Guide to Drug Therapy for Lower Urinary Tract Symptoms in Patients with Benign Prostatic Obstruction

Abstract

The relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) caused by benign prostatic obstruction (BPO) has recently gained increasing attention. Both BPO and ED are highly prevalent in older men and both conditions frequently contribute to a reduction in overall quality of life. Current medical treatment of LUTS/BPO consists of monotherapy with alpha(1)-adrenoceptor antagonists or 5alpha-reductase inhibitors, a combination of these two agents or, in some cases, various phytotherapeutic approaches. When choosing a drug therapy, it is important to recognize that while 5alpha-reductase inhibitors increase the risk of ED and ejaculatory disorders, and combined therapy carries the cumulative risk of causing sexual dysfunction, some alpha(1)-adrenergic receptor antagonists have been reported to improve overall sexual function. Therefore, the successful evaluation and management of older men with LUTS associated with BPO should include an assessment of baseline sexual function and subsequent monitoring of medication-induced sexual adverse effects. In this review, we detail the pathophysiological mechanisms involved in LUTS/BPO-associated ED, including reduced nitric oxide/cyclic guanosine monophosphate system activity, enhanced endothelin-1/rhoA/rho kinase pathway activity, sympathetic overactivity, pelvic organ atherosclerosis and potential preventive approaches.

CXC-Type Chemokines Promote Myofibroblast Phenoconversion and Prostatic Fibrosis

“…Although both types of therapeutic approaches have proven effective for improving urinary flow, they are not effective for all men and can produce adverse effects that require termination of the therapeutic regimen. Moreover, LUTD can become refractory to this therapeutics [5], [6]. There is a need to explore other targets for therapeutics that might provide relief from LUTD with improved tolerability and duration.…”

Utilidad de los alfa-bloqueantes en el tratamiento de distintos trastornos urológicos

“…Los mecanismos potenciales implicados incluyen una deficiencia de ó xido nítrico, hiperactividad autonó mica, aumento de la actividad Rho-cinasa y de la endotelina y, finalmente, la aterosclerosis pé lvica 59 (fig. 2).…”

RhoA/Rho-Kinase as a Therapeutic Target for the Male Urogenital Tract

“…Numerous studies have demonstrated that LUTS is associated with ED in men, independent of age or general health. The RhoA/Rho‐kinase pathway is involved in the mechanism of LUTS‐associated ED [95]. The action of several factors in addition to noradrenaline (e.g., ET‐1, Ang II) are likely involved in increased smooth muscle activity in both LUTS/BPH and sexual dysfunction, and are dependent on Rho‐kinase activity [96].…”