
  to SD
• Supposes a role for chronic prostate inflammation
  in the pathogenesis of some cases of PE
• SD such as ejaculation discomfort is described as
  a Sx. of CP/CPPS
• CP/CPPS affects the QoL of a man, then poor QoL
  contributes to or causes SD