Effects of tadalafil versus silodosin on voiding function in male patients with non‐neurogenic detrusor underactivity: A comparative study using propensity score matching

Abstract

To investigate and compare the effects of tadalafil and silodosin on lower urinary tract symptoms and voiding functions in men with non-neurogenic detrusor underactivity. Methods: A total of 126 treatment-naive men with lower urinary tract symptoms diagnosed as non-neurogenic detrusor underactivity received tadalafil (5 mg/day) or silodosin (8 mg/day) for 12 months. After propensity score matching, parameter changes from before administration to 12 months since treatment initiation were assessed based on subjective symptoms and urodynamic findings, including bladder contractility index and maximum urinary flow rate, and were compared between the tadalafil treatment group and the silodosin group. Detrusor underactivity was defined as bladder contractility index <100 and bladder outlet obstruction index <40. Results: After propensity score matching, the final analysis included 48 patients each in the tadalafil and silodosin groups. No significant differences in prostate volume, subjective symptoms or urodynamic parameters were detected between the groups at baseline. Compared with baseline, significant improvements in subjective symptoms and storage and voiding functions were observed at month 12 in both groups. Maximum urinary flow rate significantly improved by 1.7 mL/s in the silodosin group and by 3.0 mL/s in the tadalafil group. In addition, the mean bladder contractility index increased from 80.0 to 86.1 in the silodosin group and from 77.9 to 97.6 in the tadalafil group. Improvements in maximum urinary flow rate and bladder contractility index were significantly superior in the tadalafil group. Conclusions: Both tadalafil and silodosin significantly improve lower urinary tract symptoms and voiding function in patients with non-neurogenic detrusor underactivity. Furthermore, tadalafil is more effective than silodosin in improving bladder contractility index and maximum urinary flow rate.

Discontinuation Rates of Tadalafil Alone and in Combination with a-Blockers in the Treatment of Male Lower Urinary Tract Symptoms with or without Coexisting Erectile Dysfunction: A Systematic Review and Meta-Analysis

“…The included studies, published between 2007 and 2021, [ 5 , 6 , 18 – 59 ] included 11 prospective studies [ 27 , 28 , 35 , 39 – 41 , 43 , 47 , 50 , 51 , 58 ], 2 retrospective studies, [ 36 , 37 ] and 31 RCTs. Thirty-four studies came from a single country, with Japan and Korea predominating, while the rest were multinational studies.…”

“…Tables S3 and S4 present a full summary of the risk of bias for the included studies. Of the 13 observational studies, seven (54%) were of high quality [ 35 , 37 , 39 , 40 , 43 , 51 , 58 ] and the rest were of moderate quality; 46% of the observational studies did not mention adjustment for confounders [ 27 , 28 , 36 , 41 , 47 , 50 ]. The details of the 31 RCTs were as follows: (1) selection bias: 12 out of 31 studies reported the method of random sequence generation, [ 6 , 23 , 26 , 31 , 33 , 34 , 44 – 46 , 49 , 52 , 55 ] while the others did not.…”

Recent insights into pharmaceutical treatments for underactive bladder: a scoping review of recent studies

“…The nitric oxide system has been of partial recent interest, with both tadalafil and silodosin demonstrating some benefits towards the reduction of lower urinary tract symptoms in men with non-neurogenic detrusor underactivity. 14 As more research is conducted into the mechanisms underlying bladder physiology, and the receptors involved, systems such as these may present opportunistic areas for future research. Of particular concern is the potential for high risk of bias within the literature.…”

Underactive Bladder and Detrusor Underactivity: New Advances and Prospectives

“…However, it remains unclear whether PDE5 inhibitors can be used as standalone treatments for DU. Recently, Matsukawa et al conducted a study that found that both tadalafil and silodosin had a significant impact on improving LUTS and voiding function in patients with non-neurogenic DU, and that tadalafil was associated with an improvement in BCI (19.7 ± 17.7 vs. 6.0 ± 12.5, p < 0.001) and Q max (3.0 ± 3.0 mL/s vs. 1.7 ± 1.4, p < 0.001) [116]. The mechanism of action of tadalafil may be linked to enhanced urethral relaxation [117], increased blood flow to the lower urinary tract [118], improved oxygenation [119], and decreased chronic inflammation [120] of the bladder and prostate.…”