Hiperplasia Prostática Benigna (HPB), Sintomas do Trato Urinário Inferior (LUTS) e Função Sexual
Palavras-chave:
disfunção erétilResumo
A hiperplasia prostática benigna (HPB) representa o crescimento não maligno do tecido da próstata. Proliferação de células estromais e epiteliais na zona de transição da próstata causa compressão uretral e obstrução do fluxo vesical. Isto pode levar a manifestações de LUTS (lower urinary tract symptoms): urgência urinária, noctúria, dificuldades de micção, esvaziamento incompleto da bexiga, menor força e/ou interrupção do jato e inflamações. Mecanismos do LUTS/HPB compartilhados afetam a função sexual masculina.
Atividade aumentada de subtipos de receptores a1-adrenérgicos na próstata está associada à HPB. Tais receptores, também presentes no pênis, podem inibir a ereção, devido à HPB. Quanto à correlação entre LUTS e disfunção sexual, aventa-se que ambas resultem da contração anômala da musculatura lisa, por ativação dos receptores a1-adrenérgicos.
LUTS/HPB causam desconforto nos homens, devido a obstrução urinária, ejaculação dolorosa, disfunção erétil (DE), distúrbios ejaculatórios e baixa libido, que prejudicam a qualidade de vida, deles e de suas parcerias. A noctúria interfere negativamente na qualidade do sono e na disposição para a atividade sexual.
Tratamentos para LUTS/HPB podem induzir disfunções sexuais. Entre eles, ressecção transuretral (RTU), a1-bloqueadores, inibidores da 5a-redutase e terapia combinada (a1-bloqueador e 5a-redutase).
Os efeitos prejudiciais do LUTS/HPB e de seu tratamento sobre a função sexual ainda são subdiagnosticados e insuficientemente tratados. A atividade sexual deve ser investigada antes e durante o tratamento, também orientando o paciente sobre os possíveis efeitos de cada opção terapêutica sobre a função sexual, evitando-se assim o abandono do tratamento.
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