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Halawani A, Paterson R, Zhong T, Du K, Ren R, Forbes CM. Risks and side effects in the medical management of benign prostatic hyperplasia. Prostate Int 2024; 12:57-64. [PMID: 39036761 PMCID: PMC11255900 DOI: 10.1016/j.prnil.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 07/23/2024] Open
Abstract
Benign prostatic hyperplasia affects up to 80% of men in their lifetime. It causes bladder outflow obstruction, leading to lower urinary tract symptoms, which can have a large impact on quality of life. Lifestyle modifications and pharmacotherapy are often offered as first-line treatments for patients. These include alpha blockers, 5-alpha-reductase inhibitors, phosphodiesterase-5 inhibitors, anticholinergics, B3-agonists, and desmopressin. While often well tolerated, these pharmacotherapies do have significant side effects, which both clinicians and patients should understand and discuss in order to make an informed treatment decision among alternatives. The purpose of this review is to provide a current overview of the risks and side effects of commonly used medications in benign prostatic hyperplasia management.
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Affiliation(s)
- Abdulghafour Halawani
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ryan Paterson
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Tianshuang Zhong
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Katie Du
- University of Alberta, Edmonton, Alberta, Canada
| | - Runhan Ren
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Connor M. Forbes
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
- Vancouver Prostate Centre, Vancouver, British Columbia, Canada
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Quiros-Roldan E, Carriero C, Paghera S, Degli Antoni M, Fiorini C, Quaresima V, Castelli F, Imberti L. Symptoms and quality of life in HIV-infected patients with benign prostatic hyperplasia are improved by the consumption of a newly developed whole tomato-based food supplement. A phase II prospective, randomized double-blinded, placebo-controlled study. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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3
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Lee B, Lee SW, Kang HR, Kim DI, Sun HY, Kim JH. Relationship between lower urinary tract symptoms and cardiovascular risk scores including Framingham risk score and ACC/AHA risk score. Neurourol Urodyn 2017; 37:426-433. [PMID: 28608963 DOI: 10.1002/nau.23320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/08/2017] [Indexed: 11/10/2022]
Abstract
AIMS This study attempted to investigate the association between lower urinary tract symptoms (LUTS) and cardiovascular disease (CVD) risk using International Prostate Symptom Score (IPSS) and CVD risk scores and to overcome the limitations of previous relevant studies. METHODS A total of 2994 ostensibly healthy males, who participated in a voluntary health check in a health promotion center from January 2010 to December 2014, were reviewed. CVD risk scores were calculated using Framingham risk score and American College of Cardiology (ACC)/American Heart Association (AHA) score. Correlation and multivariate logistic regression analysis to predict the CVD risk severity were performed. RESULTS Correlation between total IPSS with CVD risk scores demonstrated significant positive associations, which showed higher correlation with ACC/AHA score than the Framingham score (r = 0.18 vs 0.09, respectively). For ACC/AHA score, the partial correlation after adjustment of body mass index (BMI) showed significant positive correlations between all LUTS parameters and PSA. For the Framingham score, all variables, except IPSS Q2 and IPSS Q6, showed significant positive correlations. After adjustment of BMI, prostate volume and PSA, only the severe LUTS group showed significant relationship with intermediate-high CVD risk severity, as compared with normal LUTS group (OR = 2.97, 95%CI (1.35-6.99)). CONCLUSION Using two validated CVD risk calculators, we observed that LUTS is closely associated with future CVD risk. To predict the intermediate-high CVD risk severity, severe LUTS was a sentinel sign, the presence of which warrants the importance of an earlier screening for CVD.
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Affiliation(s)
- Bora Lee
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sang Wook Lee
- Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchuhyang University Medical College, Bucheon, Korea
| | - Hye Rim Kang
- Medical biotechnology, Soonchunhyang University, Asan, Korea
| | - Dae In Kim
- Pharmaceutical engineering, Soonchunhyang University, Asan, Korea
| | - Hwa Yeon Sun
- Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
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Hyndman ME, Bivalacqua TJ, Mettee LZ, Su LM, Trock BJ, Pavlovich CP. Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens. Can Urol Assoc J 2016; 9:414-9. [PMID: 26788231 DOI: 10.5489/cuaj.3169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This is a report on urinary function results from a randomized trial of nightly versus on-demand sildenafil after nerve-sparing radical prostatectomy (RP), a secondary objective. We analyzed the effects of these sildenafil administration schemes on urinary health-related quality of life after RP. METHODS In total, 100 potent men were equally randomized to nightly and on-demand sildenafil 50 mg after minimally-invasive RP for 1 year. Health-related quality of life questionnaires were administered at various postoperative intervals. Urinary function was assessed using appropriate expanded prostate cancer index composite (EPIC) subscales. Analyses of covariance and linear mixed-effects modeling were used to compare the effects of treatment over time on urinary recovery, controlling for age, nerve-sparing score, and time from surgery. RESULTS The nightly (n = 50) and on-demand (n = 50) sildenafil groups were well-matched at baseline. Nightly sildenafil patients had worse EPIC urinary bother and urinary irritative/obstructive subscale scores at 3 and 6 months after RP, even after controlling for multiple variables. On mixed-model analyses, the differences between groups for these EPIC subscales (4.9 and 2.5, respectively) were greater than documented thresholds for clinical significance. Increasing nerve-sparing score was associated with improvements in EPIC urinary summary, bother, incontinence, and function scores; time from surgery was associated with improvements in all EPIC urinary health-related quality of life subscales. CONCLUSIONS In this specific population and drug dose, we found that on-demand short-acting phosphodiesterase-5 inhibitor (PDE5i) dosing may be more effective after RP to maximize early urinary health-related quality of life. In preoperatively potent men, nightly sildenafil 50 mg impaired urinary health-related quality of life more than on-demand use in the early months after nerve-sparing RP, independent of effects on urinary continence.
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Affiliation(s)
- Matthew Eric Hyndman
- Department of Surgery, Division of Urology, Southern Alberta Institute of Urology, University of Calgary, Calgary, AB
| | - Trinity J Bivalacqua
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | - Lynda Z Mettee
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | - Li-Ming Su
- University of Florida College of Medicine, Gainesville, FL
| | - Bruce J Trock
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD
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Zhao C, Kwan Park J. Phosphodiesterase Type 5 Inhibitor and Erectile Dysfunction in Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2015; 4 Suppl 1:75-80. [PMID: 26676704 DOI: 10.1111/j.1757-5672.2011.00121.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common diseases in older men and mostly induces lower urinary tract symptoms (LUTS). Multiple studies have shown that BPH inducing LUTS are intensely correlated with erectile dysfunction (ED) and that severity of LUTS was proportional to ED severity. Although a direct causal relationship has not been clarified, a tentative pathophysiology has been suggested to interpret the relationship between two disorders. Androgen plays an important role in the maintenance of the functional and structural integrity of the lower urinary tract and penis. Low testosterone, especially free testosterone, worsened detrusor overactivity and replacement of testosterone improved LUTS in the hypogonadal BPH patients. Nitric oxide synthase and nitric oxide are decreased in the transition zone of the hyperplastic prostate but phosphodiesterase types 4, 5, 11 are prominent in transition zone of hyperplastic prostate. Phosphodiesterase type 5 (PDE5) inhibitor with a long half-life could obtain the desired effect; therefore, tadalafil and undenafil frequently have been used to evaluate the effects in the two disorders. In clinical trials, tadalafil showed improvement of BPH-induced LUTS, but few of the studies showed a significant improvement on uroflowmetry. PDE5 inhibitors increase the concentration of cyclic guanosine monophosphate (cGMP) in plasma and smooth muscle, promoting erection of the penis, as well as relaxation of the bladder neck and prostate, leading to natural voiding. Sexual function and LUTS should be assessed and discussed with the patient when choosing the appropriate strategy and the patient's response to treatment should also be evaluated at the same time.
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Affiliation(s)
- Chen Zhao
- Department of Urology, Medical School, and Institute for Medical Sciences, and Research Institute of Chonbuk National University, Chonbuk National University Hospital, Jeonbuk, Korea
| | - Jong Kwan Park
- Department of Urology, Medical School, and Institute for Medical Sciences, and Research Institute of Chonbuk National University, Chonbuk National University Hospital, Jeonbuk, Korea
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6
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Heme oxygenase levels and metaflammation in benign prostatic hyperplasia patients. World J Urol 2015; 34:1183-92. [DOI: 10.1007/s00345-015-1736-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022] Open
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Predicting erectile dysfunction in sexually active patients seeking prostate health screening: proposal for a multivariable risk stratification. Int J Impot Res 2015. [PMID: 26224573 DOI: 10.1038/ijir.2015.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
To address the severity of erectile dysfunction (ED) in consecutive sexually active men seeking a prostate health screening through a multivariable risk stratification including comorbidities and lower urinary tract symptoms (LUTS). Four hundred and twenty five consecutive subjects with stable sexual relationship with normal testosterone levels were enrolled. The International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS) questionnaires were collected and health-significant comorbidities were scored with the Charlson comorbidity index (CCI). All the independent predictors of ED were combined to form four different risk categories of ED: low (age⩽65 years and IPSS<8 and CCI=0), intermediate (one of the following: age>65 years, IPSS⩾8 or CCI⩾1), high (two of the following: age>65 years, IPSS⩾8 or CCI⩾1) and very high (age >65 years, IPSS⩾8 and CCI⩾1). The prevalence of ED increased with increase of CCI (χ(2) likelihood ratio: 40.85, P=0.001). The median of the IIEF-5 significantly reduced with the increase of the CCI (P<0.001) and with the worsening of our risk group stratification (P<0.001). At univariate logistic regression analysis very high risk was significantly associated with of ED (odds ratio: 26.85, P<0.001). Very high-risk group predicted ED with 88% and 56% of specificity and sensitivity, respectively. Combining these risk factors through our risk stratification may be usefulness in revealing an underling ED.
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Russo GI, Castelli T, Privitera S, Fragalà E, Favilla V, Reale G, Urzì D, La Vignera S, Condorelli RA, Calogero AE, Cimino S, Morgia G. Increase of Framingham cardiovascular disease risk score is associated with severity of lower urinary tract symptoms. BJU Int 2015; 116:791-6. [DOI: 10.1111/bju.13053] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Giorgio I. Russo
- Department of Urology; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Tommaso Castelli
- Department of Urology; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Salvatore Privitera
- Department of Urology; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Eugenia Fragalà
- Department of Urology; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Vincenzo Favilla
- Department of Urology; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Giulio Reale
- Department of Urology; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Daniele Urzì
- Department of Urology; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Sandro La Vignera
- Department of Medical and Paediatric Sciences; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Rosita A. Condorelli
- Department of Medical and Paediatric Sciences; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Aldo E. Calogero
- Department of Medical and Paediatric Sciences; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Sebastiano Cimino
- Department of Urology; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
| | - Giuseppe Morgia
- Department of Urology; Section of Endocrinology, Andrology and Internal Medicine; University of Catania; Catania Italy
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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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10
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Discovery of 3-(4-hydroxybenzyl)-1-(thiophen-2-yl)chromeno[2,3-c]pyrrol-9(2H)-one as a phosphodiesterase-5 inhibitor and its complex crystal structure. Biochem Pharmacol 2014; 89:86-98. [DOI: 10.1016/j.bcp.2014.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 12/25/2022]
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Bond C, Cakir OO, McVary KT, Podlasek CA. Nitric Oxide Synthase is Necessary for Normal Urogenital Development. ANDROLOGY : OPEN ACCESS 2013; 2:108. [PMID: 24900949 PMCID: PMC4041737 DOI: 10.4172/2167-0250.1000108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Neuronal nitric oxide synthase (NOS-I) is significantly decreased with Cavernous Nerve (CN) injury in Erectile Dysfunction (ED) models. Increased apoptosis and collagen deposition accompany decreased NOS/CN injury, however these changes are typically attributed to the altered signaling of other factors, and a contribution of NOS in maintenance of urogenital structures has not previously been examined. Morphological changes in the corpora cavernosa occur at the same time as decreased NOS, suggesting a potential connection between decreased/inhibited NOS and morphological changes associated with ED. In this study we propose that NOS impacts urogenital morphology during development and will examine this hypothesis by NOS inhibition with L-NAME. Methods Primary outcomes were H&E, western and TUNEL to determine if penis, prostate and bladder morphology were altered with L-NAME treatment of Postnatal day 4 (P4) Sprague Dawley rats for 8 days. Tissue weight and immunohistochemical analysis for NOS were performed. Secondary evaluation of NOS-I regulation by Sonic Hedgehog (SHH) was examined by SHH inhibition in the pelvic ganglia (PG) and NOS-I protein was quantified by western in the PG/CN and penis. Nos abundance was quantified by RT-PCR during urogenital development and after CN injury. Results Apoptosis increased and penis, prostate and bladder morphology were altered with L-NAME. NOS inhibition decreased bladder weight 25%. SHH inhibition decreased NOS-I 35% in the PG/CN and 47% in the penis. Nos-III expression spiked within the first two weeks after birth in the penis but remained abundant in the adult. In the prostate, Nos-III was abundant immediately after birth and declined steadily with age. Nos-I expression in the PG/CN decreased sharply with CN injury and returned to baseline by 7 days. Conclusions NOS is required for normal urogenital development. Since NOS is decreased with ED, it may contribute to the abnormal morphology observed in ED patients and animal models.
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Affiliation(s)
- Christopher Bond
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Omer Onur Cakir
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Carol A Podlasek
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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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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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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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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15
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Gacci M, Eardley I, Giuliano F, Hatzichristou D, Kaplan SA, Maggi M, McVary KT, Mirone V, Porst H, Roehrborn CG. Critical Analysis of the Relationship Between Sexual Dysfunctions and Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Eur Urol 2011; 60:809-25. [DOI: 10.1016/j.eururo.2011.06.037] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 06/20/2011] [Indexed: 12/24/2022]
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Orabi H, Albersen M, Lue TF. Association of lower urinary tract symptoms and erectile dysfunction: pathophysiological aspects and implications for clinical management. Int J Impot Res 2011; 23:99-108. [PMID: 21593760 DOI: 10.1038/ijir.2011.14] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Aktas BK, Gokkaya CS, Bulut S, Dinek M, Ozden C, Memis A. Impact of metabolic syndrome on erectile dysfunction and lower urinary tract symptoms in benign prostatic hyperplasia patients. Aging Male 2011; 14:48-52. [PMID: 21087172 DOI: 10.3109/13685538.2010.529197] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the relationship among metabolic syndrome (MetS), erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). METHODS Our study included 106 patients with BPH, 33 (31.1%) of whom had MetS. Blood pressures, waist circumferences, serum levels of fasting blood glucose, high density lipoprotein and triglyceride of patients were recorded. Erectile functions of the patients were evaluated by International Index of Erectile Function (IIEF). Patients were divided into two groups according to IIEF scores, namely 'mild/no ED' and 'moderate/severe ED'. IIEF scores of ED groups were between 17 and 30 and 6-16 in turn. LUTS severities were assessed by International Prostate Symptom Score (IPSS) and classified as mild (IPSS 0-7), moderate (IPSS 8-19) and severe (IPSS 20-35). RESULTS There was a significant difference between ED groups concerning MetS presence (p=0.032). MetS presence was not found to be associated with the severity of LUTS (p=0.144). There was no correlation between ED groups regarding LUTS severity (p=0.303). CONCLUSION Results of the present study showed a correlation between MetS presence and ED. In the light of our results, MetS seems to play an important role in the etiopathogenesis of ED in patients with BPH.
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Affiliation(s)
- Binhan Kagan Aktas
- Ankara Numune Education and Research Hospital, 1st Urology Clinic, Ulku Mah., Ankara, 06100, Turkey.
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Current world literature. Curr Opin Urol 2010; 21:84-91. [PMID: 21127406 DOI: 10.1097/mou.0b013e328341a1a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gomelsky A, Dmochowski RR. Urodynamic Effects of Once-Daily Tadalafil in Men with LUTS Secondary to Clinical BPH. Curr Urol Rep 2010; 11:254-60. [DOI: 10.1007/s11934-010-0122-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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