Urodynamic Effects of Once-Daily Tadalafil in Men with LUTS Secondary to Clinical BPH

Abstract

Lower urinary tract symptoms (LUTS) are common and increase with age in men with benign prostatic hypertrophy (BPH). Erectile dysfunction (ED) also increases with age and is often a comorbid condition with BPH. Treatment with phosphodiesterase type 5 (PDE5) inhibitors aimed at decreasing breakdown of nitric oxide (NO) is a mainstay of treatment for ED. Because NO has been found to mediate male prostatic and urinary function in multiple ways, there is increasing interest in PDE5 inhibitors addressing concomitant LUTS. Several studies have shown significant improvement in LUTS after treatment with PDE5 inhibitors; however, concern exists that PDE5 inhibitors exert their beneficial effects through impairment of bladder function. Because limited invasive urodynamic data exist to address these queries, tadalafil's impact on bladder function was recently evaluated. Results indicate that tadalafil treatment had no negative impact on bladder function, as measured by detrusor pressure at maximum flow or any other urodynamic parameter assessed.

Lower Urinary Tract Symptoms are Associated with Erectile Function and Psychological Symptoms in Men with Late‐Onset Hypogonadism Syndrome

“…The presence of PDE‐5 has also been identified in tissues of the urogenital tract, such as the urinary bladder and prostate, and PDE‐5 appears to regulate smooth muscle tone of the bladder and prostatic urethra . It has been clinically demonstrated that PDE‐5 inhibitors have a beneficial effect on LUTS . In addition, NO synthase gene expression is reduced with aging in prostate tissue and may be a factor involved in the increased smooth muscle tone associated with LUTS .…”

Detrusor-Directed Therapy in Men With Benign Prostatic Hyperplasia

“…A strong correlation was found between sexual disorders and the severity of LUTS. Additionally, the relationship appeared to be independent of comorbidities such as hypercholesterolemia, hypertension, cardiac disease, and diabetes [14,15].…”

“…Similarly, the bladder urothelium also releases NO in response to bladder distention, the target of which may be umbrella cells. There is also significant evidence for the NO-mediated smooth muscle relaxation in the prostate; however, in BPH models, the nitrigenergic innervation was reduced [14].…”

Tadalafil for benign prostatic hyperplasia

“…There has been some concern that the beneficial effects of PDE5 inhibitors on LUTS may be associated with impairment of bladder function 19. This was addressed by a multicentre randomised double-blind placebo-controlled study that showed no statistically or clinically significant differences in urodynamic measures between tadalafil and placebo treatment groups 20…”