Background: Persistent sexual and psychological symptoms after finasteride discontinuation have been reported; however, factors associated with symptom severity remain insufficiently characterized. Methods: This cross-sectional study included 129 adult men with prior finasteride exposure for male pattern hair loss or benign prostatic hyperplasia. Sexual function, depressive symptoms, and anxiety were assessed using the International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), respectively. Associations between clinical variables (age, treatment duration, cumulative exposure, and indication) and symptom severity were evaluated using univariate and multivariable regression analyses. Results: The median treatment duration was 24 months (IQR: 12.5–36), and the median time from discontinuation to evaluation was 8 months (IQR: 1–17). Erectile function remained stable over time (mean IIEF: 15.2 ± 0.46 at baseline vs. 15.4 ± 0.47 at 6 months). Depressive symptoms decreased from 12.4 ± 0.41 to 9.1 ± 0.41, and anxiety scores from 3.29 ± 0.23 to 2.54 ± 0.20 over the same period, without normalization in most patients. In multivariable analyses, higher cumulative exposure and older age were independently associated with lower IIEF scores and higher PHQ-9 and GAD-7 scores. Conclusions: In this symptomatic cohort, greater cumulative finasteride exposure and older age were associated with more severe sexual and psychological symptoms after treatment discontinuation. These findings highlight the need for prospective studies to better define risk factors and long-term outcomes.

Background and objectives: Ischemic priapism is a rare but serious adverse effect of trazodone, associated with a high risk of long-term sexual dysfunction. While its urological consequences are well described, psychiatric and psychosocial outcomes remain insufficiently explored. This study assessed psychiatric and sexual sequelae following trazodone-associated ischemic priapism and compared clinical characteristics with trazodone-treated patients without priapism. Materials and Methods: In this single-center observational study, 268 adult patients receiving trazodone were analyzed, including 17 patients with ischemic priapism and 251 controls. Data on episode duration and urological management were collected. Psychiatric status and sexual functioning were evaluated through structured clinician-led interviews informed by validated psychometric frameworks during hospitalization and at 1-, 3-, and 6-month follow-up. Nonparametric analyses and Spearman rank correlations were applied. Results: Patients with priapism were significantly older than controls (44.1 ± 5.1 vs. 39.0 ± 4.4 years; p < 0.0001), while trazodone dose distribution did not differ between groups. The mean episode duration was 26.5 ± 16 h (median 24 h). Older age and longer ischemic duration were independently associated with increased treatment intensity, whereas trazodone dose was not. Persistent depressive and anxiety symptoms and impaired sexual functioning were observed in a subset of patients during follow-up. Conclusions: Trazodone-associated ischemic priapism is not only an acute urological emergency but may also lead to sustained psychiatric and sexual sequelae. Interdisciplinary follow-up should be considered to address long-term psychosocial outcomes.

Background and Objectives: Benign prostatic hyperplasia (BPH) is one of the most common chronic conditions in older men, significantly affecting quality of life (QoL) by causing lower urinary tract symptoms (LUTS). 5-alpha-reductase inhibitors (5-ARIs) such as finasteride and dutasteride remain a cornerstone of pharmacotherapy for BPH; however, comparative real-world data are limited. The aim of the present study was to compare the therapeutic outcomes of finasteride and dutasteride in patients diagnosed with BPH. Materials and Methods: This retrospective clinical study analyzed patients with BPH treated by either finasteride or dutasteride. Clinical parameters, including the Interna-tional Prostate Symptom Score (IPSS), QoL index, and International Index of Erectile Function-5 (IIEF-5) score; urodynamic outcomes, including maximum urinary flow rate (Qmax), average flow rate (Qave), and post-void residual urine volume (PVR); and bi-ochemical markers, including prostate-specific antigen (PSA) and creatinine levels, were assessed at baseline and after at least 6 months of continuous therapy and underwent cross-sectional statistical analysis, with significance set at p < 0.05. Results: Both treatment groups demonstrated significant improvements in clinical and urodynamic outcomes. Compared with finasteride, dutasteride was associated with greater reductions in the prostate volume and PSA levels as well as a greater im-provement in “IPSS”. Erectile function (IIEF-5) was comparable. Renal function param-eters remained stable in both groups. Predictive analysis revealed that higher body mass index and older age correlated with worse IIEF-5 scores in the finasteride group, whereas the baseline prostate volume was the key differentiating factor in the dutasteride group. Conclusions: Both 5-ARIs effectively reduced the severity of LUTS and improved uro-dynamic parameters in patients with BPH. Dutasteride showed superiority in reducing the prostate volume and PSA levels, while the overall safety profiles of both drugs were comparable. These findings highlight the importance of individualized therapy tailored to patient-specific clinical characteristics.

Background and Objectives: Benign prostatic hyperplasia (BPH) is one of the most common chronic conditions in older men, significantly impairing quality of life (QoL) by causing lower urinary tract symptoms (LUTSs). 5-alpha-reductase inhibitors (5-ARIs), including finasteride and dutasteride, remain a cornerstone of pharmacotherapy for BPH; however, comparative real-world data remain limited. The aim of this retrospective clinical study was to compare the therapeutic efficacy and safety of finasteride and dutasteride in patients with BPH. Materials and Methods: A total of 401 patients with BPH were retrospectively analyzed: 162 received finasteride and 239 received dutasteride. Clinical parameters, including the International Prostate Symptom Score (IPSS), Quality of Life (QoL) index, and International Index of Erectile Function-5 (IIEF-5) score; urodynamic outcomes, including maximum urinary flow rate (Qmax), average flow rate (Qave), and post-void residual urine volume (PVR); and biochemical markers, including prostate-specific antigen (PSA) and serum creatinine levels, were evaluated at baseline and after at least 6 months of continuous therapy. Statistical significance was defined as p < 0.05. Results: Both treatment groups demonstrated significant within-group improvements in LUTS severity and urodynamic outcomes (p < 0.001 for IPSS, Qmax, and QoL). Compared with finasteride, dutasteride achieved greater reductions in prostate volume (−26.3% vs. −18.1%, p = 0.008) and PSA levels (−43.7% vs. −32.5%, p = 0.014), as well as a slightly greater improvement in IPSS (−6.8 ± 3.9 vs. −5.9 ± 3.6, p = 0.042). Both drugs showed comparable effects on erectile function, as indicated by similar IIEF-5 score changes (Δ = −0.9 ± 2.8 vs. −0.7 ± 2.5, p = 0.51), confirming that neither agent demonstrated a clinically meaningful difference in sexual outcomes. Renal function parameters remained stable in both cohorts. Multivariate analysis identified higher BMI and older age as independent predictors of lower IIEF-5 scores in the finasteride group, while baseline prostate volume was the principal determinant of response in the dutasteride group. Conclusions: Both 5-ARIs effectively reduced LUTS severity and improved urodynamic parameters in men with BPH. Dutasteride demonstrated superior reductions in prostate volume and PSA, while both agents had comparable effects on sexual and renal function. These findings provide real-world evidence supporting the individualization of 5-ARI therapy according to patient-specific clinical characteristics.