Current Medical Issues

CLINICAL QUERIES
Year
: 2016  |  Volume : 14  |  Issue : 4  |  Page : 84--85

Clinical questions: Responses to queries from readers: Benign Prostatic Hypertrophy


TJ Nirmal 
 Professor, Department of Urology, CMC, Vellore, India

Correspondence Address:




How to cite this article:
Nirmal T J. Clinical questions: Responses to queries from readers: Benign Prostatic Hypertrophy.Curr Med Issues 2016;14:84-85


How to cite this URL:
Nirmal T J. Clinical questions: Responses to queries from readers: Benign Prostatic Hypertrophy. Curr Med Issues [serial online] 2016 [cited 2019 Aug 25 ];14:84-85
Available from: http://www.cmijournal.org/text.asp?2016/14/4/84/194455


Full Text

Question 4

What is the role of sildenafil in benign prostatic hyperplasia?

Answer:

Phosphodiesterase 5 inhibitors (PDE5i) such as sildenafil and tadalafil increase intracellular cyclic guanosine monophosphate resulting in a reduction of smooth muscle tone of the detrusor, prostate, and urethra resulting in improvement of lower urinary tract symptoms (LUTSs) related to benign prostatic hyperplasia (BPH). [1] In a meta-analysis, PDE5is have been shown to improve both voiding and storage LUTS (IPSS score) and erectile function (IIEF score) but not urinary flow rate (Qmax). [2] However, a combination of PDE5is and α-blockers (e.g., Tamsulosin) has been shown to improve flow rate as well. [2]

Despite several PDE5is showing efficacy in randomized control trials, only tadalafil (5 mg once daily) and not sildenafil has been approved for the treatment of moderate to severe male LUTSs with or without erectile dysfunction. PDE5is are contraindicated in patients using nitrates. They are also contraindicated in patients who have unstable angina pectoris, have had a recent myocardial infarction (<3 months) or stroke (<6 months), and myocardial insufficiency (New York Heart Association stage >2).

References

1Giuliano F, Ückert S, Maggi M, Birder L, Kissel J, Viktrup L. The mechanism of action of phosphodiesterase type 5 inhibitors in the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. Eur Urol 2013;63:506-16.
2Gacci M, Corona G, Salvi M, Vignozzi L, McVary KT, Kaplan SA, et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with a-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 2012;61:994-1003.