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Home / Is Thete Anything L Can Take to Be Ablebto Ejackulate Again if on Flomax

Is Thete Anything L Can Take to Be Ablebto Ejackulate Again if on Flomax

  • Journal List
  • Asian J Androl
  • v.13(6); 2011 Nov
  • PMC3739550

Asian J Androl. 2011 November; 13(half-dozen): 846–850.

Effect of tamsulosin on ejaculatory function in BPH/LUTS

Sang Hoon Song,1 Hwancheol Son,2 Kwang Taek Kim,3 Sae Woong Kim,4 Du Geon Moon,5 Ki Hak Moon,6 Kwangsung Park,7 Jong Kwan Park,8, 9 Sung-Won Lee,10 Jae Seog Hyun,xi and Nam Cheol Park12

Sang Hoon Song

1Jeungpyung Health Heart, Jeungpyung-gun, Chungbuk, 368-900, Korea

Hwancheol Son

twoDepartment of Urology, Seoul Metropolitan Boramae Hospital, Seoul, 156-707, Korea

Kwang Taek Kim

3Aerospace Medical Center, Cheongwon, Chungbuk, 363-840, Korea

Sae Woong Kim

4Cosmic University of Korea College of Medicine, Seoul, 137-701, Korea

Du Geon Moon

5Korea University College of Medicine, Seoul, 152-703, Korea

Ki Hak Moon

6Department of Urology, Yeungnam University College of Medicine, Daegu, 705-717, Korea

Kwangsung Park

7Section of Urology, Chonnam National University Medical School, Gwangju, 501-757, Korea

Jong Kwan Park

8Section of Urology, Medical School and Institute for Medical Sciences, Chonbuk National University, Chonbuk, 561-712, Korea

9Enquiry Institute of Clinical Medicine and CTC for Medical Device of Chonbuk National University Hospital, Chonbuk, 561-712, Korea

Sung-Won Lee

10Samsung Medical Middle, Sungkyunkwan University Schoolhouse of Medicine, Seoul, 135-710, Korea

Jae Seog Hyun

elevenGyeongsang National University, Gyeongnam, 660-702, Korea

Nam Cheol Park

12Pusan National Academy Higher of Medicine, Pusan, 602-739, Korea

Received 2010 Dec 16; Revised 2011 Feb 18; Accepted 2011 Mar 14.

Abstract

This written report was undertaken to decide the impact on ejaculatory function of tamsulosin (0.2 mg) given once daily (OD) for 12 weeks and to place risk factors for ejaculatory dysfunction in patients undergoing this handling. Males with an International Prostatic Symptom Score (IPSS) ≥viii were enrolled in this study. All participants completed questionnaires, including the IPSS and the Male person Sexual Health Questionnaire (MSHQ), and serum prostate-specific antigen, transrectal ultrasound and uroflowmetry with mail-void residual were measured. Later initiating 0.ii mg OD tamsulosin, patients were re-evaluated on the fourth and 12th weeks of medication. The chi-squared exam, the independent t-test and one-way ANOVA were used to compare means. Binary logistic regression analysis was used to calculate the odds ratio for all hazard factors. A total of 177 men constituted the study cohort. No meaning difference was observed betwixt baseline and follow-upward for the erectile role, ejaculatory office, satisfaction, sex and desire domains (EFD, EjFD, SDA and ADD) or for erectile or ejaculatory bother mean scores. Afterward 12 weeks, the overall incidence of ejaculatory dysfunction (EjD) was xiii.4%. Incidences of the seven dissimilar types of EjD (decreased frequency, filibuster, dryness, decreased strength/force, decreased volume, decreased pleasure and pain at ejaculation) were 2.4%, 3.one%, three.ix%, 3.9%, 6.3%, 7.1% and 3.1%, respectively. Baseline EjFD scores were higher for IPSS responders than for non-responders (26.09 vs. 24.06, P=0.03). An EjFD score reduction was more frequent in IPSS responders. The incidence of EjD was modest, just non negligible and was more frequent in patients with less lower urinary tract symptoms, a smaller prostate, higher baseline MSHQ totals and higher EjFD scores.

Keywords: blastoff-i adrenergic receptors, benign prostatic hyperplasia, ejaculation, lower urinary tract symptom, Male person Sexual Health Questionnaire, prostatic hyperplasia, tamsulosin

Introduction

Benign prostatic hyperplasia (BPH) is highly prevalent in the aged male population.1, 2 α1-Adrenoceptor antagonists are commonly administered to care for BPH and their prophylactic profiles are well-known to urologists.3, four, 5 Tamsulosin is one such agent and has preferential selectivity and a greater analogousness for α1A-adrenoceptors than for α1B-adrenoceptors.v Because α1A-adrenoceptors are widely distributed in all organs that participate in the emission phase of ejaculation (epididymis, vas deferens, seminal vesicle, prostate gland, prostatic urethra and bladder neck), tamsulosin is suspected to play an inhibitory role during the ejaculatory emission phase.6 Tamsulosin likewise has a high analogousness for D2-like and 5HT1A receptors, which play key roles in the central control of ejaculation, and thus is also suspected to have a central consequence on ejaculation.six Abnormal ejaculation is a typical side effect of tamsulosin.7, eight In a long-term, open-label, phase 3 extension study of 0.4 mg tamsulosin once daily (OD), 30% of patients experienced ejaculatory dysfunction (EjD).5 Furthermore, the effects are dose-related, every bit demonstrated by a significantly higher incidence of EjD in men receiving 0.four mg OD (8.4%) or 0.8 mg OD (18.1%) tamsulosin than in those receiving placebo (0.two%).9

In South korea, as in other Asian-Pacific countries, tamsulosin is prescribed at 0.2 mg OD, and at this dosage, it may have an adverse effect on ejaculation. For example, in a Japanese report, tamsulosin at 0.ii or at 0.4 mg OD for 3 days reduced mean ejaculatory volumes by 45% and 49%, respectively, although no sperm were detected in midstream urine obtained after ejaculation.10 Nevertheless, the prevalence of EjD (0.6%–4.v%) and of overall agin events (half dozen.ii%) after 0.two mg OD tamsulosin in South Korea is considerably lower than in Europe and the Us.11, 12 However, in the studies mentioned above, EjD was not clearly divers or was sometimes reported every bit retrograde ejaculation. Furthermore, the caste of dysfunction has non been subject to report. Although a substantial number of papers reported prevalence values for diverse types of sexual dysfunction, farther elaboration of the characteristics of EjD is lacking.xiii, fourteen, 15 Therefore, the aims of this study were to determine the degree of bear on of 0.2 mg OD tamsulosin for 12 weeks on sexuality, especially on ejaculatory role, and to evaluate voiding office efficacy after treatment with a validated, self-administered questionnaire on erection, ejaculation and sexual satisfaction, namely, the Male Sexual Health Questionnaire (MSHQ). In improver, we sought to identify risk factors for sexual dysfunction later on tamsulosin treatment.

Materials and methods

Participants

Enrollment of the study subjects was conducted in urology clinics at nine university hospitals in South Korea from December 2008 to Jan 2010. Males who visited each urology dispensary due to lower urinary tract symptoms (LUTS) suggestive of BPH and with an International Prostate Symptom Score (IPSS) of more than viii were enrolled in this study. Patients were excluded if they had any of the following: a history of taking α-blockers, 5α-reductase inhibitors, anti-androgenic hormones or anticholinergics during the previous 4 weeks due to LUTS or BPH; received androgenic hormones or phosphodiesterase type 5 inhibitors during the previous four weeks due to erectile dysfunction; been treated using not-pharmacological methods for a prostate or urethral condition; a history of urinary tract infection, prostatitis, or a malignant neoplasm of the genitourinary tract; or severe hepatic or renal dysfunction.

Study protocol

Participants were evaluated at their first visit to the clinic via a detailed medical history, the recording of vital signs and a physical examination. In add-on, they were asked to complete the IPSS, quality of life (QoL) survey and MSHQ; they were tested for serum prostate-specific antigen and underwent transrectal ultrasound and uroflowmetry with post-void residual book.

Tamsulosin (0.ii mg OD) was administered orally for 12 weeks. Vital signs, physical examinations, IPSS, QoL, MSHQ and uroflowmetry with mail service-void remainder were re-evaluated afterwards 4 and 12 weeks of treatment (TW 4 and 12). Compliance with medication and possible adverse events were recorded at each visit. This study protocol was reviewed and approved by the Institutional Review Lath.

Definitions of sexual dysfunction and the effectiveness of tamsulosin medication

The 25-particular MSHQ is composed of a 3-detail erectile role domain (EFD), a seven-detail ejaculatory function domain (EjFD), erection and ejaculation bother items, a six-item satisfaction domain (Sorry), and a vii-item sexual activeness and desire domain (ADD).sixteen Particular scores (range: 0–v), full MSHQ scores and domain scores at baseline and at TW 4 and 12 were compared and differences were analysed. Erectile dysfunction was defined as an erectile domain score of <vi or a score of <2 for any item. EjD was classified into seven types of dysfunction using the 7-item ejaculatory function domain (decreased frequency, delay, dryness, decreased strength/forcefulness, decreased volume, decreased pleasure and pain at ejaculation). Dysfunction was defined as an detail score of <1 at assessment or a decrease of ≥3 points relative to the initial assessment. The number of subjects with each EjD divided past the overall number of subjects gave the incidence of each ejaculatory dysfunction.

Tamsulosin response in terms of LUTS suggestive of BPH was determined using IPSS/QoL and pinnacle flow rate (Qmax). Those with improvements of full IPSS and Qmax of ≥25% or ≥xxx% from baseline were defined as IPSS and Qmax responders, respectively. These definitions were suggested by previous studies.v, 12, 17 To evaluate associations between the occurrence of EjD and the degree of symptom improvement, we compared the MSHQ EjFD score variation differences after medication of tamsulosin responders and non-responders.

Statistical analysis

All statistical analyses were performed using SPSS version 13.0 (SPSS Inc., Chicago, IL, U.s.). The chi-squared test was used to compare categorical information, and the contained t-test and 1-fashion ANOVA were used to compare numerical data. Wilcoxon'south rank sum test and the Kruskal–Wallis examination were used to compare non-parametric variables. Binary logistic regression assay was used to calculate the odds ratios of all risk factors. All hypotheses were evaluated in a two-sided way, and P values of <0.05 were considered pregnant. Values are presented as means±south.d. unless otherwise indicated.

Results

Demographics

Of the 213 subjects initially included in the report population, 29 were excluded because of incomplete data collection, and seven subjects were excluded because they were unable to ejaculate or lost ejaculate at their showtime visit to the clinic. As a result, 177 men composed the report cohort. General subject characteristics and baseline and follow-up data are included in Table ane. MSHQ full scores and domain scores are listed in Table 2.

Table one

Demographics at baseline and follow-up (n=177)

Baseline iv-calendar week treatment with 0.two mg tamsulosin OD 12-week treatment with 0.ii mg tamsulosin OD
Age (year) 58.x±7.90 — —
Claret pressure level (mmHg) 124.83±11.91 123.84±ten.fourscore 122.47±10.06**
Body mass alphabetize (kg m−2) 24.18±2.26 — —
PSA (ng dl−1) i.97±three.18 — —
TRUS (ml) 24.60±15.95 — —
Q max (ml due south−1) 15.63±6.61 — 17.63±6.34*
Voided book (ml) 292.75±150.69 — 260.75±92.02*
Residual urine (ml) 32.28±31.28 — xx.88±36.98*
IPSS xvi.35±7.14 xiii.71±7.05** 12.09±half dozen.14**
QoL three.54±ane.26 3.xxx±1.22* 3.08±ane.29*

Table 2

MSHQ full and domain scores at baseline and follow-up (north=177)

Baseline iv weeks 12 weeks
MSHQ total 82.06±17.05 82.12±eighteen.19 81.07±19.xi
Erection domain 9.74±3.33 nine.67±3.35 9.lx±3.43
Ejaculation domain 25.06±6.41 24.60±half-dozen.81 23.76±7.87
Satisfaction domain 19.49±four.52 19.53±4.83 19.28±4.64
Activity and desire domain 12.05±2.62 12.36±ii.65 12.28±2.57

Primary end signal

For all 177 report subjects, no pregnant difference was observed between baseline and follow-upwards for erectile function, ejaculatory function, satisfaction, sexual activeness and desire domains (EFD, EjFD, SDA, Add together) or for erectile or ejaculatory bother hateful scores (Table two and Figure ane). We analysed relations between EjFD scores and item scores in detail. Figure 1 demonstrates that all EjFD detail scores were the everyman (indicating more dysfunctional) at TW 12, but this was only significant for the pain detail of the EjFD. The overall incidence of EjD at TW 12 adamant using MSHQ EjFD scores was 13.4%. The other incidences of ejaculatory dysfunction are listed in Table 3.

An external file that holds a picture, illustration, etc. Object name is aja201125f1.jpg

Plots demonstrating MSHQ ejaculatory function domain detail scores evaluated at baseline and later 4 and 12 weeks of handling. Differences were not statistically significant except for the seventh item (pain) at 12 weeks of treatment (P=0.013). Q1–Q7: ejaculatory role domain item numbers ane–seven; Bother: MSHQ ejaculatory carp item score. MSHQ, Male person Sexual Health Questionnaire.

Table three

Incidence of ejaculatory dysfunction (%)

Ejaculatory dysfunction four weeks 12 weeks
Decreased frequency 3.1 ii.4
Filibuster of ejaculation iii.nine 3.one
Dryness (anejaculation) 2.4 iii.nine
Decreased strength of ejaculation 4.vii 3.9
Decreased volume of ejaculation 5.5 six.iii
Decreased pleasure 3.1 7.one
Pain on ejaculation two.4 3.i
Total xiv.ii 13.4

Secondary end point

IPSS responders comprised 39.0% and 49.two% of the 177 written report subjects at TW four and 12. The mean increase of Qmax from baseline was two.00 ml s−1 at TW 12, and Qmax responders comprised 18.6% of the written report subjects. The results of efficacy parameters are listed in Table 1. MSHQ scores were not different between Qmax responders and not-responders. Mean baseline MSHQ total and EjD scores at TW 12 were greater for IPSS responders than for not-responders, only the difference was significant only for MSHQ EjD scores between responders and not-responders (83.83 vs. fourscore.27, P=0.17 and 26.09 vs. 24.06, P=0.03, respectively). A reduction in MSHQ domain score over 12 weeks was observed more oftentimes among IPSS responders than non-responders, but this difference was significant for EjFD scores only (42.v% vs. 25.5%, P=0.017) (Figure ii).

An external file that holds a picture, illustration, etc. Object name is aja201125f2.jpg

MSHQ domain score reductions after 12 weeks of tamsulosin treatment were more common among IPSS responders than IPSS not-responders, but this divergence was significant for EjFD scores only (42.five% vs. 25.5%, P=0.017). (a) Erectile function domain (EFD); (b) ejaculatory function domain (EjFD); (c) satisfaction domain (SAD); (d) action and desire domain (ADD). IPSS, International Prostatic Symptom Score; MSHQ, Male Sexual Health Questionnaire.

Gamble factors for EjD

MSHQ EjD scores were reduced in lx subjects, and these patients showed higher mean baseline MSHQ total and EjFD scores than subjects whose scores were not reduced, but the differences were not statistically meaning (83.14 vs. 81.53, P=0.56; 25.73 vs. 24.71, P=0.32). Furthermore, the hateful prostate volume of these subjects was smaller (21.58 ml vs. 26.13 ml, P=0.085), the voided volume was larger (329.95 ml vs. 268.51 ml, P=0.037), Qmax was faster (17.67 ml due south−1 vs. 14.59 ml s−1, P=0.003), and PVR was smaller (26.45 vs. 35.27, P=0.076) compared to subjects with a not-reduced MSHQ EjD score. EjFD was found to be the merely meaning gamble factor for EjD occurrence by binary logistic regression analysis (P<0.001). The odds ratio for EjD was ten.14 (95% CI: 2.245–45.857) in patients with a baseline EjFD score of ≤26.

Word

This is the first multicentre study to evaluate the impact of tamsulosin at 0.2 mg OD for 12 weeks on ejaculatory function using a validated questionnaire (the MSHQ). By using this questionnaire, we were able to evaluate EjD with respect to frequency, volume and other variables. Furthermore, the occurrence of these dysfunctions was found to exist associated with the degree of LUTS improvement.

In a previous study conducted over a 53-week treatment period, EjD or abnormal ejaculation was reported in 10% and 26% of patients on 0.4 or 0.8 mg of tamsulosin OD, respectively.xviii In some other study, over a mean handling duration of 64.5 weeks, 30% of patients treated with tamsulosin (0.iv–0.8 mg OD) reported abnormal ejaculation.5 However, in these studies, EjD and abnormal ejaculation were assessed using patient cocky-reports, and the definitions used were less than articulate. Information technology has sometimes been assumed that abnormal ejaculation associated with α-blocker use represents retrograde ejaculation in an analogous style to the retrograde ejaculation encountered after transurethral resection of the prostate.viii, eighteen Nevertheless, in two contempo studies, researchers measured ejaculate and post-ejaculation urine volumes and demonstrated that α-blocker-associated aberrant ejaculation may represent anejaculation rather than retrograde ejaculation.10, 19 Hellstrom and Sikka19 reported that ejaculatory part in subjects on tamsulosin 0.8 mg OD was marked by a reduced ejaculate volume in almost 90% of subjects and that anejaculation was present in approximately 35% of participants.nineteen In the present report, nosotros found that anejaculation, decreased ejaculate volume and overall EjD occurred in 3.9%, 6.iii% and 13.4% of participants, respectively, on tamsulosin 0.2 mg OD at 12 weeks follow-upwardly (Table 3). This incidence of EjD on tamsulosin 0.2 mg is considered to exist in straight proportion to that on 0.8 mg. Therefore, the incidence of EjD may well be dose-related rather than being due to a genetic or racial difference in the analogousness or in the selectivity of tamsulosin for αone-adrenoceptors. Even so, researchers in Japan showed that the frequency distribution of the α1-adrenoceptor polymorphism is significantly unlike in Japanese than in Americans.xx Thus, the possibility of an association betwixt tamsulosin-induced EjD and the α1-adrenoceptor gene polymorphism in Koreans remains to be investigated.

A combined analysis of 12 European and United states of america clinical studies establish that BPH symptom improvements were slightly greater in patients with an ejaculation problem than in those without.21 In addition, these patients were found to be less likely to discontinue treatment than patients without an ejaculation problem. Our finding that MSHQ EjFD scores were reduced more frequently amid IPSS responders than non-responders is consistent with this previous finding. This could exist explained by a greater selectivity and/or affinity of tamsulosin for the α1A-adrenoceptors and the distribution of these receptors, which are well expressed in the organs that participate in the ejaculatory emission phase.5

In add-on, we found that tamsulosin-induced EjD was more frequent among patients with a relatively small prostate volume, a faster Qmax, a smaller balance urine volume, and higher baseline MSHQ total and EjFD scores. Although age differences betwixt the subjects with and without EjFD score reductions were non significant (57.97 years vs. 58.34 years) in our study, this effect had been reported in other studies. A pooled analysis of European phase Iii studies found abnormal ejaculation to exist more prevalent among patients aged <65 years (6.3%) than in those aged ≥65 years (2.6%), but that incidences among those treated with a placebo were similar in these historic period groups (1.0%–ane.i%).22 Furthermore, the highest incidence of aberrant ejaculation ever reported was in a clinical pharmacology study of 25-twelvemonth-sometime volunteers.19 Meanwhile, in the nowadays written report, IPSS and MSHQ EjFD scores were plant to exist significantly correlated (correlation coefficient=−0.226, P=0.004 at TW 4; correlation coefficient=−0.207, P=0.011 at TW 12). Based on our findings, we believe that patients with balmy LUTS and good ejaculatory function are more likely to suffer from abnormal ejaculation later on tamsulosin handling.

This study is express because information technology was non instance-controlled or comparative and because we did not investigate dose responsiveness at higher tamsulosin doses. In add-on, we did not measure ejaculate volumes, but rather relied on patient cocky-assessments in the MSHQ. Nonetheless, measuring ejaculate volumes in the clinical situation is inconvenient. Instead, we advise that clinicians utilize the MSHQ to obtain information almost EjD.

Using the MSHQ, we were able to investigate EjD with respect to frequency, volume, pleasure and other variables after administering tamsulosin at 0.2 mg daily for 12 weeks. The incidence of EjD was minor simply non negligible. Nosotros found that the occurrence of EjD was associated with the degree of LUTS improvement. Furthermore, patients with a relatively pocket-size prostate volume, a greater Qmax a smaller PVR, and college baseline MSHQ total and EjFD scores were found to suffer more frequently from abnormal ejaculation after receiving tamsulosin at 0.2 mg daily. However, aberrant ejaculation is found in more fifty% of men aged over 60 years, and thus, the clinical significance of the small increase in prevalence in older men requires farther investigation.

Author contributions

SSH, PJK and SH conceived of the study, participated in the blueprint of the study, performed the statistical analysis and drafted the manuscript. KKT, KSW, MDG, MKH, PK, LSW, HJS and PNC participated in the design and coordination of the study, performed participant recruitment and helped to typhoon the manuscript. All authors read and approved the final manuscript.

Notes

The authors declare no competing financial interests.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739550/