Prostatic profile, premature ejaculation, erectile function

Int Urol Nephrol
DOI 10.1007/s11255-008-9417-9
UROLOGY – ORIGINAL PAPER
Prostatic profile, premature ejaculation, erectile function
and andropause in an at-risk Mexican population
J. Jaspersen-Gastelum Æ J. A. Rodrı́guez Æ
F. J. Espinosa de los Monteros Æ L. Beas-Sandoval Æ
José Guzmán-Esquivel Æ D. D. Calvo Æ
T. Gutiérrez
Received: 1 March 2008 / Accepted: 9 June 2008
Ó Springer Science+Business Media, B.V. 2008
Abstract
Objective To determine the frequency of prostatic
symptomatology, premature ejaculation (PE), erectile
function, symptoms in the older adult/andropause
assessment and to determine the risk factors involved.
Materials and methods The study was conducted by
the Mexican Society of Urology and was carried out
from June to October 2006. Epidemiological information was obtained through the completion of four
validated questionnaires by patients receiving noninstitutional urology treatment. The large database was
statistically analyzed using a logistic regression model.
Results A total of 1,779 men with an average age of
56.6 years were included in the study. The average
prostate-specific antigen value in the sample was 1.73
J. Jaspersen-Gastelum
Hospital Ángeles Metropolitano, Tlacotalpan 59-135 Col.
Roma Sur., Mexico, DF, Mexico
e-mail: jaspersen@prodigy.net.mx
J. A. Rodrı́guez F. J. Espinosa de los Monteros L. Beas-Sandoval J. Guzmán-Esquivel D. D. Calvo
‘‘For Healthy Fathers’’ Campaign of the Mexican Society
of Urology, Mexico, Mexico
J. Guzmán-Esquivel (&)
University of Colima, Zaragoza 377, Centro. CP 28000,
Colima, Mexico
e-mail: enicetoeto@hotmail.com
T. Gutiérrez
Sanofi-Aventis, Av. Universidad esq. Miguel Ángel de
Quevedo, Coyoacan, DF, Mexico
(n = 1,316). Prostatic symptomatology in accordance with the international prostate symptom score
was 7.96 points. A total of 41.9% of participants
reported experiencing PE. The average time to reach
ejaculation was 10.97 min. Of the participating
individuals, 39.5% were diagnosed with andropause.
Prostatic symptomatology was associated with risk
factors of age and prostatitis, P \ 0.01. Premature
ejaculation and erectile dysfunction were associated
with age, P \ 0.01. Vasomotor problems in the older
adult were identified with an association tendency
towards alcoholism and excess weight, P \ 0.063,
but without statistical significance. Sexual problems
in the older adult were associated with diabetes
mellitus, P \ 0.01. Andropause was associated with
traumatic problems in general.
Keywords Andropause Erectile function Premature ejaculation
Introduction
Lower urinary tract obstructive symptoms are a very
common clinical condition in adult men and are
frequently associated with sexual disorders concerning ejaculation and signs and symptoms of androgen
deficiency. These symptoms are considered to be
inevitable age-related conditions [1, 2].
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Some studies have demonstrated a very elevated
prevalence, even higher than 50%, of prostatic
symptoms in men over 50 years of age [3].
Benign prostatic hyperplasia (BPH) is a histological diagnosis common in the medical environment.
However, even though BPH is a very frequent
condition, it is not necessarily related to obstruction
caused by prostate enlargement and urodynamic
changes [4].
Many questionnaires assessing prostatic and sexual symptoms have been validated, allowing an
evaluation to be made of the signs and symptoms
of the lower urinary tract and sexual disorders. They
provide scores or ranges for identifying disease and
its degree and they set down a treatment guide [5–7].
In particular, erectile dysfunction (ED) is a
pathological condition frequently associated with
infravesical urinary obstruction and is defined as the
incapacity to achieve and maintain penile erection of
sufficient quality and duration in order to have
satisfactory sexual relations [8].
Disease prevalence increases with age. Severe
(5%) and moderate (17%) ED have been reported in
men from 40 to 49 years of age. In men from 70 to
79 years of age, the percentages increase to 15% and
34%, respectively [9, 10].
Erectile dysfunction must be differentiated from
other sexual disorders such as premature ejaculation
(PE) and disorders of the libido. Various questionnaires have been validated to evaluate sexual function
and include the international index of erectile function and other simpler recent editions [11, 12].
Erectile dysfunction is associated with a large
number of pathological conditions that directly
influence its development, such as prostatic hyperplasia, diseases of the central nervous system,
smoking, diabetes mellitus, endocrine disorders, and
cardiovascular diseases, among others [13–17].
On the other hand, androgen deficiency has been
demonstrated in many clinical studies which report a
decline in serum testosterone levels in elderly men.
Disorders derived from this decline have been
attributed to dysfunctions of the hypothalamic–
hypophysis axis, leading to secondary hypogonadism
[18–20]. Validated questionnaires are also able to
evaluate disorders due to this hormonal decline
[21, 22].
Brown-Sequard was the first to suggest that some
of the symptoms associated with age were due to
123
testosterone deficiency. Other correlated studies have
associated body mass loss and memory disorders with
testosterone decline in elderly men.
The distribution of the principal urology pathologies in adult men in Mexico is not known with
precision. The studies that have been carried out to
define its distribution and frequency tend to be
regional and often focus on only part of the problem.
Likewise, the association of diverse urinary
pathologies to one another is not known with
certainty, nor have risk factors been identified.
Therefore, the decision was made to carry out a
national epidemiological study on various urologic
conditions such as prostatic symptomatology, PE,
erectile function and symptomatology in the older
adult as an andropause indicator.
The objective of the present study was to determine the frequency, distribution and association of
diseases in the older adult in an at-risk Mexican
population.
Materials and methods
An analytical cross-sectional study was carried out on
a national level by urologists throughout country who
had been summoned by the Mexican Society of
Urology. The study was executed from June to
October 2006 as part of the ‘‘For Healthy Fathers’’
2006 campaign. Epidemiological information was
obtained from 4 validated questionnaires completed
by patients receiving regular urologic medical attention and from their clinical histories. The applied
questionnaires included the following:
1.
2.
3.
4.
5.
Clinical History.
International Prostatic Symptomatology
Questionnaire.
International Index of Erectile Function
Questionnaire.
Premature Ejaculation Questionnaire.
Symptoms in the Older Adult Questionnaire/
Andropause Determination.
The questionnaires were applied by participating
physicians to healthy individuals receiving urologic
consultation and to patients who accepted being
enrolled in the study. All participants signed a letter
of informed consent. A large database was gathered
and later revised and subjected to statistical analysis.
Int Urol Nephrol
Variables of interest
1.
The following study variables were determined.
2.
3.
4.
Clinical history
Participants were questioned about their age, demographic characteristics, chronic-degenerative concomitant diseases (high blood pressure, diabetes
mellitus), personal history of pathologies and life-style
(alcoholism, smoking, obesity, drug or toxic substance
abuse, surgeries and traumatisms).
The types of surgery considered important for the
study were: bladder, ureteral, retroperitoneal, prostate, urethra, and spinal column surgeries as well as
central or peripheral nervous system surgeries. Traumatisms were considered to be those whose lesions
affected the urinary system such as spinal column
fractures with spinal medulla and nerve root lesions,
pelvic fractures and internal organ lesions.
5.
Prostatic symptomatology
6.
The International Prostatic Symptomatology Questionnaire was applied for this evaluation. It consists of seven
questions pertaining to prostatic symptoms for assessing
symptomatology. A final question was elaborated to
determine quality of life as a result of the urinary
symptoms [7]. The questions cover the following points:
1.
2.
3.
4.
5.
6.
7.
8.
Difficulty in controlling (holding back) urination.
Straining in order to pass urine.
Weakening of the urine stream.
Intermittent urination.
Incomplete emptying of the bladder sensation.
Repetitive urination.
Nocturnal urination.
How the person would feel if his present urinary
symptoms were to continue for the rest of his life.
This last item gives more importance to the score of
the individual or patient than to the quality of life he
perceives due to the presence of his present prostatic
symptoms.
Ejaculation before or at the beginning of
penetration.
Ejaculation before it is desired.
Anxiety level about premature ejaculation.
Partner relationship difficulty due to premature
ejaculation.
Average ejaculation time after penetration.
Erectile function
To evaluate erectile function, the International Index of
Erectile Function questionnaire assessing erection level
with the following six questions from the DAN-PSS-SEX
(Danish Prostatic Symptom Score) [12] was applied:
1.
2.
3.
4.
5.
Erection capacity during sexual activity.
Erection for achieving penetration.
Penetration frequency.
Frequency in maintaining erection.
Difficulty in maintaining erection until finishing
coitus.
Confidence level in being able to maintain
erection.
Symptoms in the older adult/andropause
The Symptoms in the Older Adult Evaluation or
Andropause Determination was applied [22] and all
study participants, regardless of their ages, completed
this questionnaire consisting of 20 questions. The
questions were grouped into 4 key areas for the
individual or urology patient:
I.
Physical problems.
II. Vasomotor problems.
III. Psychological problems.
IV. Sexual problems.
Andropause diagnosis was determined with this
questionnaire according to the score obtained and was
considered to be present when there was a score of
three or more in the physical or vasomotor problem
section, four or more in the psychological problem
section and eight or more in the sexual problem section.
Premature ejaculation
Data analysis
A questionnaire consisting of five questions evaluating PE and covering the following points was applied
[12]:
The database underwent a quality control process and only
qualifying data were included in the statistical analysis.
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Int Urol Nephrol
When an excluding or aberrant value was identified, only the questionnaire in which it was found was
eliminated. The other questionnaires completed by
the same participant were still included. This allowed
for a broad sample, strengthening the statistical
analysis.
Open responses referring to medication, products,
diet and treatment received were excluded from the
statistical analysis. Open response dispersion makes
the analysis and definition of tendencies and statistical differences difficult to carry out.
Descriptive analysis was applied to the database of
patients passing the quality control (QC) process in
order to express the characteristics and assessment of
the urology profile of the study population and a
logistic regression model was used to determine
association among variables and risk factors.
Statistical significance was considered when
P \ 0.05. The sample was made up of 1,779 patients
receiving medical treatment from participating physicians affiliated with the Mexican Society of
Urology. The study was carried out from June to
October 2006.
Results
A total of 1779 individuals were included in the
study. The questionnaires from each category were
completed by a different number of participants and
then evaluated.
The following general characteristics were found
in the study patients and are shown in Table 1. The
four variables (age, weight, height and body mass
index) were determined from only 549 patients.
Sample age distribution showed the most frequent
range to be that of 51–60 years, followed by that of
61–70 years. Sample civil status distribution showed
a higher percentage of married men (83.4%), followed by single and divorced men who made up
10.9% of the total when combined.
Table 2 shows the response distribution for different pathology histories of the study participants.
Of the participants, 14.4% reported being diagnosed
with diabetes and 64.9% of them said they were
following a specific diet. The average period of time
with the disease was 9.83 years. High blood pressure
(HBP) was reported by 19.7% of participants and
45.9% of them said they were also following a
specific diet. The average period of time with
hypertension was 7.54 years.
Only 4.1% of the participants reported cardiopathies and only 0.7% reported oncology histories. Only
10.6% of participants reported traumatism antecedents, 57.8% of them being back or pelvis
traumatisms. A total of 14.4% of the sample reported
having had prostatitis.
In relation to tobacco and alcohol consumption,
23% of the sample reported having the habit of
smoking and 32.9% reported drinking alcohol on a
regular basis. The sample average period of time
smoking was 23.06 years (range 0–60). The average
number of cigarettes smoked per day was 8.62 (range
1–45). Study participants reported an average period
Table 2 Antecedent distribution
Antecedent
Yes
Total
Table 1 General population characteristics
Characteristic
Mean
Age (years)
56.6
Weight (kg)
Height (m)
BMIb
81.6
1.72
27.6
31–84
48–164
Total
%
439
52.0
405
48.0
844
Allergies
176
16.3
902
83.7
1,078
Diabetesa
187
14.4
1,109
85.6
1,296
63
64.9
34
35.1
97
249
19.7
1,014
80.3
1,263
HTN with diet
17
45.9
20
54.1
37
Cardiopathies
51
4.1
1,195
95.9
1,246
Diabetes with diet
HTNb
Traumatisms
Range
%
Total N
Previous surgery
Neoplasias
a
No
Back/pelvis Tc
Prostatitis
Circumcision
Prostatic check up
d
8
0.7
1,177
99.3
1,185
130
10.6
1,092
89.4
1,222
52
57.8
38
42.2
90
152
14.4
902
85.6
1,054
43
10.7
358
89.3
401
165
31.7
355
68.3
520
1.51–2.00
a
21.1–41.0
b
Average HTN duration 7.54 years (n = 108)
Average diabetes duration 9.83 years (n = 124)
a
n = 549
c
Back or pelvis traumatism
b
BMI Body Mass Index equal to weight/(height)2
d
Time elapsed since last check-up 3.77 years (n = 164)
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of time consuming alcohol of 21.50 years (range 1–
50). An average of 4.2 glasses/occasion was reported
(range 1–12). The average frequency of alcohol
ingestion was every 3.8 days (range 1–10).
Other antecedents of interest reported by the study
participants showed that 49.5% had a family history
of diabetes, 39.2% a family history of HTN and
17.3% a family history of prostate or breast cancer.
Only 16.9% of the participants explored had normal
blood pressure while 60.1% were diagnosed with
high blood pressure and 23% with low blood
pressure.
Physical exploration of the patients resulted in a
wide margin of normal percentage values. Normality
for cardiac frequency was 98.9% and testicular and
rectal exploration produced values of 90.9% and
86.4%, respectively.
Prostatic exploration resulted in Grade I diagnosis
in 60% of the participants and Grade II in 27.1%.
The prostate-specific antigen (PSA) value was
highest in the younger age group, and in general PSA
increased in direct proportion to age. Table 3 shows
PSA values reported in those participants who had
blood tests to determine them. The group general
average was 1.73 with ranges from 0 to 111.
Prostatic symptomatology values are shown in
Table 4. A low tendency was seen in the answers to
the six questionnaire questions. Prostatic symptomatology assessment distribution was slight in 63.6%
of the cases, moderate in 27.5% of the cases and
severe in 8.9% of the study participants, corresponding to 157 individuals.
Quality of life as a result of present symptomatology was assessed by the study participants at an
arithmetic mean of 2.09, corresponding to ‘‘generally
satisfied’’.
Premature ejaculation was analyzed with the specific questionnaire for that disorder. Of the individuals
Table 3 Prostate-specific
antigen (PSA) values
Individuals
n
%
Table 4 Prostatic symptomatology response distribution
Variable
Meana SD
Difficulty in postponing urination
1.00
Straining to begin passing urine
0.66
1.26 1,638
Reduction in urine stream strength
Intermittent urination
1.35
1.16
1.68 1,631
1.55 1,637
Feeling that the bladder has not fully
emptied
1.11
1.54 1,629
Repetitive urination in \2 h
1.26
1.55 1,617
a
N
1.47 1,627
Value scale in the last month:
0 = Never
1 = Approx. 1 time in 5
2 = Approx. 1 time in 3
3 = Approx. 1 time 2
4 = Approx. 2 times in 3
5 = Almost always
SD: Standard deviation
with values identifying them as PE positive, 41.9%
stated that they ejaculated prematurely, but only 3.8%
reported doing so before penetration of their sexual
partners.
With respect to PE frequency, the sample
responded with an arithmetic mean of 4.65, corresponding to a frequency of ‘‘sometimes’’. Anxiety
level caused by PE reached a mean of 1.78,
corresponding to ‘‘no anxiety’’ or ‘‘a little anxiety’’.
The study response to whether PE caused some type
of difficulty with the sexual partner was a mean of
1.58, corresponding to ‘‘no difficulty’’ or ‘‘a little
difficulty’’.
Although the number of answers to the question
‘‘over the past month how much time elapsed before
ejaculation while having sexual relations’’ dropped
importantly (n = 862), the response average was
10.97 minutes (SD 9.394 min, range 0–60).
Age range
(years)
Mean PSA
Minimum
range PSA
Maximum
range PSA
272
20.7
41–50
0.90
–
512
38.9
51–60
1.27
–
21.00
314
23.8
61–70
2.75
–
111.00
141
10.7
[from 70
2.93
–
76.00
Losses
–
–
–
Total
1.73
–
111.00
75
1,314
5.7
100.0
4.010
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The International Index of Erectile Function was
applied to assess function in the study population and
the responses are shown in Table 5.
In relation to erection capacity, the study population reported a mean of 2.3, corresponding to ‘‘always
or almost always’’ having an erection during sexual
activity. Erection quality for penetration showed a
mean of 2.51, corresponding to ‘‘always/almost
always’’ and ‘‘many times’’ and penetration frequency reached a mean of 2.39, corresponding to
‘‘always/almost always’’ and ‘‘many times’’.
Post-penetration erection frequency reached a
mean of 2.62, also corresponding to ‘‘always/‘‘almost
always’’ and ‘‘many times’’. Nevertheless, when
asked about erection quality up to the end of the
sexual act, the mean response was 4.48 (SD 1.803,
n = 1,184), corresponding to ‘‘difficult/a little
difficult’’.
Normal diagnosis was reported by physicians
participating in the study in 6.9% of the subjects,
corresponding to 37 individuals.
And finally, confidence in reaching and maintaining erection was assessed by study participants with
an average response of 2.69 (SD 1.214, n = 1,166)
corresponding to ‘‘high/regular’’.
Table 6 shows the percentages the answers to each
of the variables presented in Table 5. There were
similar percentages for each answer and no significant difference was found.
Symptoms in the older adult were evaluated in order
to define andropause assessment in the study population. The symptoms in the older adult/andropause
Table 5 Erectile function/response distribution
Variable
Meana
SD
N
Erection capacity
2.43
1.273
1,192
Erection quality
2.51
1.334
1,180
Penetration frequency
2.39
1.237
1,185
Post-penetration erection frequency
2.62
1.388
1,186
a
Value scale during the past month:
1 = I had no sexual activity
2 = Always or almost always
3 = Many times
4 = Sometimes
5 = Rarely
6 = Never or almost never
SD: Standard deviation
123
Table 6 Erectile function and answer distributiona
Answer
Variables
Erection
capacity
Erection
quality
Penetration
frequency
Postpenetration
erection
frequency
I had no
sexual
activity
16.1
15.1
15.1
14.2
Always or
almost
always
58.5
56.8
62.1
52.8
Many times
7.4
7.7
5.7
8.9
Sometimes
7.0
7.5
7.1
8.1
A few times
6.8
7.7
6.1
9.4
Never or
almost
never
4.2
5.2
4.1
5.7
n = 1,192
a
Quantities presented in percentages
questionnaire consists of the evaluation of four key
elements: physical problems, vasomotor problems,
psychological problems and sexual problems. Each
element was qualified separately and andropause
evaluation was assessed by a criterion value set of the
four above-mentioned problems.
Physical problem determination included evaluations of lack of physical energy, poor sleep, poor
appetite, physical pain from no apparent cause and a
weakening of muscle strength. The score reached by
the study participants was a mean of 0.83, corresponding to ‘‘never’’. A SD of 1.08 indicated that
some patients answered ‘‘sometimes’’.
Vasomotor problem determination included the
evaluation of feeling hot, excess perspiring and
sweating and heart palpitations. The score reached
by the sample was an average of 1.39, corresponding
to ‘‘sometimes’’ for the general study population.
Response dispersion was greater in this area showing
a SD of 1.69, indicating that some patients reported
presenting these types of problems ‘‘often’’, and
others ‘‘always’’.
In regard to psychological problems, the presence of
poor memory, poor concentration, anxiety, irritability,
a general loss of interest in things, nervousness,
tension, feeling down, sadness or depression was
evaluated. Study participants reported a mean of 0.70
points, corresponding to ‘‘never’’ in the general study
Int Urol Nephrol
population. A SD of 0.90 indicated that some of the
participants experienced these types of problems
‘‘sometimes’’.
Sexual problem determination included the evaluation for the following points: loss of interest in sex,
lack of excitation in the presence of sexual objects,
no morning erections, and unsuccessful sexual acts
with erection problems during coitus. The score
reached by the sample for these problems was 0.85,
corresponding to ‘‘never’’. Response dispersion in the
definition of sexual problems was evaluated with a
SD of 0.74, indicating that some patients ‘‘sometimes’’ experienced signs of sexual deterioration.
From the scores obtained with the Symptoms in
the Older Adult questionnaire, 339 study participants
(39.5%) were diagnosed with andropause. The
remaining 60.5% did not have a high enough score
to be considered andropausal.
Risk factors among the study variables were
determined from the database using a logistic
regression model. This statistical procedure produced
associated variables and risk factors in diverse cases.
Table 7 shows the association between variables
and risk factors for prostatic symptomatology, PE and
erectile function.
Age and prostatitis were two important risk factors
for the appearance of prostatic symptomatology. This
association had a high significance with P \ 0.01.
The regression model confirmed the fact that the
Table 7 Risk factors prostatic symptomatology, premature
ejaculation and erectile function
Statistical
significance
(P \ 0.05)a
Odds
ratio
Age
0.0001
1.047
Prostatitis
0.0001
3.073
Traumatism
0.115
1.408
0.0001
0.002
0.947
1.554
Variable
Prostatic symptomatology
Premature ejaculation
Age
Previous
surgery
Erectile function
a
Age
0.033
0.986
Smoking
0.433
1.113
Logistic regression
CI 95%
prostatitis patient had a risk of developing prostatic
symptomatology that was three times greater (3.079)
than the individual who had not developed prostatitis.
Although it was determined that there was no
significant statistical association between prostatic
symptomatology and traumatism, the model indicated
that the patient with traumatism antecedents had 40%
more risk of developing prostatic symptomatology.
In the case of PE the regression model identified a
direct association between age factors and previous
surgeries. Age showed a highly significant association (P \ 0.01) with PE, and the association between
previous surgeries and PE showed statistical significance (P \ 0.002). The individuals having had
previous surgeries were found to have a 55% greater
relative risk of developing PE than those study
participants who had not had previous surgeries. PE
was present in 46.9% of a total of 1,011 patients,
being more frequent in the age range of 51–60 years
(43.3%), followed by the age range of 61–70 years
(26%). There was a 58% PE frequency in patients
having undergone surgery.
Upon analyzing erectile function, it was determined that age was the only factor directly associated
with ED. This difference showed statistical significance (P \ 0.033).
Although smoking was not found to be statistically
associated with erectile function, the individuals who
reported having the smoking habit showed 11% more
increased risk of ED than those stating they did not
smoke.
Table 8 shows the associations and risk factors for
symptoms in the older adult and andropause. Diabetes diagnosis was directly associated with the
development of symptoms in the older adult, especially with physical problems. This association had a
high statistical significance (P \ 0.0001). The model
indicated that diabetes patients had 2.29 greater risk
in developing older adult physical problems than
those without diabetes. Although no statistically
significant association was shown between HTN
and older adult physical problems, it was found that
HTN was a risk factor and that individuals diagnosed
with positive HTN had 22% more risk of developing
older adult physical problems than those who were
not hypertensive.
Regarding older adult vasomotor problems, no
direct association was found with any other factor.
However, it was found that weight (excess weight
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Table 8 Risk factors older adult symptoms/Andropause
Variable
Statistical
significance
(P \ 0.05)a
Odds
ratio
Physical problems
Diabetes
0.0001
2.196
HTN
0.235
1.217
Alcoholism
0.093
1.379
Weight
0.063
1.012
0.0001
2.305
Diabetes
0.001
2.122
Traumatism
0.003
2.086
Vasomotor problems
Sexual problems
Diabetes
Andropause
a
Logistic regression
CI 95%
and obesity) had a statistical tendency (P \ 0.063) to
be associated with the development of vasomotor
problems. The risk model indicated that the relative
risk for patients habitually consuming alcohol was
38% greater for developing older adult vasomotor
problems than those subjects who did not report
alcohol habits.
In relation to older adult sexual problems, a highly
significant association (P \ 0.0001) with diabetes
diagnosis was found. Diabetes was shown to be an
important risk factor for the development of older adult
sexual problems. Patients with diabetes had 2.39
greater risk of developing older adult sexual problems
than those without diabetes. There was also a highly
significant direct association (P \ 0.001) between
diabetes and andropause development as well as a
statistically significant association (P \ 0.003)
between traumatism antecedents and andropause
development. These two factors were identified as risk
factors for andropause development in the study
population. Both diabetic patients and patients with
traumatism antecedents showed a 2.19 greater relative
risk for andropause development than the individuals
without diabetes or traumatism antecedents.
Discussion
The percentages and averages of the urological
distress evaluated in this study give a clear idea of
123
the principal pathologies affecting the older adult.
The reported results are similar to those of other
clinical and epidemiological studies that have been
carried out in different parts of the world.
Taking into consideration a total of 1,316 valid
determinations of PSA, the average PSA in the study
population was 1.73 with a range from 0 to 111. PSA
was done on only two patients under 40 years of age,
with a mean value of 3.2 ng and no significance in the
analysis of the other age ranges.
Regarding prostatic symptomatology, more than
half the participants responded that they never
experienced difficulty passing urine once they felt
the necessity to do so.
The final prostatic symptomatology score from the
international questionnaire was a mean of 7.96,
corresponding to slight symptomatology in the study
population. Sixty percent of the participants had a
slight prostatic symptomatology score, while 9% had
a score corresponding to severe prostatic symptomalogy. From the responses concerning present urinary
symptoms, the average quality of life score for the
study participants was in the category of generally
satisfactory. These results are very similar to those
reported by Rosen et al. [23]. Prostatitis is a clinical
condition which often presents with lower urinary
tract symptoms that are similar to symptoms caused
by prostatic growth and even lower urinary infection.
Special treatment is recommended in these cases [24].
Close to 40% of the participants stated that they
experienced PE and of these, nearly all reported
having it after sexual penetration. This figure is
similar to that reported by Spector and Carey [25].
Over half the participants responded that the possibility of experiencing PE was not a source of anxiety
and six out of every ten responses indicated that PE
during their sexual relations did not cause any
difficulties in the relationship with their partners.
The average length of time elapsing before ejaculation was a mean of 10.97 min in the study population.
An average of more than 60% of the participants
reported being able to have an erection ‘‘always or
almost always’’ during sexual activity, with erections
that were hard enough to allow penetration, and that
they were able maintain penetration throughout the
sexual act. These results are similar to those reported
by Boyle et al. [26].
Study participants had a score average of 1.39,
corresponding to ‘‘sometimes’’, in reference to the
Int Urol Nephrol
presence of older adult physical problems. In the case
of psychological problems, the score average was
0.70, considered to be ‘‘low’’. And finally, andropause diagnosis from a clinical view point, was found
to be present in 40% of the study participants.
3.
4.
Conclusions
The conclusion reached in this study is that prostatic
symptoms in the older adult male are slightly above
those reported in similar studies. The largest percentage of patients presented with mild symptoms while
only a low percentage (8.9%) presented with severe
symptoms, in accordance with the international prostatic symptom scale. Prostatic symptoms were closely
related to age and prostatitis, as risk factors. These data
are clear and are also reported in other studies. The
majority of the Mexican population attributes mild
prostatic symptoms to the normal aging process in the
male and therefore individuals rarely seek medical
orientation when symptoms appear.
On the other hand, the percentage of PE was very
high (46.9%), but did not, however, present with
difficulty in the relationship with the sexual partner.
Concerning erectile function, approximately 60%
of the individuals surveyed claimed to always or
almost always have good sexual activity and only a
small percentage (almost 5%) said their erectile
function was never or almost never satisfactory.
Finally, andropause was found in 39.5% of
individuals surveyed and was closely associated with
diabetes mellitus as a risk factor.
This study is one of the first of its kind in Mexico
and gives us a clear idea of the prevalence of different
pathologies in the older adult male. It can serve as a
reference point for subsequent studies and especially
as a useful guide for adequate prevention and
management in this type of population.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Acknowledgement This study was conducted by the Mexican
Society of Urology with the support of Sanofi Aventis and the
disinterested participation of Mexican urologists.
15.
References
16.
1. Abrams P (1994) New words for old: lower urinary tract
symptoms for ‘‘prostatism’’. BMJ 308:929–930. Editorial
2. Chute CG, Panser LA, Girman CJ, Oesterling JE, Guess
HA, Jacobsen SJ, Lieber MM (1993) The prevalence of
17.
prostatism: a population-based survey of urinary symptoms. J Urol 150:85
Norman RW, Nickel JC, Fish D, Pickett SN (1994)
‘Prostate-related symptoms’ in Canadian men 50 years of
age or older: prevalence and relationships among symptoms. Br J Urol 74:542–550
Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The
development of human benign prostatic hyperplasia with
age. J Urol 132:474–479
Donovan JL, Abrams P, Peters TJ, Kay HE, Reynard J,
Chapple C, de la Rosette J, Kondo A (1996) The ICS‘BPH’ study: the psychometric validity and reliability of
the ICS-male questionnaire. Br J Urol 77:554
Epstein RS, Deverka PA, Chute CG, Panser LA, Oesterling
JE, Lieber MM, Schwartz SW, Patrick D (1992) Validation
of a new quality of life questionnaire for benign prostatic
hyperplasia. J Clin Epidemiol 45:1431. doi:10.1016/08954356(92)90205-2
Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC,
Holtgrewe HL, Mebust WK, Cockett AT (1992) The
American Urological Association symptom index for
benign prostatic hyperplasia. The Measurement Committee
of the American Urological Association. J Urol 148:
1549–1557
NIH Consensus Development Panel on Impotence (1993)
NIH Consensus Conference: impotence. JAMA 270:83–90.
doi:10.1001/jama.270.1.83
Ayta IA, McKinlay JB, Krane RJ (1999) The likely
worldwide increase in erectile dysfunction between 1995
and 2025 and some possible policy consequences. BJU Int
84:50–56. doi:10.1046/j.1464-410x.1999.00142.x
Bacon CG, Mittleman MA, Kawachi I, Giovannucci E,
Glasser DB, Rimm EB (2003) Sexual function in men
older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med 139:161–168
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J,
Mishra A (1997) The International Index of Erectile
Function (IIEF): a multidimensional scale for assessment
of erectile dysfunction. Urology 49:822–830. doi:10.1016/
S0090-4295(97)00238-0
Hansen BJ, Mortensen S, Mensink HJ, Flyger H, Riehmann M, Hendolin N et al (1998) Comparison of the
Danish Prostatic Symptom score with the International
Prostatic Symptom Score, the Madsen Iversen and Boyarsky symptom indexes. ALFECH Study Group. Br J
Urol 81:36–41
Brown JS, Wessells H, Chancellor MB et al (2005) Urologic complications of diabetes. Diabetes Care 28:
177–185. doi:10.2337/diacare.28.1.177
McVary KT (2005) Erectile dysfunction and lower urinary
tract symptoms secondary to BPH. Eur Urol 47:838–845.
doi:10.1016/j.eururo.2005.02.001
Rosen R, Altwein J, Boyle P et al (2003) Lower urinary
tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol
44:637–649. doi:10.1016/j.eururo.2003.08.015
McVary KT, Carrier S, Wessells H (2001) Smoking and
erectile dysfunction: evidence based analysis. J Urol
166:1624–1632. doi:10.1016/S0022-5347(05)65641-8
Billups KL (2005) Sexual dysfunction and cardiovascular
disease: integrative concepts and strategies. Am J Cardiol
123
Int Urol Nephrol
18.
19.
20.
21.
22.
96(Suppl 12B):57M–61M. doi:10.1016/j.amjcard.2005.10.
007
Haji M, Tanaka S, Nishi Y et al (1994) Sertoli cell function
declines earlier than Leydig cell function in aging Japanese
men. Maturitas 18:143–153. doi:10.1016/0378-5122(94)
90052-3
Montanini V, Simoni M, Chiossi G et al (1988) Agerelated changes in plasma dehydroepiandrosterone sulfate,
cortisol, testosterone and free testosterone circadian
rhythms in adult men. Horm Res 29:1–6
Deslypere JP, Kaufman JM, Vermeulen T et al (1987)
Influence of age on pulsatile luteinizing hormone release
and responsiveness of the gonadotrophs to sex hormone
feedback in men. J Clin Endocrinol Metab 64:68–73
Morley JE, Charlton E, Patrick P, Kaiser FE, Cadeau P,
McCready D, Perry HM 3rd (2000) Validation of a
screening questionnaire for androgen deficiency in aging
males. Metabolism 49(9):1239–1242. doi:10.1053/meta.
2000.8625
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ,
McKinlay JB (1994) Impotence and its medical and psychosocial correlates: results of the Massachusetts Male
Aging Study. J Urol 151:54–61
123
23. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B,
Meuleman E, O’Leary MP, Puppo P, Robertson C, Giuliano F (2003) Lower urinary tract symptoms and male
sexual dysfunction: the multinational survey of the aging
male (MSAM-7). Eur Urol 44(6):637–649. doi:10.1016/
j.eururo.2003.08.015
24. Nickel JC, Roehrborn CG, O’Leary MP, Bostwick DG,
Somerville MC, Rittmaster RS (2007) The relationship
between prostate inflammation and lower urinary tract
symptoms: examination of baseline data from the REDUCE
Trial. Eur Urol. doi:10.1016/j.eururo.2007.11.026
25. Spector IP, Carey MP (1990) Incidence and prevalence of
sexual dysfunctions. A critical review of the empirical
literature. Arch Sex Behav 19:389–408. doi:10.1007/BF01
541933
26. Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs R,
Fourcade R, Kiemeney L, Lee C (2003) UrEpik Study
Group. The association between lower urinary tract
symptoms and erectile dysfunction in four centres: the
UrEpik study. BJU Int 92(7):719–725. doi:10.1046/j.1464410X.2003.04459.x