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Sexual function in 131 patients with benign prostatic hyperplasia before prostatectomy
J Baniel1, S Israilov, J Shmueli
1Department of Urology, Rabin Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Objective:
The aim of the present study was to ascertain the frequency of sexual dysfunction in patients with benign prostatic hyperplasia (BPH) before prostatectomy.
Methods:
The study population included 131 patients aged 55-74 years (mean 61.4+/-2.7) with BPH. The patients had been complaining of daytime urgency and nocturia for the last 1-14 years (average 4.5+/-1.5 years). The diagnosis of BPH was based on the anamnestic data, the International Prostate Symptom Score (IPSS(0-35)) and quality of life assessment (L(0-6)), and results of digital rectal examination, transrectal ultrasound, and uroflowmetry. Sexual dysfunction was determined by retrospective analysis of the psychosexual history (with and separately from the spouse), penile brachial index (PBI), nocturnal penile tumescence (NPT), and blood hormone levels (testosterone).
Results:
The patients were divided into two groups by severity of the urinary disorder: group I, severe (IPSS(0-35)-L(6); n = 70); and group II, mild relative to group I (IPSS(32-34)-L(4-5); n = 61). In group I, 15 patients (21.4%) performed normal coitus, 24 (34.2%) had weak coitus with incomplete penetration, and 21 (44.2%) had unsuccessful coitus because of a weak erection. In group II, 28 patients (45.9%) had normal coitus, 25 (40.9%) incomplete penetration, and 8 (13.1%) unsuccessful coitus. There was no significant correlation between sexual function and the patients' general health condition. The quantitative assessment of sexual dysfunction yielded the following results in groups 1 and 2, respectively: negative NPT in 32.4+/-1.8 and 24.4+/-2.1% (p<0.05); PBI <0.6 in 33.4+/-1.7 and 22.3+/-1.2% (p<0.001); and testosterone decrease to <12 nmol/l in 36.4+/-1.2 and 28.5+/-1.2% (p<0.05), respectively. The differences between the groups were significant (p<0.05) for all three parameters.
Conclusions:
Considering the 44. 2% rate of unsuccessful coitus in the patients with a severe urinary dysfunction compared to only 13.1% in those with a milder dysfunction and the significant correlation between severe urinary dysfunction and measures of sexual dysfunction, we suggest that BPH may be a risk factor for sexual dysfunction.
