Urinary Tract Symptoms (LUTS) Secondary to Benign Prostatic Hyperplasia (BPH) and LUTS/BPH with Erectile Dysfunction in Asian Men: A Systematic Review Focusing on Tadalafil

Abstract

This review assesses lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with or without erectile dysfunction (ED) and related therapies focusing on tadalafil. A literature search was obtained and reviewed for the epidemiology, treatment therapies, pathophysiology, and efficacy and safety of phosphodiesterase type 5 inhibitor (PDE5i) tadalafil in patients with LUTS/BPH. Approximately 42% of men aged 51 to 60 years have BPH. Approximately 90% of men aged 45 to 80 years have LUTS. Occurrence of LUTS increases with age for almost all racial/ethnic groups (range, 32% to 56%) with prevalence of LUTS highest among Hispanic men, then Blacks, Caucasians, and Asians. There is an independent relationship with LUTS/BPH and ED, with approximately 70% of men with LUTS/BPH having ED with severity of one disease often correlating with the other. The European Urological Association guidelines include the use of the PDE5i tadalafil. Tadalafil is the only therapy recommended for treatment of co-existing BPH and ED, while other therapies have unwanted ED side effects. The mode of action of tadalafil may involve different areas of the lower urinary tract such as smooth muscle cell relaxation in the bladder neck, prostate, and urethra, but there may also be resulting modulation of the afferent nerve activity. Tadalafil (5 mg) in Asian men with LUTS/BPH, similar to global studies, is efficacious and safe. Tadalafil (5 mg) improves co-existing LUTS/BPH and ED, independently. Men with LUTS/BPH likely also have ED. Asian men with LUTS/BPH have similar incidence rates, co-existing ED, comorbid diseases, and risks as non-Asian men. Tadalafil can improve co-existing LUTS/BPH and ED.

Management of lower urinary tract symptoms associated with benign prostatic hyperplasia in elderly patients with a new diagnostic, therapeutic and care pathway

“…As recently described in the literature, ED and LUTS associated with BPH are widespread urological conditions in elderly subjects. The association between ED and LUTS/BPH and the increasing prevalence of each clinical condition has been previously shown in several population‐based epidemiological studies and summarised in a recent systematic review . Placebo‐controlled randomised studies have confirmed that Tadalafil (a PDE5i) is efficacious and safe in treating men with either ED or LUTS/BPH or in men presenting with both .…”

“…Similar results were obtained in both the QPT test and QoL among the two groups of study (QPT: 2.58±0.07 vs 2.04±0.06; P<.0001; QoL: 3.94±0.14 vs 2.38±0.14; P<.0001, in groups A and B, respectively). At 6 months of follow-up, the improvement observed in the self-administered questionnaires was related to a significant increase in the Qmax values (mean 11.34±0.35 mL/s vs 17.07±0.35 mL/s; P<.0001) and to a lower postvoid residual (116.65±5.51 mL vs 61.8±5.51 mL, P<.0001), in the two groups A and B, respectively.As recently described in the literature, ED and LUTS associated with BPH are widespread urological conditions in elderly subjects.The association between ED and LUTS/BPH and the increasing prevalence of each clinical condition has been previously shown in several population-based epidemiological studies 4,30-32 and summarised in a recent systematic review 33. Placebo-controlled randomised studies have confirmed that Tadalafil (a PDE5i) is efficacious and safe in treating men with either ED or LUTS/BPH or in men presenting with both 15,[34][35][36][37].…”

Chronic Pelvic Ischemia: Contribution to the Pathogenesis of Lower Urinary Tract Symptoms (LUTS): A New Target for Pharmacological Treatment?

“…Various clinical studies have shown that PDE5 inhibitors such as tadalafil, sildenafil, and vardenafil have therapeutic effects on LUTS, possibly as a consequence of increased pelvic organ blood flow/perfusion in the lower urinary tract. 12 PDE5 inhibitors also appear to modulate afferent activity, 12,41 upregulate cyclic guanosine monophosphate (cGMP)/protein kinase G (PKG) activity, 12,42 downregulate Rho kinase activity, 42,43 and possibly reduce inflammation. 44 In a repeat of our previous study in rats with chronic bladder ischemia, we showed that the addition of tadalafil protects bladder function and morphology, resulting in decreased bladder hyperactivity.…”

Evaluation of the Lower Urinary Tract Symptoms and Erectile Dysfunction with Uroflowmetry, IPSS and IIEF Questioniares

“…IPSS is divided into three domains: obstructive symptom (incomplete emptying, weak stream, intermittency, and straining), irritative symptom (urgency, voiding frequency, and nocturia), and IPSS-QoL. The total score of seven IPSS questions allowed to classify the patients into the low score range (0-7), intermediate score range (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and high score range (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). The 8th question, regarding the patient's quality of life (QoL), was considered separately, with a score ranging from 1 to 6 (0-delighted to 6-terrible).…”