Latest Evidence on the Use of Phosphodiesterase Type 5 Inhibitors for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia

• Published in: European urology 2016-07, Vol.70 (1), p.124-133
• Main Authors: Gacci, Mauro, Andersson, Karl-Erik, Chapple, Christopher, Maggi, Mario, Mirone, Vincenzo, Oelke, Matthias, Porst, Hartmut, Roehrborn, Claus, Stief, Christian, Giuliano, François
• Format: Article
• Language: English
• Subjects: Afferent Pathways - drug effects; Animals; Avanafil; Benign prostatic enlargement; Benign prostatic hyperplasia; Cell Proliferation - drug effects; Cell Transdifferentiation - drug effects; Erectile dysfunction; Erectile Dysfunction - drug therapy; Humans; Lower urinary tract symptoms; Male; Muscle Relaxation - drug effects; Muscle, Smooth - drug effects; Penile Erection - drug effects; Phosphodiesterase 5 Inhibitors - pharmacology; Phosphodiesterase 5 Inhibitors - therapeutic use; Phosphodiesterase type 5 inhibitors; Prostate; Prostatism - drug therapy; Prostatitis - drug therapy; Sildenafil; Tadalafil; Urinary Bladder - innervation; Urinary Tract Physiological Phenomena - drug effects; Urology; Vardenafil
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2015.12.048

Abstract Context Several preclinical reports, randomized controlled trials, systematic reviews, and posthoc analyses corroborate the role of phosphodiesterase type 5 inhibitors (PDE5-Is) in the treatment of men with lower urinary tract symptoms (LUTS) associated with benign prostatic enlargement (BPE). Objective Update of the latest evidence on the mechanisms of action, evaluate the current meta-analyses, and emphasize the results of pooled data analyses of PDE5-Is in LUTS/BPE. Evidence acquisition Literature analysis of basic researches on PDE5-Is, systematic literature search in PubMed and Scopus until May 2015 on reviews of trials on PDE5-Is, and collection of pooled data available on tadalafil 5 mg. Evidence synthesis Latest evidences on the pathophysiology of LUTS/BPE has provided the rationale for use of PDE5-Is: (1) improvement of LUT oxygenation, (2) smooth muscle relaxation, (3) negative regulation of proliferation and transdifferentiation of LUT stroma, (4) reduction of bladder afferent nerve activity, and (5) down-regulation of prostate inflammation are the proven mechanisms of action of PDE5-Is. Data from eight systematic reviews demonstrated that PDE5-Is allow to improve LUTS (International Prostate Symptom Score mean difference vs placebo: 2.35–4.21) and erectile function (International Index of Erectile Function mean difference vs placebo: 2.25–5.66), with negligible change in flow rate (Qmax mean difference vs placebo: 0.01–1.43). Pooled data analyses revealed that tadalafil 5 mg once daily allows the clinically-meaningful improvement of LUTS and nocturnal voiding frequency independent of both erectile dysfunction severity and improvement. Conclusions PDE5-Is are safe and effective in improving both LUTS and erectile function in appropriately selected men with LUTS/BPE. Data on the reduction of disease progression, long-term outcomes, and cost-effectiveness analyses are still lacking. Patient summary We reviewed recent literature on phosphodiesterase type 5 inhibitors in men with lower urinary tract symptoms associated with prostatic enlargement. We found evidence to confirm that phosphodiesterase type 5 inhibitors are a valid treatment option for men affected by bothersome urinary symptoms with or without erectile dysfunction.