Biomedical subjects

Matt T Rosenberg

Publications and source records attributed to Matt T Rosenberg.

5 recordsLinked to original sources

PubMed2006

Treatment of lower urinary tract symptoms in benign prostatic hyperplasia and its impact on sexual function.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a common disorder in older men and may be associated with lower urinary tract symptoms (LUTS) and sexual dysfunction. Men who present with symptomatic BPH and LUTS are at increased risk for sexual dysfunction, including erectile dysfunction (ED) and ejaculatory dysfunction (EjD). OBJECTIVE: This review describes treatment options recommended by the 2003 American Urological Association (AUA) guideline panel for the relief of LUTS associated with BPH, with a focus on the effects of each treatment on ED and EjD. METHODS: Relevant articles were identified via MEDLINE searches of all English-language articles published from January 1984 to January 2005 using the following search terms: benign prostatic hyperplasia and sexual dysfunction, lower urinary tract symptoms and sexual dysfunction, alfuzosin, doxazosin, terazosin, tamsulosin, dutasteride, finasteride, transurethral resection of prostate, erectile dysfunction, and ejaculatory dysfunction. Data on the effects of BPH treatments on sexual function were extracted from the articles and summarized. Because properly designed, adequately powered, direct-comparator studies have not yet been conducted, the AUA's report provides the most comprehensive analyses regarding the efficacy and safety of the current BPH treatment options. RESULTS: LUTS are an independent risk factor for sexual dysfunction in aging men, even after controlling for age and comorbidities. Although surgery, minimally invasive therapies, and pharmacologic therapies can all improve LUTS and the peak urinary flow rate, some can cause or exacerbate ED (incidence rates: surgery, 10%; minimally invasive therapies, 1%-3%; pharmacologic monotherapy or combination therapy, 3%-10%) and EjD (incidence rates: surgery, 65%; minimally invasive therapies, 4%-16%; pharmacologic monotherapy or combination therapy, 0%-10%). Among pharmacologic therapies for BPH, the frequency of EjD appears to be greater with tamsulosin (10%) than with other alpha(1)-blockers (0%-1%) or the 5alpha-reductase inhibitor finasteride (4%), based on data from a single-arm meta-analysis conducted by the AUA. CONCLUSION: Sexual function should be assessed and discussed with the patient when contemplating the appropriate management strategy for LUTS associated with BPH, as well as when evaluating the patient's response to treatment.

Adrenergic alpha-Antagonists↗

PubMed2005

Prevalence of interstitial cystitis symptoms in women: a population based study in the primary care office.

PURPOSE: We estimated the prevalence of urinary symptoms related to interstitial cystitis (IC) in women in a primary care practice and confirmed in the United States the results of a Finnish population based prevalence study. MATERIALS AND METHODS: Every female patient presenting to our office for a routine office visit between January 9, 2004 and September 24, 2004 was evaluated for urinary symptoms using 2 validated surveys, namely the O'Leary-Sant (OLS) IC symptom and problem index, and the Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale. RESULTS: Of the 1,218 women in the study group 13 (1.1%) reported severe symptoms and problems (12 or greater on the OLS survey), including 7 (0.6%) who met previously established criteria for probable IC. In the same population scores on the PUF questionnaire indicated that 154 women (12.6%) likely had IC. CONCLUSIONS: Based on previously published criteria for use of the OLS survey the prevalence of urinary symptoms corresponding to probable IC in our study population (575/100,000 or 0.57%, 95% CI 150 to 1,000) was similar to the 0.45% rate previously reported. However, the results of the PUF questionnaire indicated that the prevalence of IC in women may actually be much higher (12,600/100,000 or 12.6%, 95% CI 10,700 to 14,500). We suggest that the true prevalence of IC in women may be somewhere between these 2 extremes. Further investigation of these questionnaires as screening tools for IC is warranted. IC may be more common in women than previously reported.

Adolescent↗

PubMed2005

Quantifying symptoms in men with interstitial cystitis/prostatitis, and its correlation with potassium-sensitivity testing.

OBJECTIVE: To determine whether men previously diagnosed with prostatitis also have pathology originating in the bladder. PATIENTS, SUBJECTS AND METHODS: We administered the pelvic pain and urgency/frequency (PUF) questionnaire and the potassium-sensitivity test (PST) to 50 patients with prostatitis presenting in urological and primary care, and to 14 controls. In a separate control group of 22 men, the urethra was irrigated with KCl or NaCl (11 each) before and after experimental injury of the urethral mucosa. RESULTS: All 50 patients with prostatitis had PUF scores of > or = 7; 77% were positive for the PST. All 14 controls had PUF scores of 1 or 0 and a negative PST. In the urethral irrigation study in controls, KCl but not NaCl provoked urethral pain after mucosal injury. Before injury, neither KCl nor NaCl caused symptoms. CONCLUSION: The high rate of positive PST in patients with "classic" prostatitis indicates that pathology originating in the bladder may be an important source of symptoms in most. In patients with prostatitis and female patients with interstitial cystitis, symptoms may arise not from separate disease entities but from a continuum of epithelial dysfunction and potassium cycling that may be present throughout the lower urinary tract.

Chronic Disease↗

PubMed2005

Management of patients with interstitial cystitis or chronic pelvic pain of bladder origin: a consensus report.

BACKGROUND: Interstitial cystitis (IC) remains a challenging disease to treat, but increased awareness, better diagnostic tools, and effective pharmacologic agents can help non-urologists successfully manage this condition. Interstitial cystitis is much more prevalent than previously thought and is often misdiagnosed. Left untreated, IC can have a deleterious effect on the quality of life of the affected individual. In-office symptom-based techniques have been developed to screen for the presence of IC in both women and men presenting with symptoms of chronic pelvic pain (CPP) or chronic prostatitis (CP), and effective pharmacologic treatments exist that can provide acute and long-term symptom relief. Individual patient response to therapy varies, with some patients taking up to several months to achieve an optimal therapeutic response. To optimize patient response, a comprehensive algorithm for the diagnosis and management of IC should be utilized. Symptoms and progress should be assessed at each follow-up visit and changes in therapy made accordingly. Patients should be encouraged to learn as much as possible about IC and to take charge of the management of symptoms using their physician for guidance in decision making. The importance of this aspect of therapy should be reinforced at each subsequent visit. The entire office staff also has an important role in understanding and acknowledging each patient's pain and frustration as well as in providing support and education about IC. SCOPE: This paper presents recommendations from a multidisciplinary panel for the evaluation, diagnosis, treatment, and follow-up care of patients with IC or CPP of bladder origin.

Chronic Disease↗

PubMed2005

Overactive bladder: evaluation and management in primary care.

Primary care physicians must initiate a discussion of overactive bladder and urinary incontinence with their patients who are at risk. A stepwise approach to evaluation and diagnosis and the use of systematic evaluation and treatment algorithms suitable to the primary care setting will improve identification and effective management of the incontinent patient.

Algorithms↗