April 20, 2010 (Barcelona, Spain) — Alfuzosin (Uroxatral, Sanofi Aventis), a uroselective alpha-1-adrenergic receptor blocker, ameliorates ejaculatory dysfunction in sexually active men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hypertrophy (BPH), investigators reported here at the European Association of Urology 25th Annual Congress.
"Our data show that alfuzosin 10 mg once daily given for 6 months in sexually active men with LUTS due to BPH significantly improves LUTS and bother due to LUTS, and is well tolerated from a cardiovascular and sexual standpoint," John M. Fitzpatrick, MD, professor of surgery and consultant urologist at Mater Misericordiae Hospital and University College in Dublin, Ireland, told Medscape Urology.
Dr. Fitzpatrick and colleagues analyzed responses to 2 questionnaires completed by 1681 men at baseline and after 6 months of alfuzosin treatment. One questionnaire focused on voiding difficulty, and the other evaluated ejaculatory dysfunction. Participants were from Europe, Asia, South America, and Russia.
Ejaculatory Dysfunction Ameliorated in Men With LUTS
"Ejaculatory dysfunction is very common and very bothersome in sexually active men who have LUTS suggestive of BPH," Dr. Fitzpatrick said.
In fact, he and his coauthor Robert C. Rosen, PhD, from the New England Research Institute in Watertown, Massachusetts, found during earlier research that about 75% of men with LUTS had a decreased force of ejaculation and decreased amount of semen, suggestive of BPH.
Earlier research also revealed that ejaculatory dysfunction was considered a problem by roughly one third of men with mild LUTS, half of men with moderate LUTS, and two thirds of men with severe LUTS.
These same investigators also found that ejaculatory dysfunction in men with LUTS suggestive of BPH can be aggravated by some treatments, including BPH-related surgery and the use of a 5-alpha-reductase inhibitor plus an alpha-1-blocker, or tamsulosin alone.
Two Questionnaires Show Symptom Improvement With Alfuzosin
The questionnaires used in this study were the ejaculatory domain of the Male Sexual Health Questionnaire (MSHQ-EjD) and the International Prostate Symptom Score (IPSS).
MSHQ-EjD is a validated tool that assesses 3 ejaculatory dysfunction symptoms: reduced ability to ejaculate during sexual activity, decreased strength/force of ejaculation and decreased amount/volume of semen, and bother resulting from ejaculatory dysfunction.
The IPSS asks 7 questions on voiding, and the sum of the scores on each question enable the patient to calculate the severity of his symptoms. A score of 0 to 7 indicates mild symptoms, a score of 8 to 18 denotes mild symptoms, and a score greater than 18 denotes severe symptoms.
Study participants were divided into 3 groups on the basis of their responses to the questionnaires:
Those with no ejaculatory dysfunction were consistently able to ejaculate all or most of the time with force as strong as or slightly less strong than usual and with the usual or near-usual volume.
Those with partial ejaculatory dysfunction had decreased frequency, force, and volume of their ejaculate.
Patients with complete ejaculatory dysfunction were unable to ejaculate.
Improvements Seen on Multiple Measures
Alfuzosin significantly improved IPSS score (7.9 [–41%]; P < .0001) and nocturia (–0.9 [–18%]; P < .001) from baseline. Bother due to LUTS also significantly improved (–1.5 [–28%]; P < .0001).
Results on the MSHQ-EjD revealed that bother due to ejaculatory dysfunction, which was highly prevalent at enrollment, significantly improved with alfuzosin.
Also, the percent of men with no ejaculatory dysfunction increased in all age groups, except for men 70 years of age or older. Bother due to ejaculatory dysfunction decreased in all age groups, except for men 70 years of age or older.
Alfuzosin was well tolerated. Dizziness was the most frequently reported adverse event (2.4%). Hypotension occurred in 0.1%. There were no cases of syncope, and sexual adverse events were uncommon.
A Very Interesting Study
"This is a very interesting study, although it's actually more of a registry in which men went to see their doctor for urination complaints, were prescribed a medication, and had assessments of many other aspects of their life, including sexual function," Kevin McVary, MD, professor of urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois, told Medscape Urology.
"Patients with BPH very commonly report erectile dysfunction and ejaculatory dysfunction, and sexual dysfunction and LUTS-BPH dovetail very nicely," he added. "In fact, we actually think these 2 diseases are related biologically, which would have been heresy only a few years ago, but more evidence is now piling up."
"These investigators found that when you improve LUTS with this particular medication, you also improve their ejaculatory dysfunction and bother due to ejaculatory function, he said. "This is a finding worth noticing that represents part of a general trend we are now seeing with other medications, although there are some medications that improve LUTS and actually worsen the ejaculatory complaint."
As for how alfuzosin works, Dr. McVary said that "alfuzosin does not affect the part of the seminal vesicle and prostate that relates to ejaculation and emission. Because it doesn't affect that, these guys do a better job."
Sanofi Aventis provided funding for the study. Dr. Fitzpatrick and Dr. Rosen report receiving consulting fees from Sanofi Aventis.
European Association of Urology (EAU) 25th Annual Congress: Abstract 1000. Presented April 19, 2010.
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Cite this: Alfuzosin Improves Ejaculatory Dysfunction in Men With Probable BPH - Medscape - Apr 20, 2010.