Efficacy and Side Effects of Drugs Commonly Used for the Treatment of Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia

Abstract

Benign prostatic hyperplasia (BPH) is the most common benign disease of the prostate gland and is caused by benign hyperplasia of the smooth muscle cells and stromal cells in this important gland. BPH is also the most common disease underlying lower urinary tract symptoms (LUTS). The incidence of BPH increases with age and affects more than half of all men 50 years or older. BPH mainly exerts effects on urinary function and can seriously reduce a patient's quality of life. At present, treatment for BPH aims primarily to improve the quality of life and reduce the risk of BPH-related complications. Pharmacological therapy is recommended for moderate-to-severe cases of LUTS that are suggestive of BPH. A range of drugs is currently available to treat this condition, including a1adrenoceptor antagonists, 5a-reductase inhibitors (5-ARIs), phosphodiesterase type 5 inhibitors (PDE5Is), muscarinic receptor antagonists (MRAs), b3-adrenoceptor agonists, and plant extracts. Of these, the most commonly used drugs in the clinic are a1adrenoceptor antagonists, 5-ARIs, and combination therapy. However, these drugs exert their effects via various mechanisms and are associated with adverse reactions. The purpose of this review is to provide current comprehensive perspectives on the mechanisms of action, efficacy, and adverse reactions associated with the drugs most commonly used for the treatment of BPH.

Effects of shRNA‑mediated silencing of PDE5A3 on intracellular cGMP and free Ca2+ levels and human prostate smooth muscle cell proliferation from benign prostatic hyperplasia

“…Benign prostatic hyperplasia (BPH) is an irregular benign hyperplasia of smooth muscle cells and other stromal cells in the transitional area of the prostate gland ( 1 , 2 ). BPH may be induced by a variety of risk factors, including obesity, hyperlipidemia, type 2 diabetes and certain androgenic hormone disorders, which may lead to a series of lower urinary tract symptoms (LUTS) ( 3 , 4 ).…”

Mirabegron for treatment of erectile dysfunction concomitant with lower urinary tract symptoms in patients with benign prostatic obstruction: A randomized controlled trial

“…Of all PDE5Is, only tadalafil is FDA approved for patients with LUTS/BPO 20–22 . However, PDE5Is had shown several side‐effects, especially on long‐term follow up, such as headache, flushing and dyspepsia, which made many patients discontinue their use 23 . Recently, mirabegron, a selective β3 adrenoreceptor agonist, became FDA approved for the management of LUTS 4 .…”

“…[20][21][22] However, PDE5Is had shown several side-effects, especially on long-term follow up, such as headache, flushing and dyspepsia, which made many patients discontinue their use. 23 Recently, mirabegron, a selective b3 adrenoreceptor agonist, became FDA approved for the management of LUTS. 4 Its role in LUTS/BPO was shown by many studies.…”

Is tadalafil associated with decreased risk of major adverse cardiac events or venous thromboembolism in men with lower urinary tract symptoms?

“…Despite the well know potential erectile and cardiovascular benefits associated with tadalafil, clinicians should also take in consideration the potential side effects including mild-to-moderate headache, flushing, and dyspepsia [ 21 ]. In comparison, alpha-blocker nonsexual side effects include cardiovascular effects, such as postural hypotension, asthenia, and dizziness, as well as idiopathic floppy iris syndrome [ 8 , 22 ]. Alpha blocker use has been shown to decrease relative risk of mortality from COVID-19, while further investigation on PDE5Is effect on COVID-19 outcomes is needed [ 23 ].…”