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Abstract and Introduction
Abstract
We evaluated the effectiveness of sildenafil citrate on lower urinary system symptoms (LUTS) by using symptom score scales. We also evaluated whether or not the presence of asymptomatic inflammatory prostatitis had an effect on the alteration in the symptom scores. A total of 36 male patients were included in the study. For all the cases, 'International Prostate Symptom Score' (IPSS), 'National Health Institute Chronic Prostatitis Symptom Index' (NIH-CPSI) and 'International Index of Erectile Function' (IIEF-5) were investigated and the scores were calculated in the first visit. Sildenafil citrate was given for 30 days and at the second visit IPSS, NIH-CPSI and IIEF-5 scores were once more analyzed. Afterwards, the alterations of the scores between visits were statistically compared. Mean age of the 36 cases included in the study was 59.03±1.35. When the alterations in parameters of first visit and second visit were evaluated, we found a statistically significant increase in IIEF-5 and a statistically significant decrease in IPSS, IPSS-QOL (Quality of Life). In addition, when the cases were divided into two groups with and without asymptomatic inflammatory prostatitis, in the cases with asymptomatic inflammatory prostatitis, sildenafil citrate caused improvement only in ED, but had no effect on LUTS. Sildenafil citrate use in cases with LUTS and ED has an improving effect on LUTS as well as ED. However, in cases with asymptomatic inflammatory prostatitis, sildenafil citrate did not lead to an improvement in LUTS.
Introduction
Recently, a growing attention is being paid to the relation between lower urinary system symptoms (LUTS) and sexual dysfunction. The relation between LUTS and sexual dysfunction is confirmed by 'Multinational Survey of the Aging Male-7' (MSAM-7), without any shadow of doubt. It suggests that the two conditions have a common initiator factor and a link is present between their cause-outcome relations.
Some evidence shows that LUTS and ED are developed by similar pathophysiological mechanisms. Both conditions occur as a result of cellular and molecular changes related to age. Probably, the future studies will provide valuable data for the development of more effective and corporate methods in the treatment of age-related disorders. If LUTS/benign prostatic hyperplasia (BPH) and male sexual dysfunction share a common pathophysiological mechanism, to use a single optimal medical strategy might be possible. Preclinical and clinical data suggest that PDE5 inhibitors, which are first-line treatment for ED, may be considered as promising drugs for treating LUTS/BPH. In future, a single agent or combined therapies will be able to find a place in the treatment of both conditions.
Although an association has repeatedly been shown between LUTS and ED, little is known regarding the impact of chronic prostatitis (CP) on ED. Although there are articles underlining the link between CP and ED, its reason could not be clearly explained. It is suggested that, quality of life and psychological status of the patients are generally affected due to pain and voiding dysfunction in patients with CP/chronic pelvic pain syndrome, and it has a negative influence on sexual functions.
Interestingly, in many asymptomatic patients who do not have CP diagnosis, significant leukocytes and bacteria are found in EPS (expressed prostatic secretions) and postprostatic massage urine sediment. These patients are classified as category IV prostatitis (asymptomatic inflammatory prostatitis) according to NIH classification. Besides, asymptomatic inflammatory prostatitis is a common pathological finding in patients with BPH. However, the clinical importance of this finding is not well understood. The origin of inflammation in the prostate remains a subject of debate and is likely multifactorial.
Our aim of designing this study was to evaluate the medical therapy outcomes of LUTS/BPH and ED, which we thought to be inter-related and the effects of sildenafil citrate on LUTS, by using symptom score scales. In addition, whether or not the presence of asymptomatic inflammatory prostatitis had an effect on the change of these symptom scores was investigated.
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