PL 02. Ejaculatory disorder in medical and surgical therapy of BPH

Ejaculatory dysfunction (EjD) is a comprehensive term that includes premature ejaculation, delayed ejaculation, retrograde ejaculation, anejaculation, painful ejaculation. Epidemiologic studies on EjD shows that LUTS and increasing age are independent risk factors for EjD. Furthermore, there are many large scale clinic-based studies that demonstrated strong association between LUTS and EjD. Why are LUTS in aging men, with or without prostatic enlargement, associated with ED, EjD, pain/discomfort during ejaculation? Is there a single underlying mechanism to account for these effects or are several mechanisms, some perhaps indirect, involved? If there is indeed an association between LUTS and male sexual dysfunction, an understanding of the specific underlying mechanisms might have an important impact on the diagnosis and treatment of these disorders. I will look into current research in this area actively studying this relationship in aging men. In sexually active men, ejaculatory function could be significantly worsened after medical or surgical treatment on LUTS/BPH. The effect of BPH treatment on ejaculatory dysfunction has been intensively studied. Tamulosin, silodosin, 5-ARI are well known to be able to cause ejaculatory dysfunction. And also 17-65% of surgically treated patients develop ejaculatory dysfunction. However, additional studies are warranted to confirm the pathophysiologic background of EjD.

I introduce the results of a survey for EjD and LUTS/BPH done at our institution. We investigated baseline ejaculatory function and dysfunction of LUTS/BPH patient before the initiation of treatment. We retrospectively reviewed the medical records of 1574 patients who visited urology clinic of our hospital with complaint of lower urinary tract symptoms and completed the '5 item questionnaire assessing ejaculatory function (EjQ)'. The EjQ consisted of questions evaluating volume, power, pain, satisfaction, and duration of ejaculation during the last 4 weeks. Medical history, physical examination, voiding diary, International Prostatic Symptom Score (IPSS), and International Index of Erectile Function (IIEF) were thoroughly reviewed and their relationship with ejaculatory function was analyzed. We found 783 patients (49.7%) had sexual relationship during the last 4 weeks (Active group), whereas 791 had not (50.3%) (Inactive group). Most (93.7%) of the patients in the Inactive group almost never/never felt sexual desire (IIEF Q11). In the Active group, 53.4% reported that their ejaculatory volume was not enough, 55.7% reported their ejaculatory power is not strong enough, and 41.7% were not satisfied with their ejaculatory function. Only 6.1% of patients with low ejaculatory volume and 5.6% with low ejaculatory power satisfied with their ejaculatory function. The rate of orgasmic dysfunction was 7.4% in the total study population, 12.7% in low ejaculatory volume group, and 12.2% in low ejaculatory power group. There were strong correlation between ejaculatory volume and power (correlation coefficient=0.823, P<0.001). IPSS total score was inversely correlated with ejaculatory volume or power and this association remained significant after adjusting erectile function and age (OR=1.891, 95% CI 1.088-3.287, P=0.024). Therefore, we think that the evaluation of ejaculatory function is mandatory and that questionnaire assessing ejaculatory volume and satisfaction is appropriate tool for evaluation before the initiation of medical or surgical treatment.