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Prostatitis and Sexual dysfunction

Prostatitis and Sexual dysfunction. 김 세 웅 가톨릭의대 비뇨기과. 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

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Prostatitis and Sexual dysfunction

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  1. Prostatitis and Sexual dysfunction 김 세 웅 가톨릭의대 비뇨기과

  2. 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

  3. CP/CPPS (past) Prostate infection/ inflmmation

  4. CP/CPPS (present)

  5. EAU classification (2003)

  6. 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 Pathogenesis of prostatitis

  7. 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

  8. 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

  9. reducing sexual activity LUTS have a negative impact by reducing stiffness of erection decreasing volume of ejaculate MSAM-7: LUTS have a negative impacton sexual function Rosen R etal. Eur Urol 2003 IC.ALF.04.06.03

  10. Relations between prostatitis and sexual dysfunction ? • Only a few reports of study… • Not clear and don’t 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.

  11. 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 (P<0.05)

  12. 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 <0.01) • 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

  13. 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

  14. 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%, P<0.05) • however, little influence on the quality of semen, pH value, sperm density, and sperm motility

  15. 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(P=0.07) or among men with sexual dysfunction(P<0.01) • 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.

  16. 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 -> 20%, clearly differed from LUTS only • Of men with painful ejacuation, • E.D.:72% -> 91% considered it a problem • reduced ejaculation: 75% -> 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

  17. 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-CPSIto 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

  18. 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. -> 43 years • Participants with prostatitis-like Sx. had worse E.D. (P<0.003) and a worse QoL (P<0.001) than those without prostatitis-like Sx. • Aspect of QoL seems to be the strongest relation between E.D. and CP/CPPS.

  19. 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

  20. 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

  21. 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

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