ASPETTI ANDROLOGICI DEL DOLORE PELVICO CRONICO

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Giorgio Rossetti
6 anni fa
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1 ASPETTI ANDROLOGICI DEL DOLORE PELVICO CRONICO Bruno Giammusso Unità Operativa di Andrologia Urologica Ospedale Vittorio Emanuele - Catania

2 NIH category III prostatitis or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) common clinical syndrome, affecting up to 15% of all men. It is characterized by pain or discomfort localized to the abdomen, pelvis and genitals, as well as irritative and obstructive lower urinary tract symptoms (LUTS) in the absence of urinary tract infection Krieger JN, Nickel JC. JAMA, 1999

3 Normal male sexual response Sexual interest/ stimulation Orgasm Ejaculation accompanied by orgasm Penile tumescence Penetration Penile detumescence High arousal / penile erection Plateau Resolution Excitement Time Adapted from Donatucci (2006) J Sex Med 3(suppl 4):

4 SINTOMI ANDROLOGICI IN CP/CPPS CP/CPPS DISFUNZIONE ERETTILE EIACULAZIONE PRECOCE DOLORE EIACULATORIO

5 SINTOMI ANDROLOGICI IN CP/CPPS Epidemiologia DOLORE EIACULATORIO: Prevalenza nella popolazione generale.. 1% (Blanker MH,Urology 2001) Prevalenza in CP/CPPS.. 58% (Litwin MS,J Urol 1999).. 24% regularly 50% intermittently (Shaskes DA,J Urol 2004)

6 SINTOMI ANDROLOGICI IN CP/CPPS Epidemiologia EIACULAZIONE PRECOCE: E.P. in CP/CPPS... 77% (Gonen M et al,j Androl 2005) CP/CPPS in E.P... 64% (Shamloul R et al,j Sex Med 2005)

7 SINTOMI ANDROLOGICI IN CP/CPPS Epidemiologia DISFUNZIONE ERETTILE: ED in CP/CPPS ,5%

8 PATOGENESI DELLA DISFUNZIONE ERETTILE IN CP/CPPS

9 sistema nervoso sistema circolatorio sistema endocrino EREZIONE

10 PATOGENESI DELLA DE Psichogenic CP/CPPS has a well-recognized association with stress, anxiety and maladaptive responses to stressful situations (Shoskes DA,Curr Urol Rep 2012) In addition to pain symptoms, a number of other psychological factors influence the sexual lives of men with CP/CPPS. A statistically significant decline in erectile function was observed not only with increasing pain symptoms but also in men worse stress appraisal (Aubin S et al,j Sex Med 2008)

11 PATOGENESI DELLA DE Endocrine Hypogonadism is a common finding in men with ED The genetics of patients with CPPS suggest that an underlying problem with androgen regulation may contribute to the development of prostatitis (Pontari MA,J Urol 2004) Possibility of androgen insensitivity in the pathogenesis of CPPS (Pontari MA,J Urol 2008)

12 PATOGENESI DELLA DE vascular Arterial insufficiency case-control study involving men with CP/CPPS this group was more likely to have evidence of arterial stiffness associated with nitric oxide-mediated vascular endothelial dysfunction compared to asymptomatic controls (Shoskes DA,2011) decreased arterial inflow may also be related to extrinsic compression from pelvic floor spasm (Shoskes DA,2008)

13 PATOGENESI DELLA DE

14 Functional and dysfunctional antagonism (2) FLACCID /DETUMESCENCE Functional antagonism A critical amount of smooth muscle relaxation occurs, resulting in normal erectile function. Relaxation Contraction ERECTION /TUMESCENCE Dysfunctional antagonism Deficient relaxation and/ or augmented contraction FLACCID /DETUMESCENCE Relaxation ERECTION /TUMESCENCE does not occur Contraction Lerner et al. 14

15 PATOGENESI DELLA DE Vascular Venocclusive disease Doppler sonographic parameters in patients with adrenergic vasospasm could lead to diagnosis of venocclusive-disease (Giammusso B,Arch Urol Androl,2005) (Ghanem H,J Sex Med,2007)

16 D.E. FUNZIONALE DATI CLINICI D.E. all ottenimento e al mantenimento incremento sensibile del periodo refrattario post-eiaculatorio glande soffice, ischemico in erezione pene freddo o retratto in condizioni di flaccidità deficit di attività erettiva spontanea

17 PATOGENESI DELLA EIACULAZIONE PRECOCE adrenergic overactivity is involved in the pathophisiology of men with premature ejaculation

18 TERAPIA DELLA DE IN CP/CPPS The only studies that address the efficacy of CP/CPPS therapies and ED involve alpha-blockers and pelvic floor physical therapy (Tran CN,World J Urol 2013) Alfuzosine 10 mg once daily significantly improved LUTS, quality of life and sexual function in men with CP/CPPS (Nickel JC,BJU Int,2006) Doxazosin improved both ED and LUTS symptoms in men with CP/CPPS (Faydaci G et al, Int Urol Nephrol,2011)

19 CONCLUSIONI La popolazione maschile affetta da CP/CPPS dimostra tassi di prevalenza di disfunzioni sessuali significativamente superiori rispetto alla popolazione generale. La patogenesi delle disfunzioni sessuali maschili nei soggetti con CP/CPPS risulta essere multifattoriale. Il meccanismo patogenetico principale nell ambito delle turbe erettive risiede nell ipertono adrenergico riflesso.

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