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Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D, Magri V, Mourmouris P, Ouattara A, Perletti G, Philipraj J, Trinchieri A, Buchholz N. Effect of alpha-adrenoceptor antagonists on sexual function. A systematic review and meta-analysis. Arch Ital Urol Androl 2022; 94:252-263. [PMID: 35775356 DOI: 10.4081/aiua.2022.2.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Alpha-adrenoreceptor antagonists or alpha-blockers are used in the treatment of hypertension, in the therapy of benign prostatic hyperplasia and in medical expulsive treatment of ureteral stones. These agents may affect the sexual function, with differences between drugs within the same class, depending on their selectivity for receptor subtypes. The aim of this review was to analyze the effects of alpha-blockers on sexual function. MATERIALS AND METHODS We conducted a systematic review and meta-analysis by searching PubMed, EMBASE and other databases for randomized controlled trials (RCTs) reporting sexual adverse effects in patients treated with alpha-blockers. Odds ratios for sexual dysfunction were calculated using random effects Mantel-Haenszel statistics. RESULTS Out of 608 records retrieved, 75 eligible RCTs were included in the meta-analysis. Compared with placebo, alphablockers were associated with increased odds of ejaculatory disorders both in patients with lower urinary tract symptoms (LUTS) associated to benign prostatic hyperplasia (BPH) (OR: 7.53, 95% CI: 3.77-15.02, Z = 5.73, p < 0.00001, I2 = 55%) and in patients with ureteral stones (OR: 2.88, 95% CI: 1.50-5.44, Z = 3.19, p < 0.001, I2 = 31%). Uroselective alpha-blockers showed higher odds of ejaculatory disorders. Conversely, nonselective alpha-blockers were not associated with higher odds of ejaculatory dysfunction. Silodosin was associated with increased odds of ejaculatory dysfunction compared with tamsulosin (OR: 3.52, 95% CI: 2.18-5.68, 15 series, 1512 participants, Z = 5.15, p < 0.00001, I2 = 0%). Naftopidil and alfuzosin showed lower odds of ejaculatory dysfunction compared to uroselective alpha-blockers.No statistically significant differences in the odds of erectile dysfunction were observed when alpha-blockers were compared to placebo.
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Affiliation(s)
- Rawa Bapir
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Smart Health Tower, Sulaymaniyah, Kurdistan region.
| | - Kamran Hassan Bhatti
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Urology Department, HMC, Hamad Medical Corporation.
| | - Ahmed Eliwa
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Zagazig University, Zagazig, Sharkia.
| | | | - Nazim Gherabi
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Faculty of Medicine Algiers 1, Algiers.
| | - Derek Hennessey
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Mercy University Hospital, Cork.
| | - Vittorio Magri
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and ASST Nord Milano, Milan.
| | - Panagiotis Mourmouris
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens.
| | - Adama Ouattara
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Division of Urology, Souro Sanou University Teaching Hospital, Bobo-Dioulasso.
| | - Gianpaolo Perletti
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese.
| | - Joseph Philipraj
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry.
| | - Alberto Trinchieri
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Urology School, University of Milan.
| | - Noor Buchholz
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Sobeh's Vascular and Medical Center, Dubai Health Care City, Dubai.
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Fan Z, Shi H, Zhang J, Wang H, Wang J. Comparative Efficacy of Different Drugs for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia: A Bayesian Network Meta-Analysis. Front Pharmacol 2022; 13:763184. [PMID: 35330833 PMCID: PMC8940212 DOI: 10.3389/fphar.2022.763184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) are common in middle-aged and elderly men. The current drugs for treating this disease include α1-adrenoceptor antagonists (ABs), muscarinic receptor antagonists (MRAs), phosphodiesterase five inhibitors (PDE5-Is), and β3-adrenoceptor agonists (B3As). However, direct comparative studies analyzing different therapies are limited; therefore, we conducted a network meta-analysis (NMA) to evaluate the efficacy of different drug regimens for treating BPH/LUTS. Methods: The PubMed, EMbase, Web of Science, and Cochrane Library databases were searched to collect randomized controlled trials (RCTs) of different drug treatments for BPH/LUTS from January 2000 to April 2021. The NMA was performed using R 4.1 software. Results: Fifty-five RCTs were included among a total of 1639 trials. ① ABs + PDE5-Is, ABs + B3As, ABs + MRAs, ABs, and PDE5-IS were superior to the placebo in improving the total International Prostate Symptom Score (IPSS), IPSS-Voiding, and IPSS-storage. ② For increasing the maximum flow rate (Qmax), ABs + PDE5-Is, ABs + MRAs, and ABs were more effective than the placebo. ③ Regarding reducing post-void residual urine (PVR), none of the six treatment plans had significant effects. Conclusion: Combination therapy showed greater efficacy than monotherapy, and ABs + PDE5-Is was the most successful treatment for improving the overall IPSS score. ABs are a primary therapeutic measure to increase Qmax, and ABs + PDE5-I may be a more suitable choice for enhancing Qmax. The combination of MRA and AB+ MRA may lead to an increase in PVR. Systematic Review Registration: [website], identifier [registration number].
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Affiliation(s)
- Zhinan Fan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongjin Shi
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jinsong Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haifeng Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiansong Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Sun F, Crisóstomo V, Báez-Díaz C, Sánchez FM. Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 2, Insights into the Technical Rationale. Cardiovasc Intervent Radiol 2016; 39:161-9. [PMID: 26563245 DOI: 10.1007/s00270-015-1238-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/19/2015] [Indexed: 12/11/2022]
Abstract
Rationale of prostatic artery embolization (PAE) in the treatment of symptomatic benign prostatic hyperplasia is conventionally believed to include two parts: shrinkage of the enlarged prostate gland as a result of PAE-induced ischemic infarction and potential effects to relax the increased prostatic smooth muscle tone by reducing the number and density of α1-adrenergic receptor in the prostate stroma. This review describes new insights into the likely mechanisms behind PAE, such as ischemia-induced apoptosis, apoptosis enhanced by blockage of androgens circulation to the embolized prostate, secondary denervation following PAE, and potential effect of nitric oxide pathway immediately after embolization. Studies on therapeutic mechanisms in PAE may shed light on potentially new treatment strategies and development of novel techniques.
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Affiliation(s)
- Fei Sun
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Verónica Crisóstomo
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Claudia Báez-Díaz
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Francisco M Sánchez
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
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Abstract
BACKGROUND Despite little available evidence to determine whether recently introduced selective α-1 blockers and 5-α reductase inhibitors (5-ARIs) are superior to the existing agents in treating benign prostatic hyperplasia (BPH), they are being increasingly prescribed. OBJECTIVE To describe the prescribing patterns of new and existing agents among patients with incident BPH after the introduction of several new agents and determine whether these varied by physician specialty. RESEARCH DESIGN We analyzed a retrospective cohort from an administrative claims database from January 2004 through December 2010. SUBJECTS Patients diagnosed with incident BPH aged 40 years and above and those who received medical management. MEASURES Receipt of medical therapy for incident BPH (ie, selective α-1 blockers [prazosin (released 1976), terazosin (1987), doxazosin (1990), tamsulosin (1997), alfuzosin (2003), silodosin (2009)] and 5-ARIs [finasteride (1992) and dutasteride (2002)]). RESULTS A total of 42,769 men with incident BPH received any selective α-1 blocker or 5-ARI. Tamsulosin and dutasteride were the most widely prescribed agents of their respective drug classes. Predicted probabilities showed that urologists were more likely to prescribe alfuzosin (24.0% vs. 7.8%; P<0.001) and silodosin (2.3% vs. 0.4%; P<0.001) when compared with primary care providers (PCPs) at 6 months after diagnosis. Urologists were more likely to prescribe 5-ARIs but less likely to prescribe older α-1 blockers (terazosin, prazosin, and doxazosin) than PCPs at 6 months postdiagnosis. CONCLUSIONS Among insured patients diagnosed with BPH, our study suggests that the overall use of new agents is rising. In particular, urologists were more likely to prescribe newer selective α-1 blockers compared with PCPs.
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Yuan J, Liu Y, Yang Z, Qin X, Yang K, Mao C. The efficacy and safety of alpha-1 blockers for benign prostatic hyperplasia: an overview of 15 systematic reviews. Curr Med Res Opin 2013; 29:279-87. [PMID: 23323875 DOI: 10.1185/03007995.2013.766594] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE A great number of clinical trials and systematic reviews have evaluated the efficacy and safety of α(1) blockers for benign prostatic hyperplasia (BPH). We carried out an overview of reviews to provide an up-to-date summary of evidence regarding the efficacy and safety between different α(1) blockers for BPH. RESEARCH DESIGN AND METHODS PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, Chinese BioMedical Literature Database and VIP were searched for eligible studies. Direct evidence was analyzed narratively. We used a random-effects model within a Bayesian framework to calculate indirect estimates if no direct evidence existed. The GRADE approach was used in summarizing conclusions. RESULTS A total of 15 systematic reviews involving five α(1) blockers met the inclusion criteria. Direct evidence demonstrated that α(1) blockers were superior to placebo in reducing urinary symptom scores and improving peak urinary flow PUF. Doxazosin could significantly reduce urinary symptom scores compared with tamsulosin mean difference (MD -1.60, 95% CI -1.80 to -1.40) and alfuzosin (MD1.7, 95% CI 0.76-1.64). Indirect evidence suggested that the urinary symptom score and PUF at endpoint in men treated with naftopidil were similar to those treated with other α(1) blockers. α(1) Blockers generally lead to more adverse effects compared with placebo, and those caused by terazosin were more frequent than others. CONCLUSIONS α(1) Blockers are more effective than placebo for BPH, doxazosin and tamsulosin seem to be more effective than other α(1) blockers. The adverse effects caused by α(1) blockers are generally mild and well-tolerated.
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Affiliation(s)
- JinQiu Yuan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
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Cantrell MA, Bream-Rouwenhorst HR, Hemerson P, Magera JS. Silodosin for benign prostatic hyperplasia. Ann Pharmacother 2010; 44:302-10. [PMID: 20071497 DOI: 10.1345/aph.1m320] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the pharmacology, pharmacokinetics, clinical trials, and safety of silodosin, a recently approved alpha(1A)-adrenergic receptor (AR) antagonist for benign prostatic hyperplasia (BPH). DATA SOURCES English-only articles obtained from MEDLINE (1966-October 2009) using the search terms silodosin and KMD-3213 were reviewed. In addition, a search of International Pharmaceutical Abstracts (1970-October 2009) was conducted. STUDY SELECTION AND DATA EXTRACTION Available English-language articles were reviewed, as well as abstracts from available non-English articles. DATA SYNTHESIS Silodosin reduces urinary symptoms associated with BPH in as little as 1 day after initiation. The largest clinical trial conducted to date demonstrated a decrease in International Prostate Symptom Score of -6.4 +/- 6.63 points compared to -3.5 +/- 5.84 in patients receiving placebo (p < 0.0001). Silodosin also improved urinary flow rates by approximately 2.8 +/- 3.44 mL/sec, which is comparable to other alpha(1)-AR antagonists. The usual dose of silodosin is 8 mg once daily and should be reduced to 4 mg for patients with moderate renal dysfunction. Use is contraindicated in patients with severe renal and hepatic impairment or taking strong CYP3A4 inhibitors. In clinical trials, the most prevalent adverse effects were ejaculatory disturbances, occurring in approximately 28% of patients, although only 2.8% of patients discontinued treatment due to this adverse effect. Preliminary data suggest that, similar to other third-generation alpha(1A)-AR antagonists, silodosin has little potential to cause significant cardiovascular adverse effects such as orthostatic hypotension or syncope. To confirm these findings, long-term studies are still needed, especially in patients taking antihypertensive agents and in those with a history of intolerance to other alpha(1)-AR antagonists. CONCLUSIONS Silodosin was approved by the Food and Drug Administration in 2008. Long-term studies demonstrating improvement in clinically important outcomes of BPH have yet to be published. In addition, pharmacoeconomic analyses would assist in defining its current place in therapy. Until this information is available, silodosin may be best reserved as an alternative to other second- and third-generation alpha(1)-AR antagonists.
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Affiliation(s)
- Matthew A Cantrell
- College of Pharmacy, University of Iowa; Clinical Pharmacy Specialist, Veterans Affairs Medical Center, Iowa City, IA, USA.
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Roehrborn CG, Rosen RC. Medical therapy options for aging men with benign prostatic hyperplasia: focus on alfuzosin 10 mg once daily. Clin Interv Aging 2008; 3:511-24. [PMID: 18982921 PMCID: PMC2682383 DOI: 10.2147/cia.s3635] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) are common in aging men and can significantly affect quality of life. Men with bothersome LUTS/BPH often present with various other age-related conditions, including sexual dysfunction, heart disease, hypertension, diabetes, and the metabolic syndrome, which can complicate management decisions. Therefore, healthcare providers should be familiar with first-line treatment options for LUTS/BPH and their differing safety profiles, particularly with respect to cardiovascular and sexual function side effects. This article presents a review of first-line medical therapy options for managing aging men with LUTS/BPH and patient considerations when evaluating and selecting these therapies, with a focus on the clinical efficacy and cardiovascular and sexual function safety profiles of the uroselective alpha1-adrenergic receptor antagonist alfuzosin 10 mg once daily. Alfuzosin improves LUTS, peak urinary flow rates, and disease-specific quality of life, reduces the long-term risk of overall BPH progression, and is well tolerated in aging men, with minimal vasodilatory and sexual function side effects, even in those with comorbidities. Alfuzosin is well tolerated when used in combination with antihypertensive medications and phosphodiesterase type 5 inhibitors for the treatment of erectile dysfunction. The long-term clinical efficacy and good cardiovascular and sexual function safety profile of alfuzosin can contribute to an improved quality of life for aging men with LUTS/BPH.
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Affiliation(s)
- Claus G Roehrborn
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
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Gur S, Sikka SC, Chandra S, Koka PS, Agrawal KC, Kadowitz PJ, Hellstrom WJ. Alfuzosin attenuates erectile dysfunction in rats with partial bladder outlet obstruction. BJU Int 2008; 102:1651-7. [DOI: 10.1111/j.1464-410x.2008.07914.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Aerakis N, Vonaparti A, Panderi I. An Improved Narrow-Bore LC Method for Quantification of Alfuzosin in Pharmaceutical Formulations. Chromatographia 2008. [DOI: 10.1365/s10337-008-0601-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rosen R, Seftel A, Roehrborn CG. Effects of alfuzosin 10 mg once daily on sexual function in men treated for symptomatic benign prostatic hyperplasia. Int J Impot Res 2007; 19:480-5. [PMID: 17717526 DOI: 10.1038/sj.ijir.3901554] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We evaluated the effects of extended-release alfuzosin HCl 10 mg once daily (q.d.) on sexual function in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). In a randomized, double-blind, placebo-controlled study of men aged > or = 50 years, after a 28-day placebo run-in period, patients were randomized to receive alfuzosin 10 mg q.d. or matching placebo for 28 days. The mean change from baseline (day 1) in sexual function on day 29 was assessed using the Danish Prostate Symptom Score Sex (DAN-PSSsex) questionnaire. A total of 372 patients were randomized to receive alfuzosin (n=186) or placebo (n=186), with 355 completing the study. At baseline, 64% of the patients reported erectile dysfunction (ED) and 63% reported ejaculatory dysfunction (EjD). For the 320 patients who completed the DAN-PSSsex, alfuzosin treatment was associated with a significant improvement in the mean change from baseline in erectile function on day 29 compared with placebo (P=0.02). No significant difference was observed between the two treatment groups in the mean change from baseline in ejaculatory function on day 29. For patients with ED at baseline, a marginal improvement in erectile function was demonstrated with alfuzosin treatment (P=0.09 vs placebo). For patients with EjD at baseline, the mean change from baseline in ejaculatory function with alfuzosin was comparable to that with placebo. Dizziness was the most common adverse event with alfuzosin treatment (5 vs 0% with placebo), with other adverse events reported with comparable frequency in both treatment groups. After 1 month of treatment, alfuzosin 10 mg q.d. significantly improved erectile function in men with lower urinary tract symptoms/ benign prostatic hypertrophy and had no adverse effect on ejaculatory function.
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Affiliation(s)
- R Rosen
- New England Research Institutes, Watertown, MA 2472, USA.
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