One in two men after the age of 65 suffers from disorders of the lower urinary tract (Luts) and, among these, a substantial percentage has serious repercussions on their sex life. More and more those suffering from disorders of this type are asking to receive treatments that preserve their sexuality and medicine is responding with targeted drugs and new minimally invasive surgery techniques. Lifestyle and diagnostic timeliness, however, remain the two most important aspects. It is being talked about these days in Amsterdam, on the occasion of the congress of the European Society of Urology.
Benign prostatic hyperplasia
As early as the second or third decade of life, many men begin to suffer from benign prostatic hypertrophy, an increase in the volume of the prostate caused by the formation of small nodules, which can obstruct the urethra canal. In Italy this problem affects over 6 million men over the age of 50: between 51 and 60, one in two men suffer from this disorder, and the percentage rises to 70% among 61-70 year-olds, with a peak of 90% in eighties. The urinary function disorders associated with benign prostatic hyperplasia are mainly obstructive (difficulty in emptying the bladder) and containment (difficulty in procrastinating or, more generally, in managing the timing of urination). As for the sexual sphere, the consequences concern the alteration of the libido (often induced by the taking of drugs), the erectile difficulty and the inability to ejaculate.
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Prevention is primarily a lifestyle issue
The first area to act on, the doctors emphasize, is the lifestyle. Alcohol, smoking, insufficient hydration, a diet that is too high in fat and low in vegetables, physical inactivity, and even work-related stress are important risk factors for the onset of urinary tract problems. The alarm bells are the same as for the metabolic syndrome (more generally associated with cardiovascular disease). Acting to modify them means on the one hand preventing the onset of the disease, on the other hand being able to limit the problems connected to it – especially as regards the compromise of the quality of life also at a sexual level.
The importance of early diagnosis also concerns the sexual sphere
“We must increasingly develop patient-based medicine, where alongside scientific evidence and guidelines, we must also consider the expectations and experiences of people, who have the right to a normal life and sexuality, whatever their age. ”, Says Cosimo De Nunzio, professor of urology and medical director at the urology department of the Sant’Andrea University Hospital in Rome. The first step, however, emphasizes the urologist, is for the patient to go to a specialist for diagnosis. In recent years too many people rely on do-it-yourself rather than the general practitioner or urologist, but in the case of urinary tract disorders, acting promptly can be decisive in not compromising the patient’s health also from a sexual point of view.
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Herbal medicine can limit the damage
Also to respond to the growing concern of patients, the European Society of Urology has paid more attention to the consequences on the sexual sphere in the new guidelines for the treatment of urinary tract disorders. The problem must be considered from a medical and pharmacological point of view, also considering the consequences of surgery. The pharmacological approach to treat prostatic hypertrophy disorders has changed a lot in recent years: alongside traditional medicines, which can have important side effects on sexual desire and erectile function, herbal medicine has been added. The extract of Serenoa repens, for example, has been shown to be effective in combating disorders of urinary function, without any repercussions from a sexual point of view. However, among the phytotherapeutic drugs, doctors warn, there is still too much do-it-yourself: to prevent them from causing further damage rather than solving the problem, one must rely on those that have been evaluated from a scientific point of view and which, as such, must be prescribed by the doctor.
Traditional surgery and minimally invasive surgery
“Men who today undergo surgery after the age of 60 or even 70 ask us to have a normal sexuality, which means preserving the erection, but also the ejaculation”, says Mauro Gacci, professor of minimally invasive urological surgery , robotics and kidney transplants in the Careggi university hospital in Florence. However, surgery – underlines Gacci – is not the first choice among the solutions to treat benign prostatic hypertrophy, and can be accompanied by a greater risk of the onset of ejaculation problems, while erectile dysfunction is hardly compromised.
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Alongside traditional surgery, in recent years minimally invasive procedures have emerged, which instead guarantee a greater preservation of sexual function. It is a less invasive approach, it can also be performed on an outpatient basis and does not require anesthesia, but it is a little less effective and lasting. However, this is an important opportunity, especially for younger patients, with an active sex life and who may still have children. “The patient will be able to choose a treatment that is a little less effective, in terms of improving the urinary flow and keeping this result over time, but which preserves ejaculation”, says Gacci: “Key role for the satisfaction of the person we have in care is the time for counseling. The diagnostic-therapeutic process – he concludes – is defined together, clarifying from the beginning what are the desired in terms of improvement of urinary symptoms, but also what risks one is willing to run in terms of problems of the sexual sphere “.