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Einfluss medikamentöser BPS-Therapie auf die sexuelle Funktion

Influence of medical BPS treatment on sexual function

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Zusammenfassung

Hintergrund

Das benigne Prostatasyndrom (BPS) ist oft mit sexuellen Funktionsstörungen assoziiert. Die in der S2e-Leitlinie beschriebenen medikamentösen Therapieoptionen können vorbestehende Störungen der Sexualfunktion bessern, aber auch bestehende Störungen verstärken oder neue auslösen.

Fragestellung

Wie wirken sich die in der S2e-Leitlinie genannten medikamentösen Therapieoptionen auf die Sexualfunktion aus?

Material und Methode

Mittels selektiver Literaturrecherche zum Thema benignes Prostatasyndrom und sexuelle Funktionsstörungen wurden die Auswirkungen der in der S2e-Leitlinie genannten Medikamente ausgewertet.

Ergebnisse

Extrakte aus Serenoa repens verschlechtern nicht die Sexualfunktion, gleiches gilt für Muskarinrezeptorantagonisten. 5α-Reduktasehemmer verschlechtern häufig Erektionsfähigkeit, Libido und Ejakulation, selektive α1-Blocker die Ejakulation. Phosphodiesterase- (PDE-)5-Inhibitoren können die erektile Funktion verbessern. Eine Kombination aus α1-Blocker und 5α-Reduktasehemmer führt zu deutlich erhöhten sexuellen Funktionseinschränkungen.

Schlussfolgerungen

Die geeignete Therapie des benignen Prostatasyndroms sollte gemeinsam von Patient und Arzt gewählt werden und ist den individuellen Bedürfnissen anzupassen. Auswirkungen auf die Sexualität müssen bei der Therapiewahl berücksichtigt werden.

Abstract

Background

Benign prostate syndrome is frequently associated with sexual dysfunction. The therapeutic options discussed in the S2e guideline may be able to improve existing sexual dysfunctions but can also worsen disorders or even trigger new ones.

Objectives

What are the effects of therapeutic options as described in the S2e guideline on sexual function?

Methods

By selective literature search related to benign prostate syndrome and sexual dysfunction adverse effects of drugs mentioned in the S2e guideline have been evaluated.

Results

Serenoa repens extracts do not have adverse effects on sexual function; this is also true for muscarine receptor antagonists. 5α-Reductase inhibitors frequently worsen erectile function, libido and ejaculation; selective α1-blockers have an adverse effect on ejaculation. Phosphodiesterase (PDE)-5 inhibitors can improve sexual function. A combination of α1-blockers and 5α-reductase inhibitors worsens sexual functions significantly.

Conclusions

A suitable therapy for benign prostate syndrome should be chosen jointly by the patient and the treating physician and should be adapted to personal needs. Effects on sexual functions have to be taken into consideration when choosing a therapy.

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Abbreviations

BPS:

Benignes Prostatasyndrom

ED:

Erektile Dysfunktion

IIEF:

„International Index of Erectile Dysfunction“

LUTS:

„Lower urinary tract symptoms“

PDE:

Phosphodiesterase

Literatur

  1. Arbeitskreis Benignes Prostatasyndrom (AK BPS), Deutsche Gesellschaft für Urologie e. V., Berufsverband der Deutschen Urologen e. V. (2014) S2e Leitlinie – Therapie des Benignen Prostatasyndroms (BPS). BoD – Books on Demand GmbH, Norderstedt

    Google Scholar 

  2. Assessment report on Serenoa repens (W. Bartram) Small fructus. Committee on Herbal Medicinal Products (HMPC). European Medicines Agency (2014)

  3. Barry MJ, Meleth S, Lee JY et al (2011) Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA 306:1344–1351

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bell JR, Laborde E (2012) Update on the sexual impact of treatment for benign prostatic hyperplasia. Curr Urol Rep 13:433–440

    Article  PubMed  Google Scholar 

  5. Bent S, Kane C, Shinohara K et al (2006) Saw palmetto for benign prostatic hyperplasia. N Engl J Med 354:557–566

    Article  CAS  PubMed  Google Scholar 

  6. Bertaccini A, Giampaoli M, Cividini R et al (2012) Observational database serenoa repens (DOSSER): overview, analysis and results. A multicentric SIUrO (Italian Society of Oncological Urology) project. Arch Ital Urol Androl 84:117–122

    PubMed  Google Scholar 

  7. Cai T, Morgia G, Carrieri G et al (2013) An improvement in sexual function is related to better quality of life, regardless of urinary function improvement: results from the IDIProst(R) Gold Study. Arch Ital Urol Androl 85:184–189

    Article  PubMed  Google Scholar 

  8. Capogrosso P, Serino A, Ventimiglia E et al (2015) Effects of silodosin on sexual function—realistic picture from the everyday clinical practice. Andrology 3:1076–1081

    Article  CAS  PubMed  Google Scholar 

  9. Casabe A, Roehrborn CG, Da Pozzo LF et al (2014) Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia. J Urol 191:727–733

    Article  CAS  PubMed  Google Scholar 

  10. Corona G, Tirabassi G, Santi D et al (2017) Sexual dysfunction in subjects treated with inhibitors of 5alpha-reductase for benign prostatic hyperplasia: a comprehensive review and meta-analysis. Andrology 5:671–678

    Article  CAS  PubMed  Google Scholar 

  11. Dell’Atti L (2015) Efficacy of Tadalafil once daily versus Fesoterodine in the treatment of overactive bladder in older patients. Eur Rev Med Pharmacol Sci 19:1559–1563

    PubMed  Google Scholar 

  12. Di SS, Mollaioli D, Gravina GL et al (2016) Epidemiology of delayed ejaculation. Transl Androl Urol 5:541–548

    Article  Google Scholar 

  13. Dutkiewicz S, Skawinski D, Duda W et al (2012) Assessing the Influence of Benign Prostatic Hyperplasia (BPH) on Erectile Dysfunction (ED) among patients in Poland. Cent European J Urol 65:135–138

    Article  PubMed  PubMed Central  Google Scholar 

  14. Egan KB, Burnett AL, McVary KT et al (2015) The co-occurring syndrome-coexisting erectile dysfunction and benign prostatic Hyperplasia and their clinical correlates in aging men: results from the national health and nutrition examination survey. Urology 86:570–580

    Article  PubMed  Google Scholar 

  15. European Union herbal monograph on Serenoa repens (W.Bartram) Small fructus. European Medicines Agency (2015)

  16. Favilla V, Russo GI, Privitera S et al (2016) Impact of combination therapy 5‑alpha reductase inhibitors (5-ARI) plus alpha-blockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/BPH: a systematic review with meta-analysis. Aging Male 19:175–181

    Article  CAS  PubMed  Google Scholar 

  17. Fwu CW, Eggers PW, Kirkali Z et al (2014) Change in sexual function in men with lower urinary tract symptoms/benign prostatic hyperplasia associated with long-term treatment with doxazosin, finasteride and combined therapy. J Urol 191:1828–1834

    Article  CAS  PubMed  Google Scholar 

  18. Gacci M, Corona G, Salvi M et al (2012) A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with alpha-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 61:994–1003

    Article  CAS  PubMed  Google Scholar 

  19. Gacci M, Ficarra V, Sebastianelli A et al (2014) Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis. J Sex Med 11:1554–1566

    Article  CAS  PubMed  Google Scholar 

  20. Giulianelli R, Pecoraro S, Sepe G et al (2012) Multicentre study on the efficacy and tolerability of an extract of Serenoa repens in patients with chronic benign prostate conditions associated with inflammation. Arch Ital Urol Androl 84:94–98

    PubMed  Google Scholar 

  21. Giuliano F, Oelke M, Jungwirth A et al. (2013) Tadalafil once daily improves ejaculatory function, erectile function, and sexual satisfaction in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia and erectile dysfunction: results from a randomized, placebo- and tamsulosin-controlled, 12-week double-blind study. J. Sex Med 10: 857–865

    Article  CAS  PubMed  Google Scholar 

  22. Hagberg KW, Divan HA, Fang SC et al (2017) Risk of gynecomastia and breast cancer associated with the use of 5‑alpha reductase inhibitors for benign prostatic hyperplasia. Clin Epidemiol 9:83–91

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hirshburg JM, Kelsey PA, Therrien CA et al (2016) Adverse effects and safety of 5‑alpha reductase inhibitors (Finasteride, Dutasteride): a systematic review. J Clin Aesthet Dermatol 9:56–62

    PubMed  PubMed Central  Google Scholar 

  24. Jun JEJ, Kinkade A, Tung ACH et al (2017) 5alpha-reductase inhibitors for treatment of benign prostatic hyperplasia: a systematic review and meta-analysis. Can J Hosp Pharm 70:113–119

    PubMed  PubMed Central  Google Scholar 

  25. Kaplan SA, Roehrborn CG, Rovner ES et al (2006) Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 296:2319–2328

    Article  CAS  PubMed  Google Scholar 

  26. Karami H, Hassanzadeh-Hadad A, Fallah-Karkan M (2016) Comparing monotherapy with tadalafil or tamsulosin and their combination therapy in men with benign prostatic hyperplasia: a randomized clinical trial. Urol J 13:2920–2926

    PubMed  Google Scholar 

  27. Kiguradze T, Temps WH, Yarnold PR et al (2017) Persistent erectile dysfunction in men exposed to the 5alpha-reductase inhibitors, finasteride, or dutasteride. PeerJ 5:e3020

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kim SW, Park NC, Lee SW et al (2017) Efficacy and safety of a fixed-dose combination therapy of tamsulosin and tadalafil for patients with lower urinary tract symptoms and erectile dysfunction: results of a randomized, double-blinded, active-controlled trial. J Sex Med 14:1018–1027

    Article  PubMed  Google Scholar 

  29. Kirby RS, O’Leary MP, Carson C (2005) Efficacy of extended-release doxazosin and doxazosin standard in patients with concomitant benign prostatic hyperplasia and sexual dysfunction. BJU Int 95:103–109

    Article  CAS  PubMed  Google Scholar 

  30. Ko K, Yang DY, Lee WK et al (2014) Effect of improvement in lower urinary tract symptoms on sexual function in men: tamsulosin monotherapy vs. combination therapy of tamsulosin and solifenacin. Korean J Urol 55:608–614

    Article  PubMed  PubMed Central  Google Scholar 

  31. Leliefeld HH, Stoevelaar HJ, McDonnell J (2002) Sexual function before and after various treatments for symptomatic benign prostatic hyperplasia. BJU Int 89:208–213

    Article  CAS  PubMed  Google Scholar 

  32. Leungwattanakij S, Watanachote D, Noppakulsatit P et al (2010) Sexuality and management of benign prostatic hyperplasia with alfuzosin: SAMBA Thailand. J Sex Med 7:3115–3126

    Article  PubMed  Google Scholar 

  33. Liu L, Zhao S, Li F et al (2016) Effect of 5alpha-reductase inhibitors on sexual function: a meta-analysis and systematic review of randomized controlled trials. J Sex Med 13:1297–1310

    Article  PubMed  Google Scholar 

  34. Lopatkin N, Sivkov A, Walther C et al (2005) Long-term efficacy and safety of a combination of sabal and urtica extract for lower urinary tract symptoms–a placebo-controlled, double-blind, multicenter trial. World J Urol 23:139–146

    Article  CAS  PubMed  Google Scholar 

  35. Metzker H, Kieser M, Hölscher U (2018) Wirksamkeit eines Sabal-Urtica-Kombinationsprapärates bei der Behandlung der benignen Prostatahyperplasie (BPH). Urologe B 36:292–300

    Article  Google Scholar 

  36. Nickel CJ, Shoskes D, Roehrborn CG et al (2008) Nutraceuticals in prostate disease: the urologists role. Rev Urol 10:192–206

    Google Scholar 

  37. Novara G, Giannarini G, Alcaraz A et al (2016) Efficacy and safety of hexanic lipidosterolic extract of serenoa repens (Permixon) in the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: systematic review and meta-analysis of randomized controlled trials. Eur Urol Focus 2:553–561

    Article  PubMed  Google Scholar 

  38. Padma-Nathan H, Goldstein I, Klimberg I et al (2002) Long-term safety and efficacy of oral phentolamine mesylate (Vasomax) in men with mild to moderate erectile dysfunction. Int J Impot Res 14:266–270

    Article  CAS  PubMed  Google Scholar 

  39. Roehrborn CG, Siami P, Barkin J et al (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4‑year results from the CombAT study. Eur Urol 57:123–131

    Article  CAS  PubMed  Google Scholar 

  40. Roehrborn CG, Manyak MJ, Palacios-Moreno JM et al (2017) A prospective randomised placebo-controlled study of the impact of dutasteride/tamsulosin combination therapy on sexual function domains in sexually active men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BJU Int 121(4):647–658. https://doi.org/10.1111/bju.14057

    Article  CAS  PubMed  Google Scholar 

  41. Rosen R, Seftel A, Roehrborn CG (2007) Effects of alfuzosin 10 mg once daily on sexual function in men treated for symptomatic benign prostatic hyperplasia. Int J Impot Res 19:480–485

    Article  CAS  PubMed  Google Scholar 

  42. Rosen RC, Catania J, Pollack L et al (2004) Male Sexual Health Questionnaire (MSHQ): scale development and psychometric validation. Urology 64:777–782

    Article  PubMed  Google Scholar 

  43. Seo DH, Kam SC, Hyun JS (2011) Impact of lower urinary tract symptoms/benign prostatic hyperplasia treatment with tamsulosin and solifenacin combination therapy on erectile function. Korean J Urol 52:49–54

    Article  PubMed  PubMed Central  Google Scholar 

  44. Sinescu I, Geavlete P, Multescu R et al (2011) Long-term efficacy of Serenoa repens treatment in patients with mild and moderate symptomatic benign prostatic hyperplasia. Urol Int 86:284–289

    Article  PubMed  Google Scholar 

  45. Singh DV, Mete UK, Mandal AK et al (2014) A comparative randomized prospective study to evaluate efficacy and safety of combination of tamsulosin and tadalafil vs. tamsulosin or tadalafil alone in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. J Sex Med 11:187–196

    Article  CAS  PubMed  Google Scholar 

  46. Sökeland J, Albrecht J (2018) Kombination aus Sabal- und Urticaextrakt vs. Finasterid bei BPH (Stad. I bis II nach Alken). Urologe A 36:327–333

    Article  Google Scholar 

  47. Suter A, Saller R, Riedi E et al (2013) Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trial. Phytother Res 27:218–226

    Article  PubMed  Google Scholar 

  48. Vouri SM, Kebodeaux CD, Stranges PM et al (2017) Adverse events and treatment discontinuations of antimuscarinics for the treatment of overactive bladder in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr 69:77–96

    Article  CAS  PubMed  Google Scholar 

  49. Voznesensky I, Shaw E, DeLay KJ et al (2017) Benign prostatic hyperplasia treatment options and their effects on sexual function. Sex Med Rev 5:87–102

    Article  Google Scholar 

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Danksagung

Die Autoren danken Frau Dr. Isabell Karl für Ihre große Unterstützung bei der Erstellung des Manuskripts.

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Correspondence to T. Bschleipfer FEBU.

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Interessenkonflikt

T. Bschleipfer gibt an, Referent, Berater und/oder Studienteilnehmer für folgende Firmen zu sein: Allergan, Apogepha, Astellas, Bayer HealthCare, bene, Bionorica, Dr. R. Pfleger GmbH, GlaxoSmithKline, medac, Pfizer, Serag Wiessner, Speciality European Pharma GmbH, Laborie & Medi Tate, tic Medizintechnik GmbH & Co. KG, wellspect HealthCare, rollactiv, Grünenthal. M. Burkart gibt an, Mitarbeiter der Dr. Willmar Schwabe GmbH & Co. KG zu sein.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Bschleipfer, T., Burkart, M. Einfluss medikamentöser BPS-Therapie auf die sexuelle Funktion. Urologe 57, 1464–1471 (2018). https://doi.org/10.1007/s00120-018-0739-7

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