Ejaculatory Disorders Caused by Alpha-1 Blockers for Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: Comparison of Naftopidil and Tamsulosin in a Randomized Multicenter Study

Abstract

Introduction: To investigate the incidence of ejaculatory disorders caused by naftopidil and tamsulosin in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Materials and Methods: Ninety-five patients with LUTS/BPH who had International Prostate Symptom Scores (IPSS) of 8 or more were randomly assigned to receive naftopidil (50 mg/day, n = 48) or tamsulosin (0.2 mg/day, n = 47). Before and 12 weeks after treatment, a questionnaire was used to evaluate ejaculation. Results: Among men who had sexual activity during the 12 weeks, the proportion who reported an abnormal feeling on ejaculation was higher in the tamsulosin group (16.7%) than in the naftopidil group (7.4%), although the difference was not significant (p = 0.402). The proportion of men who reported reduced ejaculatory volume after treatment was significantly higher in the tamsulosin group (96.0%) than in the naftopidil group (73.1%, p = 0.0496). On the other hand, the improvements in IPSS and the quality of life index were significantly higher in the tamsulosin group than in the naftopidil group. Conclusions: Tamsulosin may cause a higher incidence of ejaculatory disorders than naftopidil, although the efficacy of 0.2 mg tamsulosin may be better than that of 50 mg naftopidil.

General effect of low-dose tamsulosin (0.2 mg) as a first-line treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia: a systematic review and meta-analysis

“…Considering that our eleven enrolled studies 5,7,15,[17][18][19][20][21][22]24,25 included relatively lower durations of treatment, within 3 months except for three studies 4,16,23 , these findings support the idea that low-dose tamsulosin is suitable for initial treatment.…”

“…Four of fourteen studies did not describe adverse events 19,22,23,25 while the remaining ten described adverse events 4,5,7,[15][16][17][18]20,21,24 including in the urogenital system (abnormal ejaculation, urinary incontinence, erectile dysfunction, decrease libido), circulatory system (orthostatic hypotension, palpitation), digestive system (diarrhea, constipation, abdominal distention, dyspepsia, loose stool), nervous system (headache, dizziness, sleepiness, vertigo), respiratory system (rhinitis, dyspnea, nasal stuffiness), dermatic system (pruritus, rash), musculoskeletal system (edema), and others (dry mouth, decreased potency, numbness of the tongue, unsteady gait) ( Table 3). Although not all trials mentioned specific adverse events, tamsulosin was generally well tolerated and had a lower rate of adverse events, especially compared with terazosin.…”

“…A detailed flow chart showing the selection process is shown in Figure 1. A systematic review of 14 studies was conducted on the detailed experimental differences and subject descriptions (Chinese: 4 studies, Japanese: 6 studies, Korean: 4 studies) ( Table 1) 4,5,7,[15][16][17][18][19][20][21][22][23][24][25] . The duration of treatment ranged from 4 to 52 weeks.…”

“…The WMD changes of IPSS improvement from baseline were À9.05 (95% CI: À10.36, À7.74) in China, À6.84 (95% CI: À7.71, À5.97) in Japan, and À6.01 (95% CI: À7.37, À4.65) in Korea ( Figure 3). A total of 10 trials (n ¼ 1604; 768 experimental and 836 controls) 4,15,17,18,[20][21][22][23][24][25] reported detailed data on QOL. The WMD change of QOL improvement from baseline was À1.34 (95% CI: À1.46, À1.22).…”

Comparative evaluation of naftopidil and tamsulosin in the treatment of patients with lower urinary tract symptoms with benign prostatic hyperplasia

“…[14] Masumori et al performed a head-to-head comparison of the efficacies of naftopidil and tamsulosin, in which the authors speculated that the efficacy of 0.2 mg of tamsulosin might be better than that of 50 mg of naftopidil. [15]…”