Chapter 29: Prostatic Disorders & Erectile Dysfunction

Chapter 29 focuses on the etiology, diagnosis, and pharmacologic management of three primary male genitourinary conditions—prostatic disorders (prostatitis, benign prostatic hyperplasia, and prostate cancer) and erectile dysfunction (ED). Prostatic disorders commonly increase in incidence as men age, often manifesting as lower urinary tract symptoms (LUTS). Prostatitis involves inflammation and is treated based on its classification, with acute bacterial forms requiring prolonged antibiotic courses, typically fluoroquinolones, due to common pathogens like E. coli. Benign prostatic hyperplasia (BPH) is linked to age-related hormonal shifts, particularly dihydrotestosterone (DHT) accumulation, which causes gland enlargement and increased smooth muscle tone in the lower urinary tract. Treatment for BPH depends on symptom severity, ranging from watchful waiting to medication, including alpha-adrenergic blockers (to quickly relieve obstructive symptoms by relaxing muscle tissue) or 5-alpha-reductase inhibitors (to reduce prostate volume over several months). Combination therapy using both agents may reduce the risk of BPH progression. Erectile dysfunction, defined as the repeated inability to maintain an erection firm enough for intercourse, is primarily caused by organic factors such as cardiovascular disease, impacting the complex neuroendocrine process involving nitric oxide (NO) and cyclic guanosine monophosphate (cGMP). The cornerstone of ED pharmacotherapy is the use of Phosphodiesterase-5 (PDE5) inhibitors, which enhance the cGMP pathway; however, these agents are strictly contraindicated in patients taking nitrates due to severe hypotensive risks, necessitating a thorough cardiac evaluation prior to initiation.