BERKELEY, CA (UroToday.com) - Lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and ejaculatory dysfunction (EjD) are common, non-life-threatening and age-related conditions that frequently remain untreated due to a lack of awareness of these problems in the aging male, resulting in poorer quality-of-life. Despite the high prevalence of all three conditions in aging men, I think insufficient attention continues to be given to LUTS, ED and EjD. Although there are accumulating data from epidemiological and clinical studies regarding the associations among LUTS, ED and EjD, there is, unfortunately, a lack of definition of male pelvic dysfunction (MPD) that could combine all these three abnormalities into one title. This national, population-based field survey first attempted to combine of LUTS, ED and EjD for the prevalence of MPD and its associates in 2.730 men aged ≥ 40 years by using validated questionnaires including IPSS, IIEF and MSHQ–4.
The prevalence of MPD was found to be 24.4% among the total participants of the study. When the prevalence of MPD was stratified based on age, it was 9.1% in men aged at 40–49, 27.1% at 50–59, 56.7% at 60–69, and 76.6% at ≥ 70 years. When compared to the age group of 40–49 years, the prevalence of MPD was increased 3.72−fold for 50–59, 13.13−fold for 60–69, and 32.84−fold for ≥ 70 years (<0.001). When regression models were carried out for the impact of age on the presence of MPD, the prevalence was increased with 1.14−fold, 2.18−fold, and 3.41−fold for every 1−year, 5−years and 10−years-of-increase in age, respectively (p < 0.001).
Impacts of socio-demographic characteristics and clinical features of the study population on the presence of MPD were analyzed using a regression model. Living in rural or urban areas did not have any affect on presence of MPD (p=0.066), but increase of monthly income was negatively correlated with presence of MPD (p < 0.001). When the study population was stratified based on BMI for further analysis, having abnormal BMI levels demonstrated significant impact on the presence of MPD (p=0.005). At logistic regression models, dyslipidemia (p=0.002), hypertension, diabetes mellitus, and cardiovascular diseases (p <0.001) were found to be independent determinants for having MPD.
 |
| Overall and age-stratified prevalence of Male Pelvic Dysfunction for the study populations. (Adapted from Kendirci M et al, Andrology 2014) |
We also analyzed frequency of sexual activity of the study participants by self-reported questionnaires based on the frequency of sexual activity during the past one month. The mean number of sexual activity in the study population was 7.3±6.3 per month. The average monthly frequency of sexual activity was significantly affected by age, presence of MPD, and severity of LUTS, ED and EjD.
Clearly, many metabolic, cardiovascular, endocrine, life-style and socio-demographic factors contribute to the aspects of male pelvic health. This study also looked at these factors and reported that diabetes, hypertension, dyslipidemia, cardiovascular diseases, and lower monthly income were associated with increased risk for the presence of MPD.
The potential underlying mechanisms responsible for increased sexual disorders in men with LUTS are yet to be clearly understood. Apart from epidemiological and clinical correlations, recently a number of patho-physiological links between LUTS and sexual disorders have been proposed. Based on shared molecular physiology among prostate, bladder, penis, and the ejaculatory system, there is a need to define MPD and investigate these relationships. Our study supports the scientific evidence by providing epidemiological data on explaining how pelvic organs might be simultaneously affected in the aging male.
There are some limitations of this study. First, the definition of MPD was to be attempted based on outcomes of the three validated questionnaires. Previous epidemiological works focused on associations of LUTS and sexual dysfunctions by separately elucidating all three disorders of the male pelvis. However, this study gathered LUTS, ED and EjD into one category as MPD. The calculations derived from all three questionnaires, IPSS, IIEF–5 and MSHQ–4, is to be accepted as an effort, so it needs to be discussed and supported for further studies. Another limitation of this study is the definition of EjD obtained from the MSHQ–4 questionnaires. As there is not a universally accepted stratification of degree of EjD, we communicated with experts of the field in order to define MPD by incorporating MSHQ–4 scores into IPSS and IIEF–5. The third limitation of this study was the age of the study population. In order to conform to the criteria for a population-based survey, relatively younger men had to be included into the study for representing the nation’s age, as seen in the 40−49 year-old group that consisted of 40% of the participants. We believe that this age distribution needs to be taken into account when evaluating outcomes of this survey.
A greater understanding of the relationships among LUTS, ED and EjD, will help clinicians to look outside our specialty for strategies to improve male pelvic health. As a specialty, we are considered the experts in the development of the most effective diagnostic and therapeutic approaches for male pelvic disorders. It is crucial to take a more global approach to the management of MPD, one that focuses not only on disorders of the bladder and prostate, but also on other readily diagnosed conditions such as ED and EjD, as well as medical comorbidities. We hope that the outcomes of this study would further the approaches of practicing clinicians on improving quality-of-life in aging males by improving their health care.
Written by:
Muammer Kendirci, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Professor of Urology
Department of Urology
Bahçeşehir University School of Medicine
Liv Hospital Ulus, Istanbul/Turkey