[Patient with TDS and lower urinary tract symptoms (LUTS)]

[corrected] New investigations focus on the relationship between benign prostatic hyperplasia, lower urinary tract symptoms, erectile dysfunction and testosterone deficit; giving to this last one a common role in all of them. In this paper, we present a typical patient who complains of symptoms related to BPH, to treat him in terms of micturition quality, sexual function and hypogonadism .

61 year-old male, with obesity, hypertension and hypercholesterolemia, who complains of long term mixed urinary symptoms, with an IPSS of 12 and IIEF-5 of 22. DRE: II/IVprostate, adenomatous. Blood parameters: PSA 1.9 ng/dl, total testosterone 238 ng/dl, triglycerides 213 mg/dl, glucose 89 mg/dl. Uroflowmetry :total volume 256 ml, maximum flow 12 ml/s, average 5.7 ml/s and post-void volume of 15 ml. Urinary ultra- sound: 5 mm detrusor and prostate volume of 39 cm3. Nowadays, LUTS are considered multietiologic, including testosterone as one of the causes. According to the classic criteria, this patient fits for treatment with combination therapy, as well as for daily PDE5i, recently approved for LUTS therapy. Administration of testosterone to treat LUTS is still controversial. It could restore the patient's levels of testosterone, improving the metabolic syndrome and creating an optimal environment for the 5PDEi. Nevertheless, according to some current scientific evidences, it could help improving LUTS.

Given the necessity of larger studies, testosterone supplementation therapy seems to not worsen the evolution of BHP. It could even improve them if the testosterone deficit is documented.