Tunç OZANA, AHMET KARAKEÇİ, Fatih FIRDOLAŞ, İRFAN ORHAN

Parsiyel Androjen Yetersizliğinin Alt Üriner Sistem ve Erektil Fonksiyona Etkisi

Amaç: Alt üriner sistem semptomları, erektil disfonksiyon gibi klinik bulguların testosteron ile ilişkisi ve testosteron replasman tedavisinin klinik ve biyokimyasal parametrelere olan etkisinin araştırılması. Gereç ve Yöntem: 24 aylık bir zaman diliminde Fırat Üniversitesi Hastanesi Üroloji polikliniğine erektil disfonksiyon ve libido azalması nedeniyle başvuran ve serum total testosteron seviyesi 319 ng/dl'nin altında olan 32 hasta çalışmaya dahil edilmiştir. Hastalara AMS-SF (Yaşlanan Erkek Semptom Skoru Formu), IIEF (Uluslararası Erektil Fonksiyon İndeksi) formu, IPSS (Uluslararası Prostat Semptom Skorlaması) formundan oluşan ölçekler doldurtuldu. Hastaların erektil fonksiyon ve libido düşüklüğü ile ilgili rutin laboratuar testleri olan; luteinizan hormon (LH), prolaktin (PRL), progesteron (PG), total testosteron (TT), seks hormon bağlayıcı globulin (SHBG), dehidroepiandrostenedion-sülfat (DHEA-S) ve albumin değerleri ve lipit profili ölçüldü, TT, SHBG ve albümin değerleri baz alınarak serbest testosteron (ST) ve testosteron bioyararlanımı (Biot) hesaplandı. Bulgular: Yaş ile IPSS (p=0.0383) ve SHBG (p=0.04) arasında pozitif yönde Qmax (p=0.002), Qave (p=0.001), ve Biot (p=0.028) arasında negatif yönde istatiksel olarak anlamlı bir ilişki gözlendi. Testosteron replasman tedavisi öncesi ve sonrası IIEF ile Qave (p=0.008), Qmax (p=0.042) değerleri arasında pozitif AMS, PMR (p=0.01), ve LH (p=0.023), değerleri arasında da negatif istatiksel olarak anlamlı bir ilişki saptandı. IIEF skorları ile ST (p=0.024), ve Biot (p=0.043) arasında olumlu yönde anlamlı bir ilişki saptandı. Sonuç: Veriler yaşlanmayla birlikte gerek leydig hücre sayı ve fonksiyonunda azalma, gerek testosteronun diurnal paterninin kaybolması nedeniyle sekonder hipogonadizm geliştiğini, bu semptomların IIEF, AMS ve IPSS ile değerlendirilebileceğini ve testosteron replasman tedavisi ile bazı semptomların anlamlı olarak gerileyebileceğini göstermektedir.

Effect of Partial Androgen Deficiency on Lower Urinary System and Erectile Function

Objective: To study the relationship of the clinical parameters like lower urinary tract symptoms and erectile dysfunction with testosterone and the effect of testosterone replacement therapy on the clinical and biochemical parameters. Materials and Methods: Thirty two patients with a serum total testosterone (TT) level under 319 ng/dl who applied to the Urology Outpatient Department of Firat University Hospital due to erectile dysfunction and loss of libido in a 24 months period are enrolled in the study. The patients have filled the AMS-Q (Aging Male Symptoms Questionnaire), the IIEF (International Index of Erectile Function) and the IPSS (International Prostate Symptom Score) questionnaire. The routine biochemical tests like luteinising hormone (LH), prolactine (PRL), progesterone (PG), total testosterone (TT), sex hormone binding globuline (SHBG), dehydroepiandrostenadionsulfate (DHEA-S) and albumin levels which are releated with erectile dysfunction and loss of libido are performed, the lipid profile is measured, free testosterone (fT) and bioavailable testosterone (Biot) levels were calculated by using TT, SHBG and albumin levels. Results: There was a statistically significant relation between age, IPSS (p=0.0383) and SHBG (p= 0.04), between age Qmax (p=0.002), Qave (p=0.001) and Biot (p=0.028). Between before and after treatment results of IIEF, Qave, Qmax and the testosterone forms there was a statistically significant relation in a positive and AMS, PMR and LH results in a negative way. A positive statistically significant relationship between IIEF scores, fT and Biot is detected. Conclusion: : The results show that hypogonadism may occur in aging males due to the decrease of number and function of the leydig cells and loss of the diurnal pattern of testosterone. The symptoms can be evaluated with the questionnaire IIEF, AMS and IPSS. Our results show that some of the symptoms could be eliminated with testosterone replacement therapy.

PDF

___

Thijimura A, Matsumiya K, Miyagawa Y, et al. Comparative study on evaluation methods for serum testosterone level for PADAM diagnosis. Int J Import Res 2005; 17: 259-63.
Atan A, Tuncel A. Androjen Replasman Tedavisi; Ne Zaman, Nasıl ve Kim Için? Üroloji Bülteni 2005; 16: 51-59. Ozan ve ark.
Gürkan L, Cakan M, Kadioglu A. Yaşlanan erkekte geç başlayan hipogonadizmde tanı ve tedavi. Türk Üroloji Dergisi 2005: 31: 349-55.
Cappelleri JC, Siegel RL, Osterloh IH, Rosen RC. Relationship between patients self-assessment of erectile function and the erectile function domain of the international index of erectile function. Urology 2000; 56: 477-481.
Avcı A, Bedir S, Özgök İY. Yaşlanan adam sendromu. Androloji Bülteni 2006; 24: 14-7. 6. Morales A. Andropause (or hypogonadism): facts, fiction and controversies. The Aging Male 2004; 7: 297-303. symptomatic late-onset
Nieschlag E, Swerdloff R, Behre HM, et al. lnvestigation, treatment and monitoring of late-onset hypogonadismin males: ISA, ISSAM and EAU recommendations. Int J Androl 2005; 28: 125-27.
Morales A, Heaton JPW, Carson CC. Andropause: misnomer for true clinical entity. J Urol 2000; 3:705-12.
O'Leary MP, Wei JT, Roehrborn CG, Miner M. Correlation of the International Prostate Symptom Score bother question with the Benign Prostatic Hyperplasia Impact Index in a clinical practice setting. BJU Int 2008; 101: 1531-35
Yoshiji M, Taisei K, Osamo Y. Correlation Between the Aging Males Symptoms Scale and Sex Steroids, Gonadotropins, Dihydroepiandrosterone Sulfate, and Growth Hormone Levels in Ambulatury Men. J Sex Med 2006; 3: 723-26.
Basar M, Aydın G, Mert HC, et al. Relationship between serum sex steroids and aging male symptoms score and international index of erectile function. Urology 2005; 66: 597-601.
Kratzik CW, Reiter WJ, Riedl AM, et al. Hormone profiles, body mass index and aging male symptoms; results of the Androx Vienna Municipality study. The Aging Male 2004; 7: 188-96.
Morley JE, Perry HM, Kevorkian RT, Patrick P. Comparison of screening questionnaires for the diagnosis of hypogonadism. Maturiats 2006; 53: 424-29.
Gray A, Feldman HA, McKinlay JB, Longcope C. Age, disease and changing sex hormone levels in middle-aged men. Result of the Massachusetts male aging study. J Clin Endocrinol Metab 1991; 73: 1016-25.
Roaiah MF, El Khayat YI, GamalEl Din SF, Abd El Salam MA. Pilot Study on the Effect of Botanical Medicine (Tribulus terrestris) on Serum Testosterone Level and Erectile Function in Aging Males With Partial Androgen Deficiency (PADAM). J Sex Marital Ther 2015; 7: 1-5.
Saad FG LJ, Haider A, Yasin A. An exploratory study of the effects of 12 month administration of the novel long-acting testosterone undecanoate on measures of sexual function and the matabolic syndrome. Arch Androl 2007; 53: 353-7.
Schatzl G, Brössner C, Schmid S, et al. Endocrine status in elderly men with lower urinary tract symptoms: correlation of age, hormonal status and lower urinary tract function. Urology 2000; 55: 397-402.
Kalinchenko S, Vishnevskiy EL, Koval AN, Mskhalaya GJ Saad F. Beneficial effects of testosterone administration on symptoms of the lower urinary tract in men with late-onset hypogonadism: a pilot study.Aging Male. 2008 Jun;11(2):57-61.
Karazindiyanoglu S, Cayan S. The effect of testosterone therapy on lower urinary tract symptoms, bladder and sexual functions in men with symptomatic late-onset hypogonadism. The Aging Male 2008; 11: 146-49.
Morales A, Lunenfeld B. Investigation, treatment and monitoring of late-onset hypogonadism in males. Aging Male 2002; 5: 74-86.
Hanus M, Matousková M, Stárka L, Hill M. Hormonal homeostasis in a group of 216 aging Czech Males and correlation with responses to a questionnaire of the University of St Louis. The Aging Male 2006; 9: 103-10.
Gooren L. Testosterone supplementation: why and for whom? Aging Male 2003; 6: 184-99.
Veldhuis JD, Zwart A, Mulligan T, Iranmanesh A. Muting of androgen negative feed-back unveils improve gonadotrophin- releasing hormone/luteinizing hormone secrotary in healthy older men. J Clin Endocrinol Metab 2001; 86: 529-35.
Gennazzani AR, Inglese S, Lombardi I, et al. Long-term low- dose dihydroepiandrosterone replacement theraphy in aging males with partial androgen deficiency. The Aging Male 2004; 7: 133-43.
Pechersky A. Features of diagnostics and treatment of partial androgen deficiency of aging men. Cent European J Urol 2014; 67: 397-404.