Combination of phosphodiesterase-5 inhibitors and alpha-blockers in patients with benign prostatic hyperplasia: treatments of lower urinary tract symptoms, erectile dysfunction, or both?

2006 ◽  
Vol 97 (s2) ◽  
pp. 39-43 ◽  
Author(s):  
CULLEY C. CARSON
2018 ◽  
Vol 5 (5) ◽  
pp. 1866
Author(s):  
Sanket Narayan Singh ◽  
Manoj Biswas ◽  
Ankur Mittal ◽  
Yogesh Kalra ◽  
Rajeev Sarpal ◽  
...  

Background: Benign prostatic hyperplasia (BPH) is a histologic diagnosis that refers to the proliferation of smooth muscle and epithelial cells within the prostatic transition zone. The aim of this systematic review is to determine the comparative effectiveness and safety of phosphodiesterase 5 inhibitors (PDE5-Is) and alpha blockers used alone or in combination for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).Methods: We analyzed 54 patients of BPH with LUTS with baseline IPSS, Qmax and PVR over one-year period. They were randomized equally in three groups i.e. group receiving alpha blocker, group receiving phosphodiesterase 5 inhibitors and group receiving combination of the two drugs. These patients were followed up at the end of 1st month and 3rd month and IPSS, Qmax and PVR was compared.Results: Out of 54, 45 patients completed the study. At the end of the study all the three groups showed significant improvement in IPSS, PVR and Qmax, all p <0.05, but the combination group showed much better improvement in terms of percentage. Two patients on alpha blockers had episode of hypotension.Conclusions:Thus, we summarize that phosphodiesterase 5 inhibitors should be preferred over alpha blockers in patients with LUTS/BPH as it has, firstly, outcome similar to alpha blockers. Secondly, have no documented side effect. Third, can be given in any patient, irrespective of the fact that whether the patient is suffering from erectile dysfunction or not.  


2021 ◽  
Vol 13 ◽  
pp. 175628722199328
Author(s):  
Andrea Mari ◽  
Alessandro Antonelli ◽  
Luca Cindolo ◽  
Ferdinando Fusco ◽  
Andrea Minervini ◽  
...  

Background: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are a bothersome frequent symptom in adult males. This systematic review analyzed the available evidence on the pharmacokinetic and pharmacodynamic features of alfuzosin, and its clinical efficacy both as monotherapy and in combination with other drugs for the treatment of male LUTS/BPH. Methods: A systematic review of the last 10 years was performed using the MEDLINE, EMBASE and Cochrane libraries in March 2020. The protocol for this systematic review was registered on PROSPERO (Central Registration Depository: CRD42020136120) and is available in full on the University of York website. Results: Alfuzosin is a quinazoline derivative and, although a nonspecific α1-blocker, exhibits a selective concentration in the prostate compared with plasma in patients with BPH. Three registration trials assessed the safety and efficacy of alfuzosin. The 10 mg daily formulation has a three-layered matrix containing the active substance between two inactive coats allowing a drug release over 20 h. Alfuzosin showed high tolerability, few vasodilatory effects and a low rate of ejaculation disorders over older alpha-blocking compounds thanks to the high uroselectivity of alfuzosin and its preferential concentration at urinary level. Six randomized clinical trials (RCTs) assessed efficacy and safety of alfuzosin versus other alpha-blockers ± placebo: three studies comparing with tamsulosin, one with doxazosin, and two with silodosin or tamsulosin. One RCT investigated the clinical outcomes of alfuzosin with finasteride, two with propiverine and two with phosphodiesterase-5 inhibitors. Conclusions: Alfuzosin is an effective drug for the treatment of LUTS/BPH, with a lower rate of sexual disorders compared with other alpha-blockers. Alfuzosin is also safe with low adverse events in case of concomitant antihypertensive therapy and in patients with cardiovascular morbidity. Safety and efficacy of alfuzosin has been reported also in case of combination therapy with antimuscarinic agents and PDE5i.


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