NEEDS ASSESSMENT

Men’s health encompasses a broad range of subjects in the context of urologic care. From the urologist’s point of view, the main issues are, of course, prostate and urinary functions, male sexual function, and male hormonal status. Prostate-related issues include benign prostatic hyperplasia (BPH), prostatic cancer, prostatitis, and perhaps chronic pelvic pain syndrome. Male sexual issues typically encountered include libido problems, erectile dysfunction, Peyronie's disease, and ejaculatory disorders. Because some of these “male” issues can have a hormonal basis, at least in part, the management of testosterone levels is also of major importance.

According to the 2002 task force update of the American Association of Clinical Endocrinologists (AACE) medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients, male hypogonadism, defined as a reduced serum concentration of testosterone, leads to a variety of symptoms that include a decrease in libido; erectile dysfunction; decreases in ejaculate volume, body and facial hair, bone density, and lean body mass; weakness; increased body fat; fatigue; and anemia. Numerous studies have shown that serum testosterone levels decline by approximately 1.5% per year in men older than 30 to 35 years. A 2006 study by Mulligan et al found that 38.7% of men 45 years of age or older have hypogonadism, which was defined by the 2002 AACE Task Force study as a total serum testosterone concentration of <300 ng/dL. Other issues that the urologist inevitably has to confront include metabolic syndrome, disease prevention, and bone health, all of which have an intimate relationship with specifically male urologic problems. One of the common urinary dysfunctions, overactive bladder (OAB), is more prevalent than Alzheimer’s disease and osteoporosis combined, affecting as many as 33 million Americans. The International Continence Society (ICS) defines OAB as a symptom complex characterized by urgency, with or without urge incontinence, and typically with nocturia (awakening at night to void) and frequency (voiding at least 8 times in a 24-hour period.) According to Wein and Rovner, no specific cause has been associated with OAB. There is an approximately equal distribution of OAB in men and women. In a study by Stewart et al, consisting of 5,204 adults, OAB was found in 16.9% of women and 16% of men. The leading disparity between the sexes was a higher prevalence of accompanying urinary incontinence in men (55%) compared with women (16%). As reported by Hu et al in 2003, the total direct costs associated with OAB in the United States in 2000 were more than $12 billion. The OAB condition has a significant impact on both health and quality of life. The quality of life (QoL) issues of OAB also have been heavily investigated. Reports state that OAB leads to problems ranging from anxiety to social isolation. In a study reported by Irwin et al in 2006, more than 75% of people with OAB reported that their condition made it difficult to carry out their daily activities, while almost one-third (32%) reported that OAB left them feeling depressed. In addition, more than one quarter (28%) reported feeling stressed. Patients with OAB were more likely to worry about participating in activities away from home due to bladder-related problems. At work, individuals with OAB frequently described worrying about the need to leave meetings to use the restroom. Untreated or undertreated OAB has repercussions that can undermine a patient’s selfesteem, morale, and ability to maintain employment. Despite the widespread prevalence of OAB, data suggest that only 4 million of those afflicted seek treatment and that only half of those are taking drug therapy. According to a 2001 report by Chancellor, only 15% of patients with OAB and voiding dysfunction are seeking medical help. Dmochowski and Newman concluded in the results of their national survey published in 2007 that more than half (56%) of women who discussed OAB with their health care provider waited more than a year to seek treatment, and that many tried to manage symptoms on their own. Basic science, clinical investigation, and pharmacologic and nonpharmacologic therapies for OAB have progressed. Current medical research is uncovering new medications that avoid central nervous system muscarinic receptor activity and blockade, improving bladder function with minimal impact on cognition and salivary secretion. These emerging therapies may offer patients the same or better efficacy with fewer side effects, compared with existing OAB therapies. 

TARGET AUDIENCE

This publication is intended for urologists and other medical professionals treating men’s health issues such as hypogonadism, the metabolic syndrome, and overactive bladder.

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