PDE5 inhibitors for LUTS

Mouli, S.; McVary, Kevin T.

doi:10.1038/pcan.2009.27

Cited by 25 publications

(11 citation statements)

References 93 publications

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“…LUTS were evaluated by culturally and linguistically validated versions of the IPSS. LUTS severities were classified as mild (IPSS 0-7), moderate (IPSS [8][9][10][11][12][13][14][15][16][17][18][19] and severe . The short form of the International Index of Erectile Function (IIEF) questionnaire was used for the assessment of patients' erectile function and the presence of ED was considered to be IIEF-erectile function <26 [14].…”

Section: Methodsmentioning

confidence: 99%

Increase of Framingham cardiovascular disease risk score is associated with severity of lower urinary tract symptoms

Russo

Castelli

Privitera

et al. 2015

BJU Int

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ObjectiveTo determine the relationship between lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and 10-year risk of cardiovascular disease (CVD) assessed by the Framingham CVD risk score in a cohort of patients without previous episodes of stroke and/or acute myocardial infarction. Patients and MethodsFrom September 2010 to September 2014, 336 consecutive patients with BPH-related LUTS were prospectively enrolled. The general 10-year Framingham CVD risk score, expressed as percentage and assessing the risk of atherosclerotic CVD events, was calculated for each patient. Individuals with low risk had ≤10% CVD risk at 10 years, with intermediate risk 10-20% and with high risk ≥20%. Logistic regression analyses were used to identify variables for predicting a Framingham CVD risk score of ≥10% and moderate-severe LUTS (International Prostate Symptom Score [IPSS] ≥8), adjusted for confounding factors. ResultsAs category of Framingham CVD risk score increased, we observed higher IPSS (18.0 vs 18.50 vs 19.0; P < 0.05), high IPSS-voiding (6.0 vs 9.0 vs 9.5; P < 0.05) and worse sexual function. Prostate volume significantly increased in those with intermediate-vs low-risk scores (54.5 vs 44.1 mL; P < 0.05). Multivariate logistic regression analysis showed that intermediate-[odds ratio (OR) 8.65; P < 0.01) and high-risk scores (OR 1.79; P < 0.05) were independently associated with moderate-severe LUTS. At age-adjusted logistic regression analysis, moderate-severe LUTS was independently associated with Framingham CVD risk score of ≥10% (OR 5.91; P < 0.05). ConclusionOur cross-sectional study in a cohort of patients with LUTS-BPH showed an increase of more than five-fold of having a Framingham CVD risk score of ≥10% in men with moderate-severe LUTS.

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Section: Methodsmentioning

confidence: 99%

Increase of Framingham cardiovascular disease risk score is associated with severity of lower urinary tract symptoms

Russo

Castelli

Privitera

et al. 2015

BJU Int

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“…Pelvic atherosclerosis and ischemia have their effects via these concepts. 84 Several randomized, placebo-controlled studies to assess the effect of PDE inhibitors on LUTS using sildenafil, vardenafil and tadalafil were conducted. The study employing sildenafil used a 12-week, double-blinded, placebo-controlled approach in 369 men over 45 years of age who had IIEF scores under 26 (on erectile function domain) and IPSS scores 411.…”

Section: Luts and Ed: Effects On Clinical Managementmentioning

confidence: 99%

Association of lower urinary tract symptoms and erectile dysfunction: pathophysiological aspects and implications for clinical management

2011

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There is strong evidence from multiple epidemological studies that lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are correlated, independent of age or comorbidities as diabetes or hypertension. Although a direct causal relationship is not established yet, four pathophysio logical mechanisms can explain the relationship. These include alteration in nitric oxide bioavailability, a1-adrenergic receptor hyperactivity, pelvic atherosclerosis and sex hormones. This association has different clinical implications on the management of both disorders. Men seeking care for one condition should always be screened for complaints of the other condition. Sexual function should be assessed and discussed with the patient when choosing the appropriate management strategy for LUTS, as well as when evaluating the patient's response to treatment. Multiple large clinical trials have shown an improvement in LUTS after phosphodiesterase-5 (PDE5)-inhibitor treatment. PDE5 inhibitors show promise as a future treatment for LUTS, either in conjunction with existing therapies or as a primary treatment. There may be a potential therapeutic role for testosterone in LUTS treatment in cases of testosterone deficiency that needs to be investigated. Much further investigation is required, but it is evident that the association between LUTS and ED is fundamental for future therapies and possible preventative strategies.

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“…16 Moreover, an association between LUTS and erectile dysfunction has been clearly established, and recently reviewed by Mouli and McVary. 17 Gacci and colleagues reported a small three-armed study that was similar to ours, using daily vardenafil, on-demand vardenafil, and a placebo group. 4 Based on this trial with only 12 to 14 patients per arm, the authors suggested that daily vardenafil use improved postoperative continence as determined by the UCLA-PCI (University of CaliforniaLos Angeles Prostate Cancer Index).…”

Section: Discussionmentioning

confidence: 56%

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

Hyndman

Bivalacqua

Mettee

et al. 2015

CUAJ

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Introduction: This is a report on potency results from a randomized trial of nightly versus on-demand sildenafil after nerve-sparing radical prostatectomy (RP). A secondary objective was to analyze the effects of these sildenafil administration schemes on urinary health-related quality of life after RP. Methods: In total, 100 potent men were equally randomized to nightly and on-demand sildenafil 50 mg after minimally-invasive RP for 1 year. Health-related quality of life questionnaires were administered at various postoperative intervals. Urinary function was assessed using appropriate expanded prostate cancer index composite (EPIC) subscales. Analyses of covariance and linear mixed-effects modeling were used to compare the effects of treatment over time on urinary recovery, controlling for age, nervesparing score, and time from surgery. Results: The nightly (n = 50) and on-demand (n = 50) sildenafil groups were well-matched at baseline. Nightly sildenafil patients had worse EPIC urinary bother and urinary irritative/obstructive subscale scores at 3 and 6 months after RP, even after controlling for multiple variables. On mixed-model analyses, the differences between groups for these EPIC subscales (4.9 and 2.5, respectively) were greater than documented thresholds for clinical significance. Increasing nerve-sparing score was associated with improvements in EPIC urinary summary, bother, incontinence, and function scores; time from surgery was associated with improvements in all EPIC urinary health-related quality of life subscales. Conclusions: In this specific population and drug dose, we found that on-demand short-acting phosphodiesterase-5 inhibitor (PDE5i) dosing may be more effective after RP to maximize early urinary and erectile health-related quality of life. In preoperatively potent men, nightly sildenafil 50 mg impaired urinary health-related quality of life more than on-demand use in the early months after nerve-sparing RP, independent of effects on urinary continence.

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PDE5 inhibitors for LUTS

Cited by 25 publications

References 93 publications

Increase of Framingham cardiovascular disease risk score is associated with severity of lower urinary tract symptoms

Increase of Framingham cardiovascular disease risk score is associated with severity of lower urinary tract symptoms

Association of lower urinary tract symptoms and erectile dysfunction: pathophysiological aspects and implications for clinical management

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

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