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Russell A, Chatterjee S, Seed M. Does this case hold the answer to one of the worse types of pain in medicine--that of loin pain haematuria syndrome (LPHS). BMJ Case Rep 2015; 2015:bcr-2014-209165. [PMID: 25917070 DOI: 10.1136/bcr-2014-209165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A patient with loin pain haematuria syndrome suffering chronic throbbing pulsing pain overlaid with prolonged periods of incapacitating colic and overnight vomiting was presented 10 months following diagnosis. Ultrasound was normal. No renal or ureteral stones, or filling defects were seen on CT. At cytoscopy, bladder and urethra were normal, and bloody urine effluxed from the left ureteric orifice. The ureters were normal at diagnosis, and developed new abutting non-penetrating calcifications by 8 months. Pain episodes of complete incapacitating intensity of 2-4 h duration were reduced to 10 min with 5 mg crushed tadalafil administered at onset. If tadalafil was delayed to after onset, the original course of agony resulted. Daily tadalafil reduced loin pain intensity, but not the exacerbations. Tadalafil efficacy may indicate that the pain exacerbations are due to spasm of ureter smooth muscle. 5 mg tadalafil taken at onset alleviated severe loin pain exacerbations in this case of loin pain haematuria syndrome.
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Affiliation(s)
- Alan Russell
- Brampton Pain Clinic, Main St Medical Centre, Brampton, Canada
| | - Suman Chatterjee
- William Osler Health Centre, Brampton Civic Hospital, Brampton, Canada
| | - Michael Seed
- Medicines Research Group, School of Health Sport & Bioscience, University of East London, London, UK
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Choi EPH, Chin WY, Lam CLK, Wan EYF. The responsiveness of the International Prostate Symptom Score, Incontinence Impact Questionnaire-7 and Depression, Anxiety and Stress Scale-21 in patients with lower urinary tract symptoms. J Adv Nurs 2015; 71:1857-70. [PMID: 25871549 DOI: 10.1111/jan.12662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 02/03/2023]
Abstract
AIMS To examine the responsiveness of a combined symptom severity and health-related quality of life measure, condition-specific health-related quality of life measure and mental health measure in patients with lower urinary tract symptoms. BACKGROUND To establish the responsiveness of measures that accurately capture the change in health status of patients is crucial before any longitudinal studies can be appropriately planned and evaluated. DESIGN Prospective longitudinal observational study. METHODS 402 patients were surveyed at baseline and 1-year using the International Prostate Symptom Score, the Incontinence Impact Questionnaire-7 and Depression, Anxiety and Stress Scales-21. The internal and external responsiveness were assessed. Surveys were conducted from March 2013-July 2014. RESULTS In participants with improvements, the internal responsiveness for detecting positive changes was satisfactory in males and females for all scales, expect for the Depression subscale. The health-related quality of life question of the International Prostate Symptom Score was more externally responsive than the Incontinence Impact Questionnaire-7. CONCLUSIONS The International Prostate Symptom Score and Anxiety and Stress subscales were more responsive in males than in females. The symptom questions of the International Prostate Symptom Score and Anxiety and Stress subscales were not externally responsive in females. The health-related quality of life question of the International Prostate Symptom Score outperformed the Incontinence Impact Questionnaire-7 in both males and females, in terms of external responsiveness.
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Affiliation(s)
- Edmond P H Choi
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Eric Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
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Patel HR, Ilo D, Shah N, Cuzin B, Chadwick D, Andrianne R, Henneges C, Barry J, Hell-Momeni K, Branicka J, Büttner H. Effects of tadalafil treatment after bilateral nerve-sparing radical prostatectomy: quality of life, psychosocial outcomes, and treatment satisfaction results from a randomized, placebo-controlled phase IV study. BMC Urol 2015; 15:31. [PMID: 25879460 PMCID: PMC4419565 DOI: 10.1186/s12894-015-0022-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/24/2015] [Indexed: 11/16/2022] Open
Abstract
Background This multicenter, randomized, double-blind, double-dummy, placebo-controlled trial primarily evaluated the efficacy of tadalafil once-daily (OaD) or on-demand (“pro-re-nata”; PRN) treatment, started early post-nsRP. Secondary outcome-measures on quality-of-life (QoL) and treatment satisfaction are reported. Methods Patients, aged <68 yrs, with adenocarcinoma of the prostate (Gleason ≤ 7, normal preoperative erectile function [EF]) were randomized post-nsRP 1:1:1 to 9-month treatment with tadalafil 5 mg OaD, tadalafil 20 mg PRN, or placebo, followed by 6-week drug-free washout and 3-month open-label tadalafil OaD treatment (OLT). The main outcome measures were Changes in Expanded Prostate Cancer Index Composite (EPIC-26), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), and Self-Esteem and Relationship (SEAR) questionnaires (mixed-model-for-repeated-measures, including terms for treatment, visit, treatment-by-visit interaction, age-group, country, baseline-score). LS means with 95% confidence interval (CI) are reported. Results 423 patients were randomized to 3 treatment-groups: tadalafil OaD (N = 139), PRN (N = 143), or placebo (N = 141). In each group, 57 (41.0%), 58 (40.6%), and 50 (35.5%) patients were aged 61-68 yrs. At the end of double-blind treatment (DBT), patients’ EPIC sexual domain-scores improved significantly with tadalafil OaD versus placebo (treatment effect [95% CI]: 9.6 [3.1,16.0]; p = 0.004); comparisons of PRN versus placebo at end of DBT, and comparisons of tadalafil OaD and PRN versus placebo after OLT were not significant. Only in older patients (61-68 yrs; age-by-treatment p ≤ 0.1), EPIC urinary incontinence domain-scores also improved significantly with tadalafil OaD versus placebo (overall treatment effect across all visits, 8.3 [0.4,16.1]; p = 0.040). Treatment satisfaction increased significantly in both tadalafil groups, EDITS total-scores increased significantly with OaD and PRN versus placebo during DBT (p = 0.005 and p = 0.041, respectively). At the end of OLT, improvement was significant for tadalafil OaD versus placebo only (p = 0.035). No significant differences were observed for SEAR. Conclusions These results suggest that chronic dosing of tadalafil improves QoL of patients post-nsRP. The improvement of urinary incontinence in elderly patients randomized to tadalafil OaD may contribute to this effect. Trial registration www.clinicaltrials.gov, NCT01026818. Electronic supplementary material The online version of this article (doi:10.1186/s12894-015-0022-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hitendra R Patel
- Department of Urology, University Hospital North Norway, Sykehusvegen 38, 9038, Tromsø, Norway.
| | | | | | - Béatrice Cuzin
- Department of Urology, Edouard Herriot University Hospital, Lyon, France.
| | - David Chadwick
- South Tees Hospitals NHS Foundation Trust, Stockton-on-Tees, UK.
| | - Robert Andrianne
- Centre Hospitalier Universitaire de Liège, Service d'Urologie, Belgium.
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Wagg A. Pharmacological Treatment of Voiding Dysfunction in Older Men. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kawai Y, Oka M, Yoshinaga R, Fuchikami C, Oyama T. Effects of the phosphodiesterase 5 inhibitor Tadalafil on bladder function in a rat model of partial bladder outlet obstruction. Neurourol Urodyn 2015; 35:444-9. [DOI: 10.1002/nau.22732] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/15/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Yuko Kawai
- Discovery Research Laboratories; Nippon Shinyaku Co., Ltd; Kyoto Japan
| | - Michiko Oka
- Discovery Research Laboratories; Nippon Shinyaku Co., Ltd; Kyoto Japan
| | - Ryohei Yoshinaga
- Discovery Research Laboratories; Nippon Shinyaku Co., Ltd; Kyoto Japan
| | - Chiaki Fuchikami
- Discovery Research Laboratories; Nippon Shinyaku Co., Ltd; Kyoto Japan
| | - Tatsuya Oyama
- Discovery Research Laboratories; Nippon Shinyaku Co., Ltd; Kyoto Japan
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Zhang LT, Park JK. Are phosphodiesterase type 5 inhibitors effective for the management of lower urinary symptoms suggestive of benign prostatic hyperplasia? World J Nephrol 2015; 4:138-147. [PMID: 25664256 PMCID: PMC4317624 DOI: 10.5527/wjn.v4.i1.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/22/2014] [Accepted: 10/10/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the efficacy of phosphodiesterase type 5 inhibitors (PDE5-Is) in lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (LUTS/BPH).
METHODS: A comprehensive research was conducted to identify all publications relating to benign prostate hyperplasia and treatment with sildenafil, vardenafil and tadalafil. To assess the efficacy, the changes in total international prostate symptom score (IPSS), IPSS subscore including voiding, storage and quality of life (QoL), Benign prostatic hyperplasia Impact Index (BII), maximum urinary flow rate (Qmax) and the International Index of Erectile Function (IIEF) were extracted. A meta-analytical technique was used for the analysis of integrated data from the included studies to evaluate the mean difference in the results.
RESULTS: Total IPSS score, IIEF and BII showed a significant improvement in trials in which LUTS/BPH with or without erectile dysfunction (ED) were compared with the placebo. For LUTS/BPH, the mean differences of total IPSS score, IIEF and BII are -2.17, 4.88 and -0.43, P < 0.00001, respectively. For LUTS/BPH with comorbid ED, the mean difference are -1.97, 4.54 and -0.52, P < 0.00001, respectively. PDE5-Is appear to improve IPSS storage, voiding and QoL subscore (mean difference = -0.71, -1.23 and -0.33, P < 0.00001, respectively). Although four doses of tadalafil (2.5, 5, 10 and 20 mg) failed to reach significance in Qmax (mean difference = 0.22, P = 0.10), the 5 mg dose of tadalafil significantly improved the Qmax (mean difference = 0.33, P = 0.03).
CONCLUSION: PED5-Is demonstrated efficacy for improving LUTS in BPH patients with or without ED and could be considered to be the first line treatment for LUTS/BPH.
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Gacci M, Carini M, Salvi M, Sebastianelli A, Vignozzi L, Corona G, Maggi M, McVary KT, Kaplan SA, Oelke M, Serni S. Management of benign prostatic hyperplasia: role of phosphodiesterase-5 inhibitors. Drugs Aging 2015; 31:425-39. [PMID: 24811735 DOI: 10.1007/s40266-014-0177-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Several studies have highlighted a strong association between benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) and erectile dysfunction (ED), particularly in elderly men. Many epidemiological trials, such as in vitro and in vivo studies, have reported the emerging role of metabolic syndrome, including abdominal obesity, impaired glucose metabolism, hypertriglyceridemia, low high-density lipoprotein cholesterol, and hypertension, in the development and progression of urinary and sexual symptoms. Moreover, many authors have focused their studies on the identification of all the shared pathogenetic mechanisms of LUTS/BPH and ED, including alteration of cyclic guanosine monophosphate and RhoA-ROCK pathways or vascular and neurogenic dysfunction. All these are potential targets for proposed phosphodiesterase type 5 inhibitors (PDE5-Is). Therefore, several trials have recently been designed to evaluate the role of PDE5-Is alone or in combination with conventional treatment for BPH, such as α-adrenergic blockers, in men affected by LUTS/BPH, with or without ED. Different PDE5-Is are in clinical use worldwide and currently six of them are licensed for the oral treatment of ED. All these compounds differ in pharmacokinetic factors, with influence on drug action, and subsequently in the overall safety and efficacy profile.
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Affiliation(s)
- M Gacci
- Department of Urology, University of Florence, Careggi Hospital, Viale Pieraccini 18, 50139, Florence, Italy,
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Reges R, Regadas RP, Cerqueira JBG, Gonzaga-Silva LF. Phosphodiesterase inhibitors for treatment of voiding dysfunction: An overview of experimental and clinical evidence. World J Clin Urol 2014; 3:249-257. [DOI: 10.5410/wjcu.v3.i3.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/14/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
Recently, the focus of the origin of lower urinary tract symptoms (LUTS) has change from the prostate to the bladder. Regardless of the underlying mechanism associated with the origin of LUTS, alpha-blockers continue to be the most common medicine prescribed to treat LUTS due to benign prostatic obstruction (BPO). The newest class of drug introduced to treat LUTS/BPO is phosphodiesterase inhibitors (PDEi) and the aim of this study was to review the role of PDEi in the treatment of LUTS/BPO. In this review, the first evidence was evaluated based on epidemiological studies followed by randomized clinical trials which provide evidence on the administration of PDEi in patients with LUTS/BPO. Experimental studies were also assessed to tentatively elucidate the association between LUTS and erectile dysfunction, and to elucidate the underlying mechanism. There is still controversy regarding the administration of PDEi due to the fear of detrusor impairment, response to acute administration, and the effects of PDEi combined with alpha-blockers. Following this review, we conclude that treatment of BPO/LUTS with PDEi is beneficial, based on experimental studies, strong evidence and the large number of randomized clinical trials confirming their efficiency.
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Choo SH, Sung HH, Chae MR, Kang SJ, Han DH, Park JK, So I, Lee SW. Effects of Schisandra chinensis extract on the relaxation of isolated human prostate tissue and smooth muscle cell. JOURNAL OF ETHNOPHARMACOLOGY 2014; 156:271-276. [PMID: 25178950 DOI: 10.1016/j.jep.2014.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 08/11/2014] [Accepted: 08/24/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Schisandra chinensis has been commonly used as a traditional herbal medicine to treat various diseases including body weakness, dysentery, impotence, enuresis and frequent urination in many countries including Korea, China and Russia. Benign prostate hyperplasia is a common disease for the elderly men and it induces lower urinary tract symptoms which hinder general activity and quality of life. We evaluated the therapeutic potential of Schisandra chinensis extract (SCE) in benign prostate hyperplasia using human prostate tissue. MATERIALS AND METHODS Schisandra chinensis fruit was collected and extracted with ethanol. Human prostate tissues were obtained from 14 prostate cancer patients. Macroscopically normal tissue was excised from the transition zone and the periurethral regions. Isolated prostate tissue strips were mounted in an organ-bath system, and the relaxation effect of SCE was evaluated by cumulative addition to prostate strips pre-contracted with 10(-5)M norepinephrine. The effect of tamsulosin was compared, and the additive effect was evaluated. Electrophysiological studies using cultured human prostate smooth muscle cells (HPrSMC) were conducted. RESULTS Cumulative dosing of SCE induced concentration-dependent relaxation in contracted prostate tissue (n=18, P<0.05). Simultaneous dosing of SCE and tamsulosin showed an additive relaxation effect. The relaxation effect of SCE was abolished by inhibition of K+ channels by pre-treatment with tetraethylammonium. In HPrSMC, extracellular application of 100 μg/mL SCE significantly increased outward currents, and this effect was significantly attenuated by treatment with 100 nM Iberiotoxin. CONCLUSIONS SCE showed a dose dependent relaxation effect on human prostate tissue as well as an additive effect with tamsulosin. The relaxation effects of SCE on HPrSMC were, in part, due to the activation of K+ channels.
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Affiliation(s)
- Seol Ho Choo
- Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Urology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mee Ree Chae
- Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Su Jeong Kang
- Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University School of Medicine, Jeonju-si, Republic of Korea
| | - Insuk So
- Department of Physiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Won Lee
- Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Wang X, Wang X, Li S, Meng Z, Liu T, Zhang X. Comparative effectiveness of oral drug therapies for lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and network meta-analysis. PLoS One 2014; 9:e107593. [PMID: 25216271 PMCID: PMC4162615 DOI: 10.1371/journal.pone.0107593] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 08/12/2014] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are common in elder men and a number of drugs alone or combined are clinically used for this disorder. But available studies investigating the comparative effects of different drug therapies are limited. This study was aimed to compare the efficacy of different drug therapies for LUTS/BPH with network meta-analysis. MATERIALS AND METHODS An electronic search of PubMed, Cochrane Library and Embase was performed to identify randomized controlled trials (RCTs) comparing different drug therapies for LUTS/BPH within 24 weeks. Comparative effects were calculated using Aggregate Data Drug Information System. Consistency models of network meta-analysis were created and cumulative probability was used to rank different therapies. RESULTS A total 66 RCTs covering seven different therapies with 29384 participants were included. We found that α-blockers (ABs) plus phosphodiesterase 5 inhibitors (PDE5-Is) ranked highest in the test of IPSS total score, storage subscore and voiding subscore. The combination therapy of ABs plus 5α-reductase inhibitors was the best for increasing maximum urinary flow rate (Qmax) with a mean difference (MD) of 1.98 (95% CI, 1.12 to 2.86) as compared to placebo. ABs plus muscarinic receptor antagonists (MRAs) ranked secondly on the reduction of IPSS storage subscore, although monotherapies including MRAs showed no effect on this aspect. Additionally, PDE5-Is alone showed great effectiveness for LUTS/BPH except Qmax. CONCLUSIONS Based on our novel findings, combination therapy, especially ABs plus PDE5-Is, is recommended for short-term treatment for LUTS/BPH. There was also evidence that PDE5-Is used alone was efficacious except on Qmax. Additionally, it should be cautious when using MRAs. However, further clinical studies are required for longer duration which considers more treatment outcomes such as disease progression, as well as basic research investigating mechanisms involving PDE5-Is and other pharmacologic agents alleviate the symptoms of LUTS/BPH.
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Affiliation(s)
- Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P.R.China
| | - Xiao Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P.R.China
| | - Sheng Li
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P.R.China
| | - Zhe Meng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P.R.China
| | - Tao Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P.R.China
| | - Xinhua Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan city, Hubei province, P.R.China
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Wroński S. The new horizons of pharmacotherapy. Unexpected pharmacological actions and a new therapeutic strategy of phosphodiesterase-5 inhibitors. Cent European J Urol 2014; 67:314-8. [PMID: 25247094 PMCID: PMC4165684 DOI: 10.5173/ceju.2014.03.art20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 06/20/2014] [Accepted: 06/26/2014] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Benign prostate hyperplasia and erectile dysfunction affect a significant subset of men. BPH and ED may have the same promoting conditions and are the strong predicting risk factors to each other. A significant number of these patients are bothered by lower urinary tract symptoms (LUTS). Direct correlation of age, sexual dysfunction and LUTS severity has been well documented. Many sexually dysfunctional patients with concomitant BPH receive alpha-adrenergic antagonists and any Phosphodiesterase-5 (PDE5) inhibitor simultaneously. PDE5 inhibitors relieve LUTS symptoms in the course of BPH and reduce independent detrusor contractions. This paper presents the results of clinical trials on the efficacy of PDE5 inhibitors on LUTS, new perspectives on its use and newly-identified side effects. MATERIAL AND METHODS The review is based on an internet search of PubMed and Medscape databases. The search terms were as follows: LUTS and ED, BPH and phosphodiesterase-5 inhibitors, LUTS clinical trials, phosphodiesterase-5 inhibitors mechanisms. RESULTS Clinical trials show an epidemiological and pathophysiological relationship between BPH, LUTS and ED. Numerous studies reveal the alleviating effect of phosphodiesterase-5 inhibitors on LUTS, expressed as the reduction of IPSS score, but not followed by a change in Qmax. Opponents raise a link of PDE5 inhibitors with increased risk of melanoma. New studies reveal that phosphodiesterase-5 inhibitors are effective in the treatment of neurological disorders. CONCLUSIONS Researches reveal the efficacy of phosphodiesterase-5 inhibitors in LUTS along with an improvement of erectile function. The molecular mechanism of action of such drugs suggests imminent novel applications. Potential benefits will be multidimensional. Unfortunately, interfering with particular molecular mechanisms may alleviate some diseases, but may lay groundwork for others - new and even more devastating.
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Affiliation(s)
- Stanisław Wroński
- Department of Urology, Skin & Tissue Bank, Jan Biziel Memorial University Hospital, Bydgoszcz, Poland
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62
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Hatzimouratidis K. A review of the use of tadalafil in the treatment of benign prostatic hyperplasia in men with and without erectile dysfunction. Ther Adv Urol 2014; 6:135-47. [PMID: 25083163 DOI: 10.1177/1756287214531639] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Epidemiological data link erectile dysfunction (ED) and benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS), two highly prevalent conditions in aging men, assuming common pathophysiological pathways. Tadalafil 5 mg once daily has been approved for the treatment of men with LUTS with or without comorbid ED. The aim of this review is to provide an overview of current knowledge on the epidemiological and pathophysiological links between ED and LUTS and to focus on tadalafil as a new treatment option in men with BPH-associated LUTS. A Medline search was completed using the Medical Subject Headings (MESH® keywords) 'prostatic hyperplasia' and 'phosphodiesterase inhibitors'. This search revealed 125 relevant references (entire Medline database up to 11 March 2014). The efficacy of tadalafil 5 mg once daily for the treatment of LUTS has been reported by several well-designed studies. Tadalafil improves significantly the total International Prostate Symptom Score (IPSS), the voiding and storage subscores, the IPSS Quality of Life (QoL) and the BPH Impact Index (BII). Its efficacy is irrelevant to the erectile function status of the patients. However, in the majority of these studies tadalafil is not associated with improvement in maximum urine flow or post-void residual volume (PVR). Its safety profile is well established and no new or unexpected adverse events other than those reported in ED studies have been recorded. Tadalafil is today a new treatment alternative to other established drugs for LUTS such as the α-adrenergic antagonists or 5α-reductase inhibitors. However, it is not just an alternative, since sexual adverse events associated with these drugs are avoided and tadalafil is the only drug that can treat both ED and LUTS at the same time.
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Affiliation(s)
- Konstantinos Hatzimouratidis
- 2 Department of Urology, General Hospital 'Papageorgiou', Aristotle University of Thessaloniki, Kimiseos Theotokou 26B, Pefka, Thessaloniki, 54006 Thessaloniki, Greece
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Bortolini MAT, Bilhar APM, Castro RA. Neural control of lower urinary tract and targets for pharmacological therapy. Int Urogynecol J 2014; 25:1453-62. [PMID: 25001574 DOI: 10.1007/s00192-014-2452-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 06/10/2014] [Indexed: 12/30/2022]
Abstract
Studies on the physiology and pharmacology of the lower urinary tract have brought new information and concepts about the complex neural control of micturition. There are many mechanisms, some proven and others not yet completely understood, in which pharmacological agents may act facilitating the filling, storage, and emptying of the bladder. This review describes the peripheral innervation and the main pathways involved in lower urinary tract control. It also presents potential targets for the treatment of voiding dysfunctions.
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Affiliation(s)
- Maria Augusta T Bortolini
- Sector of Urogynecology and Vaginal Surgery, Department of Gynecology, Federal University of São Paulo, Rua Rodolfo Belz, 220/42A, São Paulo, 05639-010, SP, Brazil,
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Comparison of the efficacy and safety of 5-mg once-daily versus 5-mg alternate-day tadalafil in men with erectile dysfunction and lower urinary tract symptoms. Int J Impot Res 2014; 27:33-7. [DOI: 10.1038/ijir.2014.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/04/2014] [Accepted: 05/12/2014] [Indexed: 11/08/2022]
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65
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Lee SW, Paick JS, Park HJ, Won JE, Morisaki Y, Sorsaburu S, Viktrup L. The Efficacy and Safety of Tadalafil 5 mg Once Daily in Korean Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: An Integrated Analysis. World J Mens Health 2014; 32:28-35. [PMID: 24872949 PMCID: PMC4026231 DOI: 10.5534/wjmh.2014.32.1.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 03/17/2014] [Accepted: 03/24/2014] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This post hoc integrated analysis assessed the efficacy and safety of tadalafil 5 mg once daily in a large Korean population with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH-LUTS). MATERIALS AND METHODS Individual Korean participant data were integrated from three 12-week, randomized, double-blind, placebo-controlled studies in Asian men with BPH-LUTS, wherein 177 Korean men received placebo and 177 received tadalafil 5 mg once daily. The primary objective was to compare the change from baseline to week 12 in total International Prostate Symptom Score (IPSS) after treatment with tadalafil versus placebo. RESULTS A significantly greater improvement (p<0.001) in total IPSS from baseline to week 12 was observed for tadalafil compared to placebo (least squares mean: tadalafil=-5.97; placebo=-3.94 ). Total IPSS at weeks 4 and 12, IPSS voiding and storage subscores at weeks 4, 8, and 12, and IPSS quality of life index at weeks 8 and 12 were also significantly improved (p<0.05) for tadalafil compared to placebo. There was significant improvement (p<0.001) in the patient global Impression of improvement responses and numerical improvement in the clinician global impression of improvement responses with tadalafil compared to placebo. There were no significant treatment differences for peak urine flow rate or postvoid residual volume. Few participants had treatment-emergent adverse events and there were no unexpected safety findings. CONCLUSIONS This integrated analysis of three randomized, placebo-controlled Asian studies confirmed tadalafil 5 mg once daily as an efficacious and well-tolerated treatment for Korean men with BPH-LUTS.
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Affiliation(s)
- Sung Won Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Seung Paick
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyun Jun Park
- Department of Urology, Pusan National University Hospital, Medical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | | | | | | | - Lars Viktrup
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
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Park HJ, Moon KH, Lee SW, Lee WK, Kam SC, Lee JH, Park NC. Mirodenafil for the treatment of erectile dysfunction: a systematic review of the literature. World J Mens Health 2014; 32:18-27. [PMID: 24872948 PMCID: PMC4026230 DOI: 10.5534/wjmh.2014.32.1.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/11/2014] [Indexed: 11/15/2022] Open
Abstract
Phosphodiesterase type 5 (PDE5) inhibitors are the most commonly used treatment for erectile dysfunction (ED). Since the launch of sildenafil, several drugs-including mirodenafil, sildenafil citrate (sildenafil), tadalafil, vardenafil HCL (vardenafil), udenafil, and avanafil-have become available. Mirodenafil is a newly developed pyrrolopyrimidinone compound, which is a potent, reversible, and selective oral PDE5 inhibitor. Mirodenafil was launched in Korea in 2007, and an orally disintegrating film of mirodenafil was developed in 2011 for benefitting patients having difficulty in swallowing tablets. This study aimed to review the pharmacokinetic characteristic profile of mirodenafil and report evidence on its efficacy in the case of ED. In addition, we reviewed randomized controlled studies of mirodenafil's daily administration and efficacy for lower urinary tract symptoms.
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Affiliation(s)
- Hyun Jun Park
- Department of Urology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Kyung Hyun Moon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seung Wook Lee
- Department of Urology, Hanyang University Guri Hospital, Guri, Korea
| | - Won Ki Lee
- Department of Urology, Chuncheon Sacred Heart Hospital, Hallym Unversity College of Medicine, Chuncheon, Korea
| | - Sung Chul Kam
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jun Ho Lee
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Nam Cheol Park
- Department of Urology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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67
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Polland A, Mock S, Dmochowski RR. Emerging treatments for urinary incontinence. Expert Opin Emerg Drugs 2014; 19:281-90. [PMID: 24624940 DOI: 10.1517/14728214.2014.895324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Urinary incontinence (UI) is a common and distressing problem that can adversely affect a patient's quality of life. Medical treatment is integral in the management of UI, of which there are a number of novel therapeutic targets. AREAS COVERED In this review, an overview of UI and its associated burden on patients and on the healthcare system is provided. While there are many options for therapy currently available, the focus of this review is emerging therapies that may contribute in the near future to the management of UI. EXPERT OPINION Healthcare expenditures for diagnosis, evaluation and treatment are substantial and are increasing as the general population ages and as access to healthcare increases. Pharmacological therapy for stress UI is limited and autologous muscle-derived cell therapy holds great promise. Despite the myriad of antimuscarinics for urge UI, all those presently FDA approved have comparable efficacy and adverse events, despite advertisements that suggest otherwise. Antimuscarinics and β agonists are likely to remain mainstays of treatment as agents that act on novel targets such as transient receptor potential vanilloid type 1 and neurokinin-1 require further study.
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Affiliation(s)
- Allison Polland
- The Mount Sinai Hospital, Department of Urology , 1 Gustave L. Levy Pl, Box 1272, New York, NY 10029 , USA
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68
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Cellek S, Cameron NE, Cotter MA, Fry CH, Ilo D. Microvascular dysfunction and efficacy of PDE5 inhibitors in BPH–LUTS. Nat Rev Urol 2014; 11:231-41. [DOI: 10.1038/nrurol.2014.53] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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69
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Takeda M, Yokoyama O, Lee SW, Murakami M, Morisaki Y, Viktrup L. Tadalafil 5 mg once-daily therapy for men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: results from a randomized, double-blind, placebo-controlled trial carried out in Japan and Korea. Int J Urol 2014; 21:670-5. [PMID: 24571205 DOI: 10.1111/iju.12410] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 01/08/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To gain further evidence on the efficacy, safety and tolerability of tadalafil 5 mg once-daily in Asian men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. METHODS Japanese and Korean men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia were randomized to once-daily tadalafil 5 mg (n = 306) or placebo (n = 304) for 12 weeks. RESULTS A significantly greater improvement (P < 0.001) in total International Prostate Symptom Score for the change from baseline (week 0) to study end-point (week 12) was observed for tadalafil (-6.0) versus placebo (-4.5). Significantly greater improvements (P < 0.01) in total International Prostate Symptom Score for the change from baseline to weeks 4 and 8 were observed for tadalafil versus placebo. Significantly greater improvements (P < 0.05) in International Prostate Symptom Score voiding and storage subscores, and International Prostate Symptom Score Quality of Life Index were observed for the change from baseline to end-point for tadalafil versus placebo. Significantly greater improvements (P < 0.001) in urinary symptoms were observed for tadalafil versus placebo for both Patient and Clinician Global Impressions of Improvement. No new safety concerns were identified. CONCLUSIONS These findings confirm the efficacy and safety profile of tadalafil 5 mg once-daily in Asian men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.
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Affiliation(s)
- Masayuki Takeda
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
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Corona G, Vignozzi L, Rastrelli G, Lotti F, Cipriani S, Maggi M. Benign prostatic hyperplasia: a new metabolic disease of the aging male and its correlation with sexual dysfunctions. Int J Endocrinol 2014; 2014:329456. [PMID: 24688539 PMCID: PMC3943333 DOI: 10.1155/2014/329456] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 12/05/2013] [Indexed: 12/21/2022] Open
Abstract
Metabolic syndrome (MetS) is a well-recognized cluster of cardiovascular (CV) risk factors including obesity, hypertension, dyslipidemia, and hyperglycaemia, closely associated with an increased risk of forthcoming cardiovascular disease and type 2 diabetes mellitus. Emerging evidence indicates that benign prostate hyperplasia (BPH) and its related lower urinary tract symptoms (LUTS) represent other clinical conditions frequently observed in subjects with MetS. Several modifiable factors involved in MetS determinism, such as inadequate diet, lack of physical exercise, and smoking and drinking behaviours are emerging as main contributors to the development of BPH. The pathogenetic mechanisms underlying the connection between MetS and BPH have not been completely clarified. MetS and its components, hypogonadism, and prostate inflammation probably play an important role in inducing BPH/LUTS. Although historically considered as a "normal" consequence of the aging process, BPH/LUTS should now be faced proactively, as a preventable disorder of the elderly. Type of diet and level of physical activity are now considered important factors affecting prostate health in the aging male. However, whether physical exercise, weight loss, and modifications of dietary habit can really alter the natural history of BPH/LUTS remains to be determined. Further research is advisable to better clarify these points.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Linda Vignozzi
- Sexual Medicine Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Giulia Rastrelli
- Sexual Medicine Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Francesco Lotti
- Sexual Medicine Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Sarah Cipriani
- Sexual Medicine Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Mario Maggi
- Sexual Medicine Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
- *Mario Maggi:
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McVary KT, Gange SN, Shore ND, Bolton DM, Cowan BE, Thomas Brown B, Te AE, Chin PT, Rukstalis DB, Roehrborn CG. Treatment of LUTS Secondary to BPH While Preserving Sexual Function: Randomized Controlled Study of Prostatic Urethral Lift. J Sex Med 2014; 11:279-87. [DOI: 10.1111/jsm.12333] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Park HJ, Won JEJ, Sorsaburu S, Rivera PD, Lee SW. Urinary Tract Symptoms (LUTS) Secondary to Benign Prostatic Hyperplasia (BPH) and LUTS/BPH with Erectile Dysfunction in Asian Men: A Systematic Review Focusing on Tadalafil. World J Mens Health 2013; 31:193-207. [PMID: 24459652 PMCID: PMC3888888 DOI: 10.5534/wjmh.2013.31.3.193] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 10/24/2013] [Accepted: 11/07/2013] [Indexed: 01/03/2023] Open
Abstract
This review assesses lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with or without erectile dysfunction (ED) and related therapies focusing on tadalafil. A literature search was obtained and reviewed for the epidemiology, treatment therapies, pathophysiology, and efficacy and safety of phosphodiesterase type 5 inhibitor (PDE5i) tadalafil in patients with LUTS/BPH. Approximately 42% of men aged 51 to 60 years have BPH. Approximately 90% of men aged 45 to 80 years have LUTS. Occurrence of LUTS increases with age for almost all racial/ethnic groups (range, 32% to 56%) with prevalence of LUTS highest among Hispanic men, then Blacks, Caucasians, and Asians. There is an independent relationship with LUTS/BPH and ED, with approximately 70% of men with LUTS/BPH having ED with severity of one disease often correlating with the other. The European Urological Association guidelines include the use of the PDE5i tadalafil. Tadalafil is the only therapy recommended for treatment of co-existing BPH and ED, while other therapies have unwanted ED side effects. The mode of action of tadalafil may involve different areas of the lower urinary tract such as smooth muscle cell relaxation in the bladder neck, prostate, and urethra, but there may also be resulting modulation of the afferent nerve activity. Tadalafil (5 mg) in Asian men with LUTS/BPH, similar to global studies, is efficacious and safe. Tadalafil (5 mg) improves co-existing LUTS/BPH and ED, independently. Men with LUTS/BPH likely also have ED. Asian men with LUTS/BPH have similar incidence rates, co-existing ED, comorbid diseases, and risks as non-Asian men. Tadalafil can improve co-existing LUTS/BPH and ED.
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Affiliation(s)
- Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
| | | | | | | | - Seung Wook Lee
- Department of Urology, Hanyang University Guri Hospital, Guri, Korea
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73
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Abolyosr A, Elsagheer GA, Abdel-Kader MS, Hassan AM, Abou-Zeid AMM. Evaluation of the effect of sildenafil and/or doxazosin on Benign prostatic hyperplasia-related lower urinary tract symptoms and erectile dysfunction. Urol Ann 2013; 5:237-40. [PMID: 24311901 PMCID: PMC3835979 DOI: 10.4103/0974-7796.120293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 09/08/2012] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To verify the association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) and evaluate the influence of sildenafil and doxazosin either as single agents or combined on both symptoms. MATERIAL AND METHODS A prospective randomized study including 150 patients presented with LUTS caused by BPH in association with clinically diagnosed ED, with age equal or more than 45 years from April 2010 to April 20011. They were categorized into three comparative groups each one containing 50 patients. These groups were comparable regarding pretreatment international prostate symptoms score (IPSS) and international index of erectile function (IIEF). The patients of the first group were given sildenafil 50 mg as monotherapy, those of the second group were given doxazosin 2 mg and those of the third group were given combination of both drugs for 4 months for each group. The main post-treatment parameters for assessment and comparison include assessment of patient's symptoms by repeated IPS Sand IIEF, uroflowmetry and assessment of PVR. The statistics was done by use of the Qui--square test. RESULTS Pre-treatment parameters were assessed and compared between the three groups. After 4 months of treatment, the comparative parameters were applied to all groups and the differences were measured post-treatment regarding IPSS, erectile function score, uroflowmetry, and post-void residual (PVR) urine. Sildenafil alone caused mild improvement in IPSS, more improvement in IIEF score, and little effect on flow rate and PVR urine. Doxazosin alone caused more improvement in IPSS, flow rate and PVR urine and less improvement in IIEF score. A combination of both sildenafil and doxazosin caused more improvement in all of the comparative parameters than when each drug was given alone. CONCLUSIONS There is a strong relationship between LUTS and ED. Doxazosin or sidenafil as a single drug could be used in treating mild or mild to moderate symptoms but more severe symptoms may usually need a combination of both drugs.
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Affiliation(s)
- Ahmed Abolyosr
- Urology Department, Qena Faculty of Medicine, South valley University, Egypt
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74
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Maciejewski CC, Tredget EE, Metcalfe PD. Urodynamic improvements following oral medical therapy for partial bladder outlet obstruction in an animal model. Neurourol Urodyn 2013; 34:286-91. [DOI: 10.1002/nau.22528] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/22/2013] [Indexed: 11/10/2022]
Affiliation(s)
| | - Edward E. Tredget
- Division of Plastic Surgery, Department of Surgery; University of Alberta; Edmonton Canada
| | - Peter D. Metcalfe
- Division of Urology, Department of Surgery; University of Alberta; Edmonton Canada
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Bechara A, Casabe A, Rodriguez Baigorri G, Cobreros C. Effectiveness of tadalafil 5 mg once daily in the treatment of men with lower urinary tract symptoms suggestive to benign prostatic hyperplasia with or without erectile dysfunction: results from naturalistic observational TadaLutsEd study. J Sex Med 2013; 11:498-505. [PMID: 24224728 DOI: 10.1111/jsm.12386] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Naturalistic clinical trials provide data on the effectiveness of drugs in nonexperimental and everyday situations and are extremely helpful for decision-making purposes and for confirming experimental findings in clinical trials. No data have been published from naturalistic studies performed in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) with or without erectile dysfunction (ED) and treated with phosphodiesterase type 5 inhibitors. AIM The aim of this study (TadaLutsEd Study) was to assess, in the context of medical practice, the effectiveness of tadalafil 5 mg once daily in patients with LUTS/BPH with or without erectile dysfunction. METHODS The study was a 6-week uncontrolled, prospective, open-label, multicentric, observational study. The patient population involved sexually active males aged ≥ 50 years, diagnosed with LUTS/BPH with or without concomitant ED, and treated with tadalafil 5 mg daily in accordance with standard urological practice. MAIN OUTCOME MEASURES Effectiveness was assessed through the self-administered International Prostate Symptom Score (IPSS) questionnaire; quality of life was evaluated through the IPSS quality of life section (IPSS-QoL). The patients were also evaluated with the International Index of Erectile Function (IIEF-5). Adverse events were recorded. Statistical analyses using paired data samples was applied (Wilcoxon signed-ranks test). RESULTS Sixty-two patients (mean age 62.2 years) completed the treatment, of whom 85.5% showed improvement in their urinary symptoms. Pre- and post-treatment differences in the IPSS, IPSS-QoL, and IIEF-5 scores were statistically significant at 4.4, 1, and 5.4 points, respectively (P < 0.0001). Tadalafil was well tolerated, and adverse events were mild, with a discontinuation rate of 1.6%. CONCLUSION According to study results, the use of tadalafil 5 mg once daily in a nonselected patient population with LUTS/BPH with or without ED led to improvements in terms of symptoms and quality of life and exhibited a safety profile similar to that obtained in controlled tadalafil clinical trials.
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Affiliation(s)
- Amado Bechara
- División Urología, Hospital Durand, Buenos Aires, Argentina
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76
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Singh DV, Mete UK, Mandal AK, Singh SK. A comparative randomized prospective study to evaluate efficacy and safety of combination of tamsulosin and tadalafil vs. tamsulosin or tadalafil alone in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. J Sex Med 2013; 11:187-96. [PMID: 24165272 DOI: 10.1111/jsm.12357] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and erectile dysfunction are common disorders of advancing age. AIM To evaluate the efficacy and safety of tamsulosin and tadalafil in patients with LUTS due to BPH. METHODS In this prospective randomized study, 133 men complaining of LUTS due to BPH were included. Forty-five patients received tamsulosin 0.4 mg/day alone (Group A), 44 patients received tadalafil 10 mg/day (Group B), and combination therapy (tamsulosin and tadalafil both) was instituted in 44 patients (Group C). After a 2-week medication free run-in period, they were evaluated for International Prostatic Symptom Score (IPSS), International Index of Erectile Function score (IIEF5), quality of life (IPSS QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR) volume, and safety parameters before and at 3 months of treatment. MAIN OUTCOME MEASURES There were primary (IPSS, IPSS QoL index, Qmax, and PVR) and secondary (erectile function [EF] domain scores from IIEF5) efficacy end points. Safety assessment included laboratory tests and patient's reporting of adverse event. RESULTS A significant improvement in IPSS score was observed in all the 3 groups A, B, and C (-50.90%, P < 0.05; -33.50%, P < 0.05; and -53.90%, P < 0.05, respectively). IIEF5 score increased significantly in these three groups (+39.28%, P < 0.05; +45.96%, P < 0.05; and +60.23%, P < 0.05, respectively). A significant increase in Qmax and decrease in PVR were also observed (33.99%, P < 0.05; 29.78%, P < 0.05; and 37.04%, P < 0.05) and (-60.90%, P < 0.05; -49.45%, P < 0.05; and -62.97%, P < 0.05, respectively). The QoL scores improved significantly (-73.35%, P < 0.05; -70.26%, P < 0.05; and -79.65%, P < 0.05, respectively). Side effects were dyspepsia, heartburn, headache, flushing, myalgia, and backache. Adverse effect dropout was 3.7%. No participant experienced any severe or serious adverse events. CONCLUSIONS In patients with LUTS due to BPH, tamsulosin and tadalafil alone or in combination cause a significant improvement in patients with LUTS. Their EF also improves with these medications. The improvement is better with combination therapy compared with single agent alone.
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Affiliation(s)
- Dig Vijay Singh
- Department of Urology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Roehrborn CG, Chapple C, Oelke M, Cox D, Esler A, Viktrup L. Effects of tadalafil once daily on maximum urinary flow rate in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. J Urol 2013; 191:1045-50. [PMID: 24445278 DOI: 10.1016/j.juro.2013.10.074] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE Tadalafil significantly improves lower urinary tract symptoms suggestive of benign prostatic hyperplasia. We post hoc characterized changes in the maximum urinary flow rate using integrated data from 4 international, placebo controlled studies of tadalafil once daily for lower urinary tract symptoms suggestive of benign prostatic hyperplasia. MATERIALS AND METHODS After a 4-week placebo lead-in period 1,500 men were randomized to tadalafil 5 mg or placebo for 12 weeks. Data were analyzed using ANCOVA. Maximum urinary flow rate values were rank transformed for analysis. RESULTS Baseline maximum urinary flow rate data were available on 1,371 men with a mean age of 63.1 years and end point data were available on 1,197. Tadalafil 5 mg significantly increased maximum urinary flow vs placebo (median 1.1 vs 0.4 ml per second, p = 0.003). At a baseline voided volume of 125 to less than 250 ml the median change in the maximum urinary flow rate was 0.9 and 1.2 ml per second (p = 0.142) in 731 patients, at a baseline of 250 to 450 ml the change was -0.3 and 0.7 ml per second (p = 0.011) in 428, and at a baseline of greater than 450 ml the change was -0.2 and 2.0 ml per second (p = 0.186) in 38 for placebo and tadalafil, respectively. The difference was 0.3, 1.0 and 2.2 ml per second, respectively. At a baseline maximum urinary flow rate of greater than 15 ml per second in 128 patients the median flow rate change was -2.1 and -0.8 ml per second (p = 0.246), at a maximum of 10 to 15 ml per second in 522 the change was 0.2 and 0.8 ml per second (p = 0.044), and at a maximum of less than 10 ml per second in 547 the change was 1.2 and 1.8 ml per second (p = 0.189) for placebo and tadalafil, respectively. Tadalafil improved I-PSS (International Prostate Symptom Score) voiding subscores significantly vs placebo across all baseline maximum urinary flow subgroups (each p <0.001). CONCLUSIONS This integrated analysis revealed a small but statistically significant median maximum urinary flow rate improvement for tadalafil vs placebo. The numerical difference in the maximum urinary flow change from baseline between tadalafil and placebo increased with increased voided volume.
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Affiliation(s)
- Claus G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Christopher Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospital National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Matthias Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - David Cox
- Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana
| | - Anne Esler
- inVentiv Health Clinical, Indianapolis, Indiana
| | - Lars Viktrup
- Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana
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Lower urinary tract symptoms improve with testosterone replacement therapy in men with late-onset hypogonadism: 5-year prospective, observational and longitudinal registry study. World J Urol 2013; 32:1049-54. [DOI: 10.1007/s00345-013-1187-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/08/2013] [Indexed: 12/17/2022] Open
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The use of PDE-5 Inhibitors in the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Curr Urol Rep 2013; 14:585-94. [DOI: 10.1007/s11934-013-0373-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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80
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Fusco F, D'Anzeo G, Sessa A, Pace G, Rossi A, Capece M, d'Emmanuele di Villa Bianca R. BPH/LUTS and ED: Common Pharmacological Pathways for a Common Treatment. J Sex Med 2013; 10:2382-93. [DOI: 10.1111/jsm.12261] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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81
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Dmochowski RR. Elucidation of Phosphodiesterase Type 5 Inhibitor Mechanism of Action. J Urol 2013; 190:1161-2. [DOI: 10.1016/j.juro.2013.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Roger R. Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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Presence of Phosphodiesterase Type 5 in the Spinal Cord and its Involvement in Bladder Outflow Obstruction Related Bladder Overactivity. J Urol 2013; 190:1430-5. [DOI: 10.1016/j.juro.2013.03.112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 12/15/2022]
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83
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Rahnama'i MS, Van Koeveringe GA, Van Kerrebroeck PE. Overactive bladder syndrome and the potential role of prostaglandins and phosphodiesterases: an introduction. Nephrourol Mon 2013; 5:934-45. [PMID: 24350100 PMCID: PMC3842572 DOI: 10.5812/numonthly.14087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/15/2013] [Indexed: 12/14/2022] Open
Abstract
In this paper, a general introduction is given, presenting the overactive bladder syndrome (OAB) and its impact on the quality of life and economical burden in patients affected. Moreover, the anatomy, physiology and histology of the lower urinary tract are discussed, followed by a brief overview on the possible role of prostaglandin (PG) and phosphodiesterase type 5 (PDE5) in the urinary bladder. The current literature on the role and distribution of PGE2 and its receptors in the urinary bladder is discussed. In both animal models and in human studies, high levels of signaling molecules such as PG and cGMP have been implicated, in decreased functional bladder capacity and micturition volume, as well as in increased voiding contraction amplitude. As a consequence, inhibition of prostanoid production, the use of prostanoid receptor antagonists, or PDE inhibitors might be a rational way to treat patients with detrusor overactivity. Similarly, prostanoid receptor agonists, or agents that stimulate their production, might have a function in treating bladder underactivity.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Corresponding author: Mohammad Sajjad Rahnama'i, Department of Urology, Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ Maastricht, The Netherlands. Tel: +31-433875255, Fax: +31-433875259, E-mail:
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84
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Ferguson JE, Carson CC. Phosphodiesterase type 5 inhibitors as a treatment for erectile dysfunction: Current information and new horizons. Arab J Urol 2013; 11:222-9. [PMID: 26558086 PMCID: PMC4443003 DOI: 10.1016/j.aju.2013.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/28/2013] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Over the past 15 years, the discovery and development of oral medications that selectively inhibit the enzyme phosphodiesterase type 5 (PDE5) have revolutionised the treatment of erectile dysfunction (ED). Currently, three PDE5 inhibitors are widely available clinically, i.e., sildenafil, vardenafil and tadalafil. New PDE5 inhibitors, including avanafil and udenafil, are now in clinical use in a few countries, and other compounds are under development. METHODS We describe the current use and future direction of PDE5 inhibitors in the treatment of ED. RESULTS AND CONCLUSION Each PDE5 inhibitor has an excellent and comparable efficacy and tolerability. These drugs are highly effective for ED of various causes, and are effective in preventing ED after radical prostatectomy. However, whilst being at least 60% effective, PDE5 inhibitors are still ineffective in at least 30% of patients, prompting current research into other pharmacological targets for ED.
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Key Words
- Cmax, maximum serum concentration
- ED, erectile dysfunction
- Erectile dysfunction
- FDA, USA Food and Drug Administration
- GTP, guanosine triphosphate
- IIEF, International Index of Erectile Function
- NO, nitric oxide
- PDE5(i), phosphodiesterase type 5 (inhibitors)
- Penile disorders
- Phosphodiesterase type 5 inhibitors
- RCT, randomised controlled trial
- SHIM, Sexual Health Inventory in Men
- Tmax, time to Cmax
- cGMP, cyclic guanosine monophosphate
- sGC, soluble guanylyl cyclase
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Affiliation(s)
- James E. Ferguson
- Division of Urology, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
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85
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Brock G, Broderick G, Roehrborn CG, Xu L, Wong D, Viktrup L. Tadalafil once daily in the treatment of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) in men without erectile dysfunction. BJU Int 2013; 112:990-7. [PMID: 23937669 DOI: 10.1111/bju.12251] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess the safety and efficacy of tadalafil once daily on lower urinary tract symptoms suggestive of clinical benign prostatic hyperplasia (BPH-LUTS) in men without erectile dysfunction (ED). To compare these with effects in men with ED. PATIENTS AND METHODS After a 4-week washout period and 4-week placebo run-in period, 1089 men without ED (n = 338) and with ED (n = 751) were randomly assigned to placebo or tadalafil 5 mg once daily for 12 weeks in three global clinical studies with similar designs. In the pooled dataset, post hoc analyses of covariance assessed the impact and severity of BPH-LUTS using the International Prostate Symptom Score (IPSS) and the BPH Impact Index (BII) and IPSS quality-of-life (IPSS-QoL) subscores. Safety was assessed using treatment-emergent adverse events. The treatment-by-ED-status interaction was used to assess efficacy differences between the with/without ED subgroups. RESULTS Men without ED were similar in BPH-LUTS severity/previous therapy to men with ED. Tadalafil significantly reduced BPH-LUTS from baseline when compared with placebo in men without ED (IPSS -5.4 vs -3.3, P < 0.01; IPSS voiding subscore -3.5 vs -2.0, P < 0.01; IPSS storage subscore -1.9 vs -1.3, P < 0.05). Tadalafil also significantly improved quality of life from baseline when compared with placebo in men without ED (IPSS-QoL -1.0 vs -0.7, BII -1.4 vs -1.0; both P < 0.05). Between-ED-subgroup interactions were not significant (all P > 0.68). Tadalafil was safe and well tolerated. CONCLUSION Tadalafil 5 mg once daily improved BPH-LUTS in men without ED by a magnitude similar to that observed in men with ED. The adverse event profile in men without ED was consistent with that observed in men with ED.
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Affiliation(s)
- Gerald Brock
- St Joseph's Health Care London, University of Western Ontario, London, Canada
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86
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Gacci M, Sebastianelli A, Salvi M, Vignozzi L, Corona G, McVary KT, Kaplan SA, Oelke M, Maggi M, Carini M. PDE5-Is for the Treatment of Concomitant ED and LUTS/BPH. CURRENT BLADDER DYSFUNCTION REPORTS 2013; 8:150-159. [PMID: 23888186 PMCID: PMC3715684 DOI: 10.1007/s11884-013-0184-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Epidemiologic data in adult men exhibit a strong relationship between erectile dysfunction (ED) and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), indicating that men affected by ED should also be investigated for LUTS/BPH and those presenting with storage or voiding LUTS should be investigated for co-morbid ED. Common pathophysiolgical mechanisms underlying both LUTS/BPH and ED, including alteration of NO/cGMP or RhoA/Rho-kinase signaling and/or vascular or neurogenic dysfunction, are potential targets for proposed phosphodiesterase type 5 inhibitors (PDE5-Is). Several randomized controlled trials and only a few reviews including all commercially available PDE5-Is demonstrated the safety and efficacy of these drugs in the improvement of erectile function and urinary symptoms, in patients affected either by ED, LUTS, or both conditions.
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Affiliation(s)
- M. Gacci
- />Department of Urology, University of Florence, Careggi Hospital, Viale Pieraccini 18, 50139 Florence, Italy
| | - A. Sebastianelli
- />Department of Urology, University of Florence, Careggi Hospital, Viale Pieraccini 18, 50139 Florence, Italy
| | - M. Salvi
- />Department of Urology, University of Florence, Careggi Hospital, Viale Pieraccini 18, 50139 Florence, Italy
| | - L. Vignozzi
- />Sexual Medicine & Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - G. Corona
- />Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | - K. T. McVary
- />Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL USA
| | - S. A. Kaplan
- />Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY USA
| | - M. Oelke
- />Department of Urology, Hannover Medical School, Hannover, Germany
| | - M. Maggi
- />Sexual Medicine & Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - M. Carini
- />Department of Urology, University of Florence, Careggi Hospital, Viale Pieraccini 18, 50139 Florence, Italy
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87
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Rahnama'i MS, Ückert S, Hohnen R, van Koeveringe GA. The role of phosphodiesterases in bladder pathophysiology. Nat Rev Urol 2013; 10:414-24. [DOI: 10.1038/nrurol.2013.101] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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88
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Kang JY, Kim EK, Kim KM. Effects of mirodenafil, a phosphodiesterase-5 inhibitor, on female rat bladder in a partial bladder outlet obstruction model: physiological and immunohistochemical aspects. Korean J Urol 2013; 54:339-44. [PMID: 23700501 PMCID: PMC3659229 DOI: 10.4111/kju.2013.54.5.339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 03/11/2013] [Indexed: 01/24/2023] Open
Abstract
Purpose We investigated the effects of mirodenafil, a phosphodiesterase-5 inhibitor developed in South Korea, on the female rat bladder in a partial bladder outlet obstruction (BOO) model. Materials and Methods Thirty-six female Sprague-Dawley rats were divided into four groups: the control group, BOO without medication group, BOO with mirodenafil 1 mg/kg group, and BOO with mirodenafil 4 mg/kg group. Mirodenafil was administered orally for 2 weeks after the induction of BOO. Two weeks after BOO, the rats in each group underwent cystometry under urethane anesthesia. After cystometry, the bladder was excised to perform immunohistochemical staining for connexin 43. Results The three BOO groups showed significant increases in mean bladder weight compared with the control group. Baseline pressure, threshold pressure, and maximum contraction pressure were not significantly different between the four groups. Although the contraction interval was decreased in all BOO groups compared with the control group, it was prolonged in the two groups treated with mirodenafil compared with the untreated BOO group. In the immunohistochemical examination, connexin 43 staining intensity in the lamina propria increased in the three BOO groups compared with the control group. The two groups treated with mirodenafil, however, showed decreased connexin 43 staining compared with the untreated BOO group. Conclusions Mirodenafil may increase the contraction intervals of female rat bladders in a partial BOO model. Decreasing bladder overactivity by mirodenafil may be related to intracellular communication mechanisms involving connexin 43.
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Affiliation(s)
- Jung Yoon Kang
- Department of Urology, Eulji General Hospital, Seoul, Korea
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89
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Bell JR, Laborde E. Update on the sexual impact of treatment for benign prostatic hyperplasia. Curr Urol Rep 2013; 13:433-40. [PMID: 23065462 DOI: 10.1007/s11934-012-0278-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is an established link between lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). The medical and surgical management of LUTS can affect erectile function (EF), cause ejaculatory dysfunction (EjD) or affect libido. This article will review the effects of these therapies on sexual function.
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Affiliation(s)
- John Roger Bell
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
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90
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Gacci M, Salvi M, Sebastianelli A, Vignozzi L, Corona G, McVary KT, Kaplan SA, Maggi M, Carini M, Oelke M. The use of a single daily dose of tadalafil to treat signs and symptoms of benign prostatic hyperplasia and erectile dysfunction. Res Rep Urol 2013; 5:99-111. [PMID: 24400241 PMCID: PMC3826864 DOI: 10.2147/rru.s31580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A strong and independent association between lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) and erectile dysfunction (ED) has been widely evidenced in several clinical epidemiologic studies. Preclinical animal models have provided a great deal of information on potential common pathogenic mechanisms underlying these two clinical identities. Although the efficacy of the most commonly used treatments for LUTS/BPH is well defined, the negative impact of these treatments on sexual function – in particular, on ED – has triggered the search for new treatment options. In this regard, a new role for phosphodiesterase type 5 inhibitors in the treatment of LUTS/BPH and ED has been claimed. Tadalafil is one of the most extensively investigated phosphodiesterase type 5 inhibitors for this new indication. All evidence reported to date suggests that tadalafil 5 mg once daily is a safe and effective treatment option for both LUTS/BPH and ED.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Florence, Italy
| | - Matteo Salvi
- Department of Urology, University of Florence, Florence, Italy
| | | | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Kevin T McVary
- Division of Urology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Steven A Kaplan
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, University of Florence, Florence, Italy
| | - Matthias Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
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91
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Randomized Controlled Trial to Assess the Efficacy of the Combination Therapy of Alfuzosin and Tadalafil in Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Low Urin Tract Symptoms 2013; 6:35-40. [DOI: 10.1111/luts.12016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/25/2012] [Accepted: 02/05/2013] [Indexed: 12/01/2022]
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92
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Giuliano F, Rouprêt M, Doridot G, de la Taille A. Effets des inhibiteurs de la phosphodiestérase de type 5 sur les symptômes du bas appareil urinaire associés à une hypertrophie bénigne de la prostate. Prog Urol 2013; 23:283-95. [DOI: 10.1016/j.purol.2012.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/24/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
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93
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Reges R, D'ancona C, Monica F, Antunes E. Effect of acute administration of sildenafil to rats with detrusor overactivity induced by chronic deficiency of nitric oxide. Int Braz J Urol 2013; 39:268-75. [DOI: 10.1590/s1677-5538.ibju.2013.02.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/20/2013] [Indexed: 11/21/2022] Open
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94
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Marberger M. Medical management of lower urinary tract symptoms in men with benign prostatic enlargement. Adv Ther 2013; 30:309-19. [PMID: 23584673 DOI: 10.1007/s12325-013-0022-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Indexed: 11/24/2022]
Abstract
With the high prevalence of bothersome lower urinary tract symptoms (LUTS) in older men, clinical management has to be fairly simple and straightforward. In the absence of severe problems requiring immediate action, and after excluding possible other etiological factors by a simple diagnostic algorithm, the key parameter for therapeutic decisions is the severity of LUTS, in particular the degree of annoyance and irritation, and prostatic enlargement. Patients with bothersome LUTS request rapid improvement but also worry about possible deterioration, complications, and the need for surgery. With a prostate volume above 30-40 mL and/or prostate-specific antigen (PSA) serum >1.5 ng/mL, the combination of an alpha-1 blocker with a 5-alpha-reductase inhibitor (5-ARI) should be first-line treatment. With prostates <30 mL at baseline the issue whether the prostate really is the culprit becomes central. Given the rapid onset of action of alpha-1 blockers, a 4-6-week trial appears to be a logical approach. If the International Prostate Symptom Score does not improve and storage symptoms prevail, an overactive bladder appears more likely as causative factor and antimuscarinics are the next step. Based on available data this is recommended as add-on medication to the alpha-1 blocker. With no improvement, or increasing postvoid residual the diagnostic algorithm needs to be revisited and more extensive urodynamic evaluation may be needed.
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Affiliation(s)
- Michael Marberger
- Department of Urology, Medical University Vienna, Waehringer Guertel, Vienna, Austria.
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95
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Cantrell MA, Baye J, Vouri SM. Tadalafil: a phosphodiesterase-5 inhibitor for benign prostatic hyperplasia. Pharmacotherapy 2013; 33:639-49. [PMID: 23529917 DOI: 10.1002/phar.1243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Tadalafil is a phosphodiesterase (PDE)-5 inhibitor recently approved by the United States Food and Drug Administration for lower urinary tracts symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). The mechanism for improved LUTS is thought to be related to three principal theories: alterations in nitric oxide levels, Rho-associated protein kinase deactivation, and reductions in pelvic atherosclerosis. The efficacy of PDE-5 inhibitors for the treatment of LUTS associated with BPH has been demonstrated in several randomized placebo-controlled trials. Tadalafil is thought to be superior based on an extended half-life; however, other PDE-5 inhibitors have positive results in BPH and have not been proved to be inferior to tadalafil. Before administration, concomitant use of medications such as nonselective α-adrenergic antagonists, nitrates, and cytochrome P450 inhibitors should be assessed for possible drug interactions. Potential adverse drug events seen in Food and Drug Administration-approved tadalafil include back pain, dyspepsia, headache, and dizziness. Given the efficacy and safety data currently available, the PDE-5 inhibitor tadalafil represents a reasonable alternative for selected male patients with LUTS associated with BPH, especially with concomitant erectile dysfunction.
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Affiliation(s)
- Matthew A Cantrell
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa, USA
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96
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Chung JH, Kang DH, Oh CY, Chung JM, Lee KS, Kim TH, Moon KH, Lee W, Cho JM, Lee SW. Safety and Efficacy of Once Daily Administration of 50 mg Mirodenafil in Patients with Erectile Dysfunction: a Multicenter, Double-Blind, Placebo Controlled Trial. J Urol 2013; 189:1006-13. [DOI: 10.1016/j.juro.2012.08.243] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Hyuk Kang
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Cheol Young Oh
- Department of Urology, College of Medicine, Hallym University, Chuncheon, Busan, Korea
| | - Jae Min Chung
- Department of Urology, Kosin University College of Medicine, Busan, Korea
| | - Ki Soo Lee
- Dong-A University College of Medicine, Busan, Korea
| | - Tae Hyo Kim
- Dong-A University College of Medicine, Busan, Korea
| | - Kyung Hyun Moon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Wan Lee
- Department of Urology, Cancer Center, Dongnam Institute of Radiological & Medical Science, Busan, Korea
| | - Jeong Man Cho
- Department of Urology, Eulji University School of Medicine, Gyeonggi-do, Korea
| | - Seung Wook Lee
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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97
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Kupelian V, McVary KT, Kaplan SA, Hall SA, Link CL, Aiyer LP, Mollon P, Tamimi N, Rosen RC, McKinlay JB. Association of lower urinary tract symptoms and the metabolic syndrome: results from the Boston area community health survey. J Urol 2013; 189:S107-14; discussion S115-6. [PMID: 23234611 DOI: 10.1016/j.juro.2012.11.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE In this study we investigated the relationship between lower urinary tract symptoms as defined by the American Urological Association symptom index and the metabolic syndrome, and determined the relationship between individual symptoms comprising the American Urological Association symptom index and the metabolic syndrome. MATERIALS AND METHODS The Boston Area Community Health Survey used a 2-stage cluster design to recruit a random sample of 2,301 men 30 to 79 years old. Analyses were conducted on 1,899 men who provided blood samples. Urological symptoms comprising the American Urological Association symptom index were included in the analysis. The metabolic syndrome was defined using a modification of the Adult Treatment Panel III guidelines. The association between lower urinary tract symptoms and the metabolic syndrome was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models. RESULTS Increased odds of the metabolic syndrome were observed in men with mild to severe symptoms (American Urological Association symptom index 2 to 35) compared to those with an American Urological Association symptom index score of 0 or 1 (multivariate OR 1.68, 95% CI 1.21-2.35). A statistically significant association was observed between the metabolic syndrome and a voiding symptom score of 5 or greater (multivariate adjusted OR 1.73, 95% CI 1.06-2.80) but not for a storage symptom score of 4 or greater (multivariate adjusted OR 0.94, 95% CI 0.66-1.33). Increased odds of the metabolic syndrome were observed even with mild symptoms, primarily for incomplete emptying, intermittency and nocturia. These associations were observed primarily in younger men (younger than 60 years) and were null in older men (60 years old or older). CONCLUSIONS The observed association between urological symptoms and the metabolic syndrome provides further evidence of common underlying factors between lower urinary tract symptoms and chronic conditions outside the urinary tract.
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Affiliation(s)
- Varant Kupelian
- New England Research Institutes, 9 Galen St., Watertown, MA 02472, USA.
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98
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Miller MS. Role of phosphodiesterase type 5 inhibitors for lower urinary tract symptoms. Ann Pharmacother 2013; 47:278-83. [PMID: 23386068 DOI: 10.1345/aph.1r528] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the efficacy of phosphodiesterase inhibitors for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). DATA SOURCES MEDLINE and PubMed were searched from January 1, 2000, to October 31, 2012, using the MeSH terms phosphodiesterase inhibitor, lower urinary tract symptoms, benign prostatic hyperplasia, sildenafil, vardenafil, and tadalafil. Additional articles were obtained from references identified in the original search. STUDY SELECTION AND DATA EXTRACTION English-language randomized controlled trials and review articles were evaluated. DATA SYNTHESIS Men with BPH commonly experience lower urinary tract symptoms (LUTS) such as urgency, frequency, nocturia, and dribbling. α-Adrenergic antagonists have been the mainstay of medical treatment of LUTS but are associated with adverse effects such as orthostatic hypotension, dizziness, and sexual dysfunction. The 5-α reductase inhibitors are associated with sexual dysfunction, and treatment effects may be delayed for 6-12 months. Phosphodiesterase type 5 (PDE-5) inhibitors are effective for the treatment of erectile dysfunction (ED), and large-scale epidemiologic studies suggest a strong link between LUTS and ED. The available PDE-5 inhibitors (sildenafil, tadalafil, and vardenafil) have shown efficacy in the treatment of LUTS in several randomized controlled trials in men with and without concomitant ED. CONCLUSIONS PDE-5 inhibitors consistently reduce LUTS associated with BPH. These medications may offer advantages over conventional therapies such as rapid onset of action, fewer adverse effects, and enhanced sexual function. Quality of life improvements have also been realized in men with BPH who receive PDE-5 inhibitors.
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Affiliation(s)
- Mindi S Miller
- College of Pharmacy, University of Georgia, Atlanta, GA, USA.
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99
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Lin CS, Albersen M, Xin Z, Namiki M, Muller D, Lue TF. Phosphodiesterase-5 expression and function in the lower urinary tract: a critical review. Urology 2013; 81:480-7. [PMID: 23333001 DOI: 10.1016/j.urology.2012.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/15/2012] [Accepted: 11/19/2012] [Indexed: 01/20/2023]
Abstract
Both clinical and preclinical studies have mostly shown beneficial effects for Phosphodiesterase-5 (PDE-5) inhibitors in the treatment of lower urinary tract symptoms. Molecular studies have consistently shown abundant PDE-5 expression in bladder smooth muscle. Data concerning urethral PDE-5 expression have been surprising because striated muscle was not only positively identified, but also found to express more PDE-5 than the smooth muscle. In the prostate, highly variable results have been obtained. For PDE-5 expression, the data have ranged from extremely low to highly abundant. PDE-5 has been found in the glandular epithelium, vascular smooth muscle, endothelium, and fibromuscular stroma.
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Affiliation(s)
- Ching-Shwun Lin
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA.
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100
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Hood B, Andersson KE. Common theme for drugs effective in overactive bladder treatment: inhibition of afferent signaling from the bladder. Int J Urol 2013; 20:21-7. [PMID: 23072271 PMCID: PMC3558796 DOI: 10.1111/j.1442-2042.2012.03196.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 09/19/2012] [Indexed: 12/21/2022]
Abstract
The overactive bladder syndrome and detrusor overactivity are conditions that can have major effects on quality of life and social functioning. Antimuscarinic drugs are still first-line treatment. These drugs often have good initial response rates, but adverse effects and decreasing efficacy cause long-term compliance problems, and alternatives are needed. The recognition of the functional contribution of the urothelium/suburothelium, the autonomous detrusor muscle activity during bladder filling and the diversity of nerve transmitters involved has sparked interest in both peripheral and central modulation of overactive bladder syndrome/detrusor overactivity pathophysiology. Three drugs recently approved for treatment of overactive bladder syndrome/detrusor overactivity (mirabegron, tadalafil and onabotulinum toxin A), representing different pharmacological mechanisms; that is, β-adrenoceptor agonism, phosphodiesterase type 5 inhibition, and inhibition of nerve release of efferent and afferent transmitters, all seem to have one effect in common: inhibition of the afferent nervous activity generated by the bladder during filling. In the present review, the different mechanisms forming the pharmacological basis for the use of these drugs are discussed.
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Affiliation(s)
- Brandy Hood
- Institute for Regenerative Medicine, Wake Forest University School of MedicineWinston-Salem, North Carolina, USA
- Department of Urology, Wake Forest Baptist Medical CenterWinston-Salem, North Carolina, USA
| | - Karl-Erik Andersson
- Institute for Regenerative Medicine, Wake Forest University School of MedicineWinston-Salem, North Carolina, USA
- Department of Urology, Wake Forest Baptist Medical CenterWinston-Salem, North Carolina, USA
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