Sexual and overall quality of life

The role of Alpha Blockers in BPH, sexual and overall quality of life

Lower urinary tract symptoms, LUTS related to BPH not only impair the quality of life
but also affect sexual function.  The symptoms may be related to bladder outlet
obstruction or altered bladder muscle function.  There are two components of obstruction
viz static and dynamic.  Alpha adrenergic blocker therapy act on the dynamic component
by reducing the sympathetic tone of the prostatic urethra:

(1) irrespective of the size of the prostate gland
(2) improve the symptoms score viz IPSS by  8 points including nocturia and border
score
(3) improve the uroflow by 3 mls/s.
(4) works rapidly, within days
(5) can therefore be used before a trial off catheter in acute urinary retention.
(Alfuzosin XL 10 mg when  used for 3 days, 62% have successful trial off catheter.
Alfuzosin 10 mg daily achieves its maximum dose effect without the need of titration
and on a once daily basis, improving compliance.)
(6) The effect of alpha-blockers is sustained for many years; most clinical trials are up
to 48 months.  For uro-selective alpha-blockers, its systemic side effects are
minimal with 4.2% withdrawals from treatment due to side effects,  the main one of
Alfuzosin is that of dizziness, 3.1%.

There is a close relation between LUTS and sexual dysfunction.  This is possibly
related to the presence of PDE-5, nitride oxide, sympathetic tone of the prostate and penis
as well as similar innervation.  Accordingly, 70% of patients with severe LUTS have ED.
Treatment with Alfuzosin “improves the sexual drive, decreases ED by 26%, improve
painful ejaculation in 65%”.  There is a significant 30% abnormal ejaculation for patients
who are on Tamsulosin 0.8 mg versus a very low rate of 0.3% for patients on Alfuzosin.
Conversely, treatment with PDE-5 inhibitors either alone or in combination with alphablockers (which is safe) also improves LUTS.  Indeed, prolonged erection or priapism has
occasionally been reported as a complication of alpha-blocker therapy.

Improvement of LUTS and sexual function from alpha-blockers without significant
adverse events & positively impact on quality of life (BPH QoL20 score improved 45%
at 36 months).    This is more so when patients in this group have significant comorbidities.  In the AMORE, Asian Multi-national Prospective Observational Registry of
patients with BPH, there are significant associated hypertension (43%), diabetes mellitus
(14%), IHD (10%) and obesity (36%).  Treatment with Alfuzosin 10 mg daily has
marginal blood pressure changes in this group of patients, even >65 years of age and on
anti-hypertensive therapy.  Alpha-blocker therapy (e.g. Alfuzosin 10 mg daily) is
efficacious in the treatment of BPH, improves sexual function and quality of life.
 
e-References available on request from author.
Malaysian Urological Conference Lecture on 8.12.2007

by Dr Clarence Lei Chang Moh, FRCS Urol, FEBU,
Adjunct Professor, Universiti Malaysia Sarawak
e-mail: clarencelei@gmail.com