Int Urol Nephrol DOI 10.

1007/s11255-008-9417-9

UROLOGY ORIGINAL PAPER

Prostatic prole, premature ejaculation, erectile function and andropause in an at-risk Mexican population
J. Jaspersen-Gastelum J. A. Rodrguez F. J. Espinosa de los Monteros L. Beas-Sandoval Jose Guzman-Esquivel D. D. Calvo T. Gutierrez

Received: 1 March 2008 / Accepted: 9 June 2008 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-specic antigen value in the sample was 1.73
J. Jaspersen-Gastelum Hospital Angeles Metropolitano, Tlacotalpan 59-135 Col. Roma Sur., Mexico, DF, Mexico e-mail: jaspersen@prodigy.net.mx J. A. Rodrguez F. J. Espinosa de los Monteros L. Beas-Sandoval J. Guzman-Esquivel D. D. Calvo For Healthy Fathers Campaign of the Mexican Society of Urology, Mexico, Mexico J. Guzman-Esquivel (&) University of Colima, Zaragoza 377, Centro. CP 28000, Colima, Mexico e-mail: enicetoeto@hotmail.com T. Gutierrez Sano-Aventis, Av. Universidad esq. Miguel Angel 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 identied with an association tendency towards alcoholism and excess weight, P \ 0.063, but without statistical signicance. 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 deciency. These symptoms are considered to be inevitable age-related conditions [1, 2].

123

Int Urol Nephrol

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 [57]. In particular, erectile dysfunction (ED) is a pathological condition frequently associated with infravesical urinary obstruction and is dened as the incapacity to achieve and maintain penile erection of sufcient 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 inuence its development, such as prostatic hyperplasia, diseases of the central nervous system, smoking, diabetes mellitus, endocrine disorders, and cardiovascular diseases, among others [1317]. On the other hand, androgen deciency 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 [1820]. Validated questionnaires are also able to evaluate disorders due to this hormonal decline [21, 22]. Brown-Sequard was the rst to suggest that some of the symptoms associated with age were due to

testosterone deciency. 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 dene 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 identied. 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.

123

Int Urol Nephrol

Variables of interest The following study variables were determined. 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. Prostatic symptomatology The International Prostatic Symptomatology Questionnaire was applied for this evaluation. It consists of seven questions pertaining to prostatic symptoms for assessing symptomatology. A nal 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. Difculty 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.

1. 2. 3. 4. 5.

Ejaculation before or at the beginning of penetration. Ejaculation before it is desired. Anxiety level about premature ejaculation. Partner relationship difculty 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. 6. Erection capacity during sexual activity. Erection for achieving penetration. Penetration frequency. Frequency in maintaining erection. Difculty in maintaining erection until nishing coitus. Condence 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. Data analysis

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. Premature ejaculation A questionnaire consisting of ve 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.

123

Int Urol Nephrol

When an excluding or aberrant value was identied, 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 denition of tendencies and statistical differences difcult 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 prole of the study population and a logistic regression model was used to determine association among variables and risk factors. Statistical signicance was considered when P \ 0.05. The sample was made up of 1,779 patients receiving medical treatment from participating physicians afliated 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 5160 years, followed by that of 6170 years. Sample civil status distribution showed
a

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 specic 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 specic 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 060). The average number of cigarettes smoked per day was 8.62 (range 145). Study participants reported an average period
Table 2 Antecedent distribution Antecedent Yes Total Previous surgery Allergies Diabetesa Diabetes with diet HTNb HTN with diet Cardiopathies Neoplasias Traumatisms 439 176 187 63 249 17 51 8 130 52 152 43
d

No % 52.0 16.3 14.4 64.9 19.7 45.9 4.1 0.7 10.6 57.8 14.4 10.7 31.7 Total 405 902 1,109 34 1,014 20 1,195 1,177 1,092 38 902 358 355 % 48.0 83.7 85.6 35.1 80.3 54.1 95.9 99.3 89.4 42.2 85.6 89.3 68.3

Total N

844 1,078 1,296 97 1,263 37 1,246 1,185 1,222 90 1,054 401 520

Table 1 General population characteristics Characteristic Age (years) Weight (kg) Height (m) BMIb
a b

Mean 56.6 81.6 1.72 27.6

Range 3184 48164 1.512.00 21.141.0

Back/pelvis Tc Prostatitis Circumcision Prostatic check up

a b c d

165

Average diabetes duration 9.83 years (n = 124) Average HTN duration 7.54 years (n = 108) Back or pelvis traumatism Time elapsed since last check-up 3.77 years (n = 164)

n = 549 BMI Body Mass Index equal to weight/(height)2

123

Int Urol Nephrol

of time consuming alcohol of 21.50 years (range 1 50). An average of 4.2 glasses/occasion was reported (range 112). The average frequency of alcohol ingestion was every 3.8 days (range 110). 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-specic 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 satised. Premature ejaculation was analyzed with the specic questionnaire for that disorder. Of the individuals
Table 3 Prostate-specic antigen (PSA) values Individuals n 272 512 314 141 75 1,314 % 20.7 38.9 23.8 10.7 5.7 100.0

Table 4 Prostatic symptomatology response distribution Variable Difculty in postponing urination Straining to begin passing urine Reduction in urine stream strength Intermittent urination Feeling that the bladder has not fully emptied Repetitive urination in \2 h
a

Meana SD 1.00 0.66 1.35 1.16 1.11 1.26

1.47 1,627 1.26 1,638 1.68 1,631 1.55 1,637 1.54 1,629 1.55 1,617

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 difculty with the sexual partner was a mean of 1.58, corresponding to no difculty or a little difculty. 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 060).
Age range (years) 4150 5160 6170 Mean PSA Minimum range PSA Maximum range PSA 4.010 21.00 111.00 76.00 111.00

0.90 1.27 2.75 2.93 1.73

[from 70 Losses Total

123

Int Urol Nephrol

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 difcult/a little difcult. Normal diagnosis was reported by physicians participating in the study in 6.9% of the subjects, corresponding to 37 individuals. And nally, condence 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 signicant difference was found. Symptoms in the older adult were evaluated in order to dene andropause assessment in the study population. The symptoms in the older adult/andropause
Table 5 Erectile function/response distribution Variable Erection capacity Erection quality Penetration frequency Post-penetration erection frequency
a

Table 6 Erectile function and answer distributiona Answer Variables Erection capacity Erection quality Penetration frequency Postpenetration erection frequency 14.2

I had no sexual activity Always or almost always Many times Sometimes A few times Never or almost never n = 1,192
a

16.1

15.1

15.1

58.5

56.8

62.1

52.8

7.4 7.0 6.8 4.2

7.7 7.5 7.7 5.2

5.7 7.1 6.1 4.1

8.9 8.1 9.4 5.7

Quantities presented in percentages

Meana 2.43 2.51 2.39 2.62

SD 1.273 1.334 1.237 1.388

N 1,192 1,180 1,185 1,186

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

questionnaire consists of the evaluation of four key elements: physical problems, vasomotor problems, psychological problems and sexual problems. Each element was qualied 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

123

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 denition 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 signicance with P \ 0.01. The regression model conrmed the fact that the
Table 7 Risk factors prostatic symptomatology, premature ejaculation and erectile function Variable Statistical signicance (P \ 0.05)a Odds ratio

Prostatic symptomatology Age Prostatitis Traumatism Premature ejaculation Age Previous surgery Erectile function Age Smoking
a

0.0001 0.0001 0.115 0.0001 0.002

1.047 3.073 1.408 0.947 1.554

0.033 0.433

0.986 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 signicant 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 identied a direct association between age factors and previous surgeries. Age showed a highly signicant 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 5160 years (43.3%), followed by the age range of 6170 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 signicance (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 signicance (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 signicant 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

123

Int Urol Nephrol Table 8 Risk factors older adult symptoms/Andropause Variable Statistical signicance (P \ 0.05)a Odds ratio

Physical problems Diabetes HTN Vasomotor problems Alcoholism Weight Sexual problems Diabetes Andropause Diabetes Traumatism
a

0.0001 0.235 0.093 0.063 0.0001 0.001 0.003

2.196 1.217 1.379 1.012 2.305 2.122 2.086

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 signicant 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 signicant direct association (P \ 0.001) between diabetes and andropause development as well as a statistically signicant association (P \ 0.003) between traumatism antecedents and andropause development. These two factors were identied 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

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 signicance in the analysis of the other age ranges. Regarding prostatic symptomatology, more than half the participants responded that they never experienced difculty passing urine once they felt the necessity to do so. The nal 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 gure 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 difculties 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

123

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 nally, 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 difculty 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 rst 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.
Acknowledgement This study was conducted by the Mexican Society of Urology with the support of Sano Aventis and the disinterested participation of Mexican urologists.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

References
16. 1. Abrams P (1994) New words for old: lower urinary tract symptoms for prostatism. BMJ 308:929930. 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 74:542550 Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The development of human benign prostatic hyperplasia with age. J Urol 132:474479 Donovan JL, Abrams P, Peters TJ, Kay HE, Reynard J, Chapple C, de la Rosette J, Kondo A (1996) The ICSBPH 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, OLeary 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: 15491557 NIH Consensus Development Panel on Impotence (1993) NIH Consensus Conference: impotence. JAMA 270:8390. 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 84:5056. 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 139:161168 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 49:822830. 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 81:3641 Brown JS, Wessells H, Chancellor MB et al (2005) Urologic complications of diabetes. Diabetes Care 28: 177185. doi:10.2337/diacare.28.1.177 McVary KT (2005) Erectile dysfunction and lower urinary tract symptoms secondary to BPH. Eur Urol 47:838845. 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 44:637649. doi:10.1016/j.eururo.2003.08.015 McVary KT, Carrier S, Wessells H (2001) Smoking and erectile dysfunction: evidence based analysis. J Urol 166:16241632. 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 96(Suppl 12B):57M61M. 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 18:143153. 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 29:16 Deslypere JP, Kaufman JM, Vermeulen T et al (1987) Inuence of age on pulsatile luteinizing hormone release and responsiveness of the gonadotrophs to sex hormone feedback in men. J Clin Endocrinol Metab 64:6873 Morley JE, Charlton E, Patrick P, Kaiser FE, Cadeau P, McCready D, Perry HM 3rd (2000) Validation of a screening questionnaire for androgen deciency in aging males. Metabolism 49(9):12391242. 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 151:5461 23. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, OLeary 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):637649. doi:10.1016/ j.eururo.2003.08.015 24. Nickel JC, Roehrborn CG, OLeary MP, Bostwick DG, Somerville MC, Rittmaster RS (2007) The relationship between prostate inammation 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 19:389408. 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):719725. doi:10.1046/j.1464410X.2003.04459.x

18.

19.

20.

21.

22.

123