Drugs, behavioral changes both needed to combat GU disorders

Today's men tend to favor laser treatments, or at least the quickest treatment possible, for their GU conditions, but fast isn't necessarily the best option, said Richard G. Roberts, MD, JD, Professor of Family Medicine at the University of Wisconsin Medical School in Madison.

Erectile dysfunction should be diagnosed using the 4-fold system of psychological, hormonal, vascular, and tumescence testing. Treatment options include PDE-5 agents, vacuum devices, yohimbine, or injectable prostaglandins.

Benign prostatic hyperplasia can be treated in minimally invasive ways, including transurethral microwave heat treatment, transurethral needle ablation or stents, alpha-blockers and 5-alpha reductase inhibitors. Surgeries include lasers, which, Dr Roberts said, patients usually want but aren't always effective, transurethral electrovaporization, and open prostatectomies. Treatments that might become available or more widespread soon include phytotherapeutic agents, absolute ethanol injections, high-intensity ultrasound, or heat-based therapies.

As with postmenopausal breast cancer, the demographics of age, race, and location matter greatly in prostate cancer. Above the age 90, Dr Roberts said, studies have shown that nearly 100% of men have or have had prostate cancer, eliciting gasps from the audience.

For patients with overactive bladder, Dr Roberts said a combination of drug treatment and behavioral modifications works best. Anticholinergic therapies, a balanced diet, and pelvic floor muscle exercises can all help.