Phosphodiesterase type 5 inhibitor therapy provides sustained relief of symptoms among patients with chronic pelvic pain syndrome

Abstract

Background: Chronic prostatitis/chronic pelvic pain syndrome type III (CP/CPPS) is associated with pelvic pain, sexual dysfunction and irritative voiding. Sustained symptom relief has proven difficult with alpha blockers, antibiotics, and nonsteroidal anti-inflammatory drugs (NSAIDs). Phosphodiesterase type 5 (PDE5) inhibitors (PDE5is) have the potential to alleviate bladder urgency, relax the pelvic floor, and correct underlying erectile dysfunction; however, few studies have investigated the application of PDE5i's to CP/ CPPS. The purpose of this study was to assess the effect of long-term PDE5i therapy on symptoms among patients with diagnosed CP/CPPS. Methods: A group of patients older than 18 years diagnosed with CP/CPPS presenting from 2009 to 2018 were followed prospectively while they were being prescribed off-label PDE5i therapy for symptoms.National Institute of Health chronic prostatitis symptom index (CPSI) scores before PDE5i therapy initiation and after at least 3 months were utilized to assess impact on symptoms.Results: A total of 25 patients (mean age 44.4±12.9 years) met study criteria. The mean duration of PDE5i therapy was 1.3±1.6 years. Continued use of daily PDE5is was associated with significant decreases in total CPSI, pain, urinary symptom and quality of life scores [total CPSI: −12.8, standard deviation (SD) 9.5; pain:

Tadalafil monotherapy in management of chronic prostatitis/chronic pelvic pain syndrome: a randomized double-blind placebo controlled clinical trial

“…Clinically, there are few studies discussing its role in CP/CPPS. Unfortunately, most of these studies either lacked control arm or run in BPH associated CP/CPPS or in combination with other medications [19][20][21].…”

“…In Pineault et al study, 25 patients (mean age 44.4 ± 12.9 years) were treated with tadalafil 5 mg daily for a mean duration of 1.3 ± 1.6 years. Although lacked control arm, they concluded that daily use of tadalafil for long time was associated with significant decreases in CPSI total, pain, urinary symptom and quality of life scores (− 12.8 ± 9.5, − 6.1 ± 4.1, − 2.4 ± 2.1 and − 4.5 ± 3.9, respectively) [21] The significant changes in CPSI scores, compared to baseline, in our study are found to be in accordance with the previously mentioned reports but with much limited changes. That limited changes of CPSI may be explained as our study included younger ages with longer duration of moderate/severe complaint or may be attributed to shorter study duration.…”

“…In Pineault et al study, 25 patients (mean age 44.4 ± 12.9 years) were treated with tadalafil 5 mg daily for a mean duration of 1.3 ± 1.6 years. Although lacked control arm, they concluded that daily use of tadalafil for long time was associated with significant decreases in CPSI total, pain, urinary symptom and quality of life scores (− 12.8 ± 9.5, − 6.1 ± 4.1, − 2.4 ± 2.1 and − 4.5 ± 3.9, respectively) [ 21 ]…”

“…Clinically; few limited studies had investigated the outcome of PDE5-inhibitors in management of CP/CPPS, unfortunately, these studies mostly lacked control arm [19][20][21][22]. In this placebo-controlled clinical trial we aimed to evaluate the results of tadalafil treatment alone in management of non BPH-related CP/CPP patients.…”

International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction

“…12.1.8 PDE5i : See 7.4. PDE5i may alleviate Cp/CPPS symptoms by reducing oxidative stress and inflammation on the prostate and PF 105 . (NEW)…”