sildenafil-citrate and Prostatic-Hyperplasia

The purpose of this study was to compare the relative safety and efficacy of different types of phosphodiesterase type 5 inhibitors (PDE5-Is) with tamsulosin for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) (BPH-LUTS) with or without erectile dysfunction (ED).. We use the Stata version 13.0 to conduct the network meta-analysis (NMA) with a random effects model of the Bayesian framework. The International Prostate Symptom Score (IPSS), Maximum Urinary Flow Fate (. Seven RCTs including 531 participants with seven interventions were analyzed. The results of NMA SUCRA showed that compared with different doses or types of PDE5-Is combined with tamsulosin (0.4 mg qd), the sildenafil (25 mg qd) combined with tamsulosin (0.4 mg qd) group had the greatest probabilities of being the best in the achievement of improving IIEF. The sildenafil (25 mg 4 days per week) combined with tamsulosin (0.4 mg qd) group had the greatest probabilities of being the best in the achievement of improving. This meta-analysis indicates that sildenafil combined with tamsulosin is the best effective and tolerated treatment option for BPH-LUTS with or without ED. Further RCTs are strongly required to provide more direct evidence.

Topics: Bayes Theorem; Databases, Factual; Drug Therapy, Combination; Erectile Dysfunction; Humans; Lower Urinary Tract Symptoms; Male; Network Meta-Analysis; Phosphodiesterase 5 Inhibitors; Prostatic Hyperplasia; Safety; Sildenafil Citrate; Tadalafil; Tamsulosin; Treatment Outcome

Phosphodiesterase-5 (PDE5) inhibitors, such as sildenafil, tadalafil and vardenafil are first line treatment for erectile dysfunction (ED). These PDE5 inhibitors are known to increase cyclic guanosine monophosphate (cGMP) concentrations in the smooth muscle cells of the corpora cavernosa penis by inhibiting PDE5, leading to smooth muscle relaxation. This mode of action is also believed to result in prostatic smooth muscle relaxation and to improve lower urinary tract symptoms (LUTS). Randomized controlled trials have shown beneficial effects on LUTS and on objective parameters such as maximum urinary flow rate (tadalafil). Based on these data tadalafil was recently approved for treatment of patients with male LUTS; however, the mechanisms leading to improvement of symptoms are still under debate.

Topics: Carbolines; Controlled Clinical Trials as Topic; Cyclic GMP; Cyclic Nucleotide Phosphodiesterases, Type 5; Erectile Dysfunction; Humans; Imidazoles; Lower Urinary Tract Symptoms; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Sildenafil Citrate; Sulfones; Tadalafil; Triazines; Urodynamics; Vardenafil Dihydrochloride

The objective of this literature review was to report currently available clinical data on the effects of phosphodiesterase type 5 inhibitors (PDE5I) on lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).. An international literature review was carried out in February 2012 from the Medline database (National Library of Medicine, United States). Studies on the effects of PDE5I on LUTS secondary to BPH published within the last 15 years (1997 to 2012) were extracted. In total, 12 studies were selected: four studies on sildenafil including one randomized, controlled, double-blind study; one randomized, controlled, double-blind study on vardenafil; and seven studies on tadalafil including five randomized, controlled, double-blind studies and a 1-year open-label extension study.. PDE5Is significantly improve the overall international prostatic symptom score (IPSS) compared to placebo. Most often, the maximum urinary flow rate (Qmax) was not significantly increased versus placebo. A statistically significant improvement of Qmax was nevertheless observed in certain studies.. The available clinical data assessing the efficacy of PDE5 inhibition in LUTS secondary to BPH are convincing. PDE5Is thus are a new therapeutic class in the treatment of this disease and are especially interesting in patients suffering from both LUTS and erectile dysfunction (ED), two frequently associated diseases.

Topics: Carbolines; Humans; Lower Urinary Tract Symptoms; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Randomized Controlled Trials as Topic; Sildenafil Citrate; Sulfones; Tadalafil

To determine the efficacy of phosphodiesterase inhibitors for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH).. MEDLINE and PubMed were searched from January 1, 2000, to October 31, 2012, using the MeSH terms phosphodiesterase inhibitor, lower urinary tract symptoms, benign prostatic hyperplasia, sildenafil, vardenafil, and tadalafil. Additional articles were obtained from references identified in the original search.. English-language randomized controlled trials and review articles were evaluated.. Men with BPH commonly experience lower urinary tract symptoms (LUTS) such as urgency, frequency, nocturia, and dribbling. α-Adrenergic antagonists have been the mainstay of medical treatment of LUTS but are associated with adverse effects such as orthostatic hypotension, dizziness, and sexual dysfunction. The 5-α reductase inhibitors are associated with sexual dysfunction, and treatment effects may be delayed for 6-12 months. Phosphodiesterase type 5 (PDE-5) inhibitors are effective for the treatment of erectile dysfunction (ED), and large-scale epidemiologic studies suggest a strong link between LUTS and ED. The available PDE-5 inhibitors (sildenafil, tadalafil, and vardenafil) have shown efficacy in the treatment of LUTS in several randomized controlled trials in men with and without concomitant ED.. PDE-5 inhibitors consistently reduce LUTS associated with BPH. These medications may offer advantages over conventional therapies such as rapid onset of action, fewer adverse effects, and enhanced sexual function. Quality of life improvements have also been realized in men with BPH who receive PDE-5 inhibitors.

Topics: Adrenergic alpha-Antagonists; Carbolines; Drug Resistance; Drug Therapy, Combination; Erectile Dysfunction; Humans; Imidazoles; Lower Urinary Tract Symptoms; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Prostate; Prostatic Hyperplasia; Purines; Randomized Controlled Trials as Topic; Sildenafil Citrate; Sulfones; Tadalafil; Triazines; Vardenafil Dihydrochloride; Vasodilator Agents

As men age, there is an increase in the frequency of pathologic diseases affecting the genitourinary tract. Most notable among these changes are the rising prevalence of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). The pathogenesis of these conditions seems to be multifactorial and includes age-related changes in the nervous system and neuroregulatory factors, such as nitric oxide and RhoA/Rho-kinase. Various pharmacologic agents that target these pathways, such as α-blockers and PDE-5is, underscore the contribution of neuroregulatory factors on the development of LUTS/BPH and ED.

Topics: Age Factors; Aged; Aged, 80 and over; Aging; Carbolines; Disease Progression; Erectile Dysfunction; Humans; Imidazoles; Lower Urinary Tract Symptoms; Male; Men's Health; Middle Aged; Neurotransmitter Agents; Piperazines; Prognosis; Prostatic Hyperplasia; Purines; Receptors, Neurotransmitter; Risk Assessment; Sildenafil Citrate; Sulfones; Tadalafil; Triazines; Vardenafil Dihydrochloride

Several randomized controlled trials (RCTs) on phosphodiesterase type 5 inhibitors (PDE5-Is) have showed significant improvements in both lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men affected by one or both conditions, without a significant increase in adverse events. However, the results are inconsistent.. Perform a systematic review and meta-analysis of available prospective and cross-sectional studies on the use of PDE5-Is alone or in combination with α1-adrenergic blockers in patients with LUTS/benign prostatic hyperplasia (BPH).. A systematic search was performed using the Medline, Embase, and Cochrane Library databases through September 2011 including the combination of the following terms: LUTS, BPH, PDE5-Is, sildenafil, tadalafil, vardenafil, udenafil, α-blockers, and α1-adrenergic blocker. The meta-analysis was conducted according to the guidelines for observational studies in epidemiology.. Of 107 retrieved articles, 12 were included in the present meta-analysis: 7 on PDE5-Is versus placebo, with 3214 men, and 5 on the combination of PDE5-Is with α1-adrenergic blockers versus α1-adrenergic blockers alone, with 216 men. Median follow-up of all RCTs was 12 wk. Combining the results of those trials, the use of PDE5-Is alone was associated with a significant improvement of the International Index of Erectile Function (IIEF) score (+5.5; p<0.0001) and International Prostate Symptom Score (IPSS) (-2.8; p<0.0001) but not the maximum flow rate (Q(max)) (-0.00; p=not significant) at the end of the study as compared with placebo. The association of PDE5-Is and α1-adrenergic blockers improved the IIEF score (+3.6; p<0.0001), IPSS score (-1.8; p = 0.05), and Q(max) (+1.5; p<0.0001) at the end of the study as compared with α-blockers alone.. The meta-analysis of the available cross-sectional data suggests that PDE5-Is can significantly improve LUTS and erectile function in men with BPH. PDE5-Is seem to be a promising treatment option for patients with LUTS secondary to BPH with or without ED.

Topics: Adrenergic alpha-Antagonists; Carbolines; Drug Therapy, Combination; Erectile Dysfunction; Humans; Imidazoles; Lower Urinary Tract Symptoms; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Pyrimidines; Sildenafil Citrate; Sulfonamides; Sulfones; Tadalafil; Treatment Outcome; Triazines; Vardenafil Dihydrochloride

To critically review the physiological roles of phosphodiesterase-5 (PDE5), to explain and support the putative impact and clinical significance of PDE5 inhibitors (PDE5-Is) in the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), both highly prevalent in men aged > or =50 years, as PDE5-Is are very effective as a first-line therapy for ED, and attractive for further physiological functional investigations.. We searched Medline for peer-reviewed articles in English, from 1991 to 2008, to provide a critical contemporary review of PDE5 pertaining to the potential interest of findings supporting a role for PDE5-Is in LUTS due to BPH. The selection of papers was based on the relevance of subject matter. A critical analysis of available fundamental and clinical data is reported.. Several studies assessed the role of the nitric oxide/cGMP signalling pathway in the regulation of the prostate tone, with the support of clinical observations. PDE5-Is can also represent a potential mode of action allowing the targeting of transcriptional activity implicated in the regulation of the progression of the inflammatory process involved in BPH. PDE5-Is can inhibit human stromal cell proliferation of the prostate mediated by cGMP accumulation. New targeting hypotheses of pathophysiological processes are also reported.. There is evidence that LUTS and ED are strongly linked. This analysis of the regulatory basis of PDE5 biology could indicate several directions of investigation. However, it is necessary to devise well-designed large prospective studies that would produce significant data before this approach becomes a standard of care.

Topics: Aged; Carbolines; Erectile Dysfunction; Humans; Imidazoles; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Prostatism; Purines; Quality of Life; Quinazolines; Sildenafil Citrate; Sulfones; Tadalafil; Treatment Outcome; Triazines; Vardenafil Dihydrochloride

Three different phosphodiesterase 5 (PDE5) inhibitors are currently available for the treatment of erectile dysfunction: sildenafil, vardenafil and tadalafil. The differences between these 3 are limited: tadalafil has a long duration of action, while vardenafil has a rapid onset of action after intake. Various studies have suggested that there is an improvement in the partners' sex lives when men use a PDE5 inhibitor for erectile dysfunction. The introduction of PDE5 inhibitors has renewed the interest in PDE inhibitors in general, for example in the treatment of pulmonary hypertension. In the near future PDE inhibitors may be used for various disorders as chronic obstructive pulmonary disease, benign prostatic hyperplasia, hypertension and coronary heart disease.

Topics: Carbolines; Coronary Disease; Erectile Dysfunction; Humans; Hypertension; Imidazoles; Male; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Pulmonary Disease, Chronic Obstructive; Purines; Sildenafil Citrate; Sulfones; Tadalafil; Treatment Outcome; Triazines; Vardenafil Dihydrochloride

Topics: Adrenergic alpha-Antagonists; Erectile Dysfunction; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Prostate-Specific Antigen; Prostatic Hyperplasia; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones

To compare the efficacy and adverse events of sildenafil monotherapy for benign prostatic hyperplasia (BPH) with its FDA-approved counterpart, tadalafil.. In this single-arm self-controlled clinical trial, 33 patients were enrolled. All patients underwent a 6-week treatment with sildenafil, followed by a 4-week washout period and finally a 6-week treatment with tadalafil. Patients were examined on each appointment and post-void residual (PVR) urine, International Prostate Symptom Score (IPSS) and Quality of life index (IPSS-QoL index) were recorded subsequently. Efficacy of each drug regimen was then evaluated by comparing these outcome parameters.. Both sildenafil and tadalafil were shown to improve PVR (both p < .001), IPSS (both p < .001) and IPSS- QoL index (both p < .001) significantly. Sildenafil was more effective than tadalafil in reducing PVR (mean difference (95%CI) = 9.91% (4.11, 15.72), p < .001) and ameliorating IPSS-QoL index (mean difference (95%CI) = 19.3% (4.47, 34.41), p = .027). Moreover, although not significant, sildenafil reduced IPSS more than tadalafil (mean difference (95%CI) = 3.33% (-0.22, 6.87), p = .065). Concurrent erectile dysfunction did not affect responsiveness to therapy with either sildenafil or tadalafil but age was inversely related to post-treatment IPSS in both sildenafil (B = 0.21 (0.04, 0.37), p = .015) and tadalafil (B = 0.14 (0.02, 0.26), p = .021) regimens with a more prominent role in responsiveness to sildenafil (β = 0.31) compared to tadalafil (β = 0.19).. Considering the significantly better improvement of PVR and IPSS-Qol index with sildenafil, this drug can be nominated as a suitable alternative for tadalafil as a BPH treatment, especially in younger patients who don't have any contraindications.

Topics: Erectile Dysfunction; Humans; Lower Urinary Tract Symptoms; Male; Phosphodiesterase 5 Inhibitors; Prostatic Hyperplasia; Quality of Life; Sildenafil Citrate; Tadalafil; Treatment Outcome; Urinary Retention

To compare the efficacy and safety of sildenafil 25 mg qd, 25 mg bid or 50 mg qd - on treating lower urinary tract symptoms with benign prostatic hyperplasia (LUTS/BPH).. Men aged > 45 years with LUTS/BPH were randomly assigned to receive sildenafil 25 mg qd (n = 42), bid (n = 41), 50 mg qd (n = 38) or placebo (n = 41) for 8 weeks. Changes from baseline in International Prostate Symptom Score (I-PSS), maximum urinary flow rate (Qmax) and postvoid residual urine volume (PVR) were assessed at week 4 and week 8.. Sildenafil 25 mg qd (-7.3 ± 5.8) and 25 mg bid (-7.0 ± 5.7) exhibited significant improvements of I-PSS compared to placebo (-5.2 ± 6.4) (p = 0.020, 0.025, respectively). In particular, voiding domain was more affected than storage domain. Only sildenafil 50 mg qd improved nocturia significantly (versus placebo, p = 0.027). Quality of life score was improved in all treatment groups. Q. Sildenafil 25 mg qd, 25 mg bid and 50 mg qd are safe and effective to improve LUTS/BPH in long term, along with coexisting ED. In particular, nocturia is most well-controlled by 50 mg qd.

Topics: Aged; Analysis of Variance; Double-Blind Method; Erectile Dysfunction; Humans; Male; Middle Aged; Nocturia; Phosphodiesterase 5 Inhibitors; Prostatic Hyperplasia; Quality of Life; Sildenafil Citrate; Urination

High incidences of benign prostatic hyperplasia and lower urinary tract symptoms have a high socioeconomic importance. There are several published studies which have proved the efficiency of phosphodiesterase type 5 inhibitors in treatment of benign prostatic hyperplasia and lower urinary tract symptoms. However, more studies are needed to make this therapy the standard option for treating benign prostatic hyperplasia and lower urinary tract symptoms. This study was aimed at exploring changes in International Prostate Symptom Score, post voiding residuum and maximal urine flow in benign prostatic hyperplasia and lower urinary tract symptoms patients treated by sildenafil for benign prostatic hyperplasia and lower urinary tract symptoms. Matcrial and Methods. This study, which was conducted as a prospective:controlled, opened, randomized study, included 30 patients with benign prostatic hyperplasia and lower urinary tract symptoms. Research was conducted at the Department of Urology, Clinical Center of Vojvodina (November 2011 till November 2012). The inclusion criteria were as following: >45 years of age, International Prostate Symptom Score >3, prostatic specific antigen < l0, normal urinalysis. The patients were periodically tested for International Prostate Symptom Score, maximal urine flow, and post voiding residuum.. Statistically significant changes were found in all pprameters: mean International Prostate Symptom Score value improved from 12.8 to 8.6 (32.8% change), mean post voiding residuum value decreased from 49.4 ml to 40.2 ml (186% change), mean maximal urine flow value increased from 11.8 mI/s to 12.8 mI/s (8.5% change).. Treatment of benign prostatic hyperplasia and lower urinary tract symptoms with a continuous low dose of sildenatil seems to be a good treatment choice for the patients with mild to moderate benign prostatic hyperplasia and lower urinary tract symptoms, especially in the patients with concomitant erectile dysfunction. The authors are aware that their study is limited by a small number of patients. Since there are not too many studies on this topic, they believe that their study will contribute to the determination of place and role of this treatment approach.

Topics: Humans; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Prospective Studies; Prostatic Hyperplasia; Sildenafil Citrate; Treatment Outcome

Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are frequently encountered in ageing males. We compared the efficacy of alfuzosin 10 mg alone or in combination with sildenafil 50 mg in the treatment of LUTS due to benign prostatic hyperplasia. One hundred male patients older than 45 years were randomized to two groups containing 50 patients each; one group receiving alfuzosin 10 mg and the other group alfuzosin 10 mg combined with sildenafil 50 mg. International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Q(max)), prostate volume and post-void residual urine were evaluated. The mean age was 60.2 ± 17.8. Mean data of evaluated parameters in both groups at the end of 3rd month compared with baseline values are given respective order as; 5.1 (26.8%) and 5.8 (28.2%) points decreases in IPSS; 1.6 (41.1%) and 1.8 (45%) points decreases in QoL; and 3.4 (29.6%) and 3.4 (33%) points increases in Q(max) . The outcomes of our study cannot be interpreted in such a way to report that alpha blocker-PDE5 inhibitor combination has a better efficacy than alpha blocker treatment alone in patients with LUTS.

Topics: Adrenergic alpha-1 Receptor Antagonists; Adult; Aged; Drug Therapy, Combination; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Quinazolines; Sildenafil Citrate; Sulfones; Urination Disorders

This study sought to investigate the clinical efficacy and safety of combined oral therapy with sildenafil and doxazosin GITS compared to sildenafil monotherapy in treating Chinese patients with erectile dysfunction (ED) and lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH/LUTS). The trial was conducted in hospitals in Beijing, Shanghai, Changsha, Wuhan and Guangzhou, five major cities in China. A total of 250 patients diagnosed with ED and BPH/LUTS aged 50-75 years, and who had International Index of Erection Function-5 (IIEF-5) scores ≤21 and International Prostate Symptom Score (IPSS) ≥10 points, were enrolled and randomly divided into Group A (168 cases; doxazosin GITS 4 mg once daily plus sildenafil 25-100 mg on demand) and Group B (82 cases; sildenafil 25-100 mg on demand). Efficacies were evaluated by IIEF-5 and IPSS scores and a quality of life (QoL) questionnaire, and adverse effects were evaluated during the treatment period. There were no statistically significant differences in mean age, and IIEF-5, IPSS and QoL scores pre-treatment between the two groups. After treatment, IIEF-5, IPSS and QoL scores were significantly improved in Group A, while only IIEF-5 scores were significantly improved in Group B compared with pre-treatment. There were no significant differences in side effects between the two groups. The results indicated that combined therapy with sildenafil and doxazosin GITS for the treatment of ED and BPH/LUTS is safe and effective compared to sildenafil monotherapy.

Topics: Aged; Asian People; China; Doxazosin; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Prostatic Hyperplasia; Purines; Quality of Life; Sildenafil Citrate; Sulfones; Treatment Outcome; Urination Disorders

To evaluate the acute effects of sildenafil (50 mg) on the micturation of men with erectile dysfunction (ED) and concomitant benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) using uroflowmetric parameters.. A total of 68 male patients randomized into two groups (36 treatment, 32 control groups) with International Prostate Symptom Score (IPSS) greater than 7 and International Index of Erectile Dysfunction-erectile function domain score lower than 26 were enrolled in the study. Patients in the treatment group received a single dose of 50 mg of oral sildenafil. Patients in the control group received no treatment. Prevoiding urine volumes determined ultrasonographically and voided urine volumes were also recorded. Statistical comparisons were made with the use of analysis of variance (ANOVA).. Mean ages were similar between treatment and control groups (60.4 +/- 9.8 and 58.6 +/- 8.3 years, respectively, P = 0.430). In the treatment group the maximum and average flow rates increased significantly (Q (max) from 15.6 +/- 6.8 cc/s to 19.3 +/- 7.2 cc/s, P < 0.0001; Q (avg) from 7.3 +/- 3.0 cc/s to 9.1 +/- 3.0 cc/s, P < 0.0001) with sildenafil administration, while other parameters studied remained unchanged.. Despite the limitations of variations of uroflowmetry, this study showed that sildenafil improves Q (max) and Q (avg) in patients suffering from ED with concomitant BPH-LUTS. Long-term studies are needed to evaluate the effects on IPSS, side effects, and drug interactions.

Topics: Administration, Oral; Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Sildenafil Citrate; Sulfones; Time Factors; Urination; Urodynamics

Erectile dysfunction (ED) has been associated with several comorbidities and can cause significant loss of quality of life and self-esteem.. In men with ED, to use the validated Self-Esteem and Relationship (SEAR) questionnaire to evaluate changes in self-esteem associated with sildenafil treatment of ED and to assess changes dependent on concomitant comorbid conditions.. This was a 14-week, international, randomized, parallel-group, double-blind, flexible-dose (25, 50, or 100 mg), placebo-controlled study of sildenafil in men aged >or=18 years with a clinical diagnosis of ED (score

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Depressive Disorder; Double-Blind Method; Erectile Dysfunction; Expressed Emotion; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Quality of Life; Self Concept; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Young Adult

This pilot study was undertaken to assess the efficacy and safety of the alpha(1)-blocker alfuzosin 10mg once daily (OD), the PDE-5 inhibitor sildenafil 25mg OD, and the combination of both on lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and erectile dysfunction (ED).. Men aged 50-76 yr with previously untreated LUTS and ED were randomized to receive alfuzosin (n=20), sildenafil (n=21), or the combination of both (n=21) for 12 wk. Changes from baseline in International Prostate Symptom Score (IPSS), voiding diary, maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and erectile function domain of the International Index of Erectile Function (IIEF) were assessed at week 12.. Improvement of IPSS was significant with the three treatments but greatest with the combination (-24.1%) compared with alfuzosin (-15.6%) and sildenafil (-11.8%) [corrected] alone (p<0.03). Frequency, nocturia, PVR, and Qmax were significantly improved with alfuzosin only and the combination. Improvement in IIEF was slight with alfuzosin (16.7%), marked with sildenafil (49.7%), and greatest with the combination (58.6%). Likewise, increases in the frequency of penetration (Q3) and of maintained erection (Q4) were greater with the combination therapy (65.2% and 68.2%, respectively) than with sildenafil (41.7% and 59.1%, respectively) and alfuzosin (27.3% and 33.3%, respectively) alone. All three treatments were well tolerated.. In this pilot study, the combination of alfuzosin 10 mg OD and sildenafil 25 mg OD is safe and more effective than monotherapy with either agent to improve both voiding and sexual dysfunction in men with LUTS suggestive of BPH.

Topics: Adrenergic alpha-Antagonists; Aged; Drug Therapy, Combination; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Pilot Projects; Piperazines; Prostatic Hyperplasia; Purines; Quinazolines; Sildenafil Citrate; Sulfones; Treatment Outcome; Urination Disorders

We evaluated sildenafil for erectile dysfunction and lower urinary tract symptoms in men with the 2 conditions.. This was a 12-week, double-blind, placebo controlled study of sildenafil in men 45 years or older who scored 25 or less on the erectile function domain of the International Index of Erectile Function and 12 or greater on the International Prostate Symptom Score. Men with confirmed or suspected prostate malignancy, or prostate specific antigen 10 ng/ml or more were excluded. End points were changes in International Index of Erectile Function domain scores, International Prostate Symptom Score (irritative, obstructive and quality of life), the Benign Prostatic Hyperplasia Impact Index, the Self-Esteem And Relationship questionnaire and Erectile Dysfunction Inventory of Treatment Satisfaction Index Score.. The 189 men receiving sildenafil had significant improvements in erectile function domain score vs the 180 on placebo (9.17 vs 1.86, p<0.0001) and on all other International Index of Erectile Function domains. In men on sildenafil vs placebo significant improvements were observed in International Prostate Symptom Score (-6.32 vs -1.93, p<0.0001), Benign Prostatic Hyperplasia Impact Index (-2.0 vs -0.9, p<0.0001), mean International Prostate Symptom Score quality of life score (-0.97 vs -0.29, p<0.0001) and total Self-Esteem And Relationship questionnaire scores (24.6 vs 4.3, p<0.0001). There was no difference in urinary flow between the groups (p=0.08). Significantly more sildenafil vs placebo treated patients were satisfied with treatment (71.2 vs 41.7, p<0.0001). Sildenafil was well tolerated.. Improved erectile dysfunction and lower urinary tract symptoms with sildenafil in men with the 2 conditions were associated with improved quality of life and treatment satisfaction. Daily dosing with sildenafil may improve lower urinary tract symptoms. However, the lack of effect on urinary flow rates may mean that a new basic pathophysiology paradigm is needed to explain the etiology of lower urinary tract symptoms.

Topics: Aged; Double-Blind Method; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Quality of Life; Sildenafil Citrate; Sulfones; Treatment Outcome; United States; Urination Disorders

Topics: Animals; Carbolines; Cell Division; Dose-Response Relationship, Drug; Double-Blind Method; Humans; Imidazoles; Isometric Contraction; Male; Middle Aged; Muscle, Smooth; Organ Culture Techniques; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Prostate; Prostatic Hyperplasia; Purines; Rats; Sildenafil Citrate; Stromal Cells; Sulfones; Syndrome; Tadalafil; Triazines; Urethra; Urinary Bladder; Vardenafil Dihydrochloride

To evaluate once-daily 100-mg sildenafil for the treatment of erectile dysfunction (ED) in men with ED and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).. This was a 12-week, randomised, double-blind, placebo-controlled (DBPC) trial, with an 8-week open-label (OL) extension, in men > or = 45 years of age who scored < or = 25 on the erectile function (EF) domain of the International Index of Erectile Function (IIEF) and > or = 12 on the International Prostate Symptom Score.. At DBPC end of treatment (EOT), the sildenafil group (n = 189, vs. placebo, n = 180) had improved EF (IIEF), improved emotional well-being [Self-Esteem And Relationship questionnaire (SEAR)], and greater treatment satisfaction (Erectile Dysfunction Inventory of Treatment Satisfaction) (p < 0.0001). At OL EOT, IIEF and SEAR scores improved slightly in the group previously randomised to sildenafil (n = 168), but much more in the group previously randomised to placebo (N = 155), such that total improvement over the 20-week trial was comparable between the groups. Erections at baseline were hard enough for penetration on approximately half of occasions and lasted long enough for successful intercourse on less than one quarter of occasions, increasing at sildenafil DBPC and OL EOT to approximately 90% (penetration) and 80% (intercourse success) vs. 61% (penetration) and 39% (intercourse success) for DBPC placebo. At sildenafil DBPC and OL EOT, > or = 90% of men were taking sildenafil 100 mg. Sildenafil was generally well tolerated.. In this trial of men with ED and BPH-associated LUTS, sildenafil treatment for ED was efficacious, effective and generally well tolerated.

Topics: Aged; Double-Blind Method; Erectile Dysfunction; Humans; Male; Middle Aged; Patient Satisfaction; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Prostatism; Purines; Quality of Life; Self Concept; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome

We measured the detailed hemodynamic effects of tamsulosin and sildenafil separately and together in patients with benign prostatic enlargement.. The supine effects of and responses to passive orthostasis (60 degrees for 8 minutes) were measured in 16 patients with benign prostatic enlargement with the finger blood pressure method and whole-body impedance cardiography. The medications, 100 mg sildenafil (single doses) and 0.4 mg tamsulosin (once daily for up to 14 days), were administered in a randomized, double-blind, crossover fashion.. Supine systolic arterial pressure decreased with sildenafil (mean +/- SEM -11 +/- 2 mm Hg) and sildenafil plus tamsulosin (-14 +/- 2 mm Hg) more than with placebo (-2 +/- 4 mm Hg, p <0.05). In comparison to placebo sildenafil plus tamsulosin decreased the systemic vascular resistance index (328 +/- 129 vs -241 +/- 134 dyn.sec/cm.m, p = 0.01). Tamsulosin alone did not cause any significant changes in comparison to placebo. Heart rate, diastolic arterial pressure, stroke index, cardiac index and arterial pulse wave velocity were not affected to a statistically significant degree by any of the treatments compared to placebo. Upon head-up tilt the drugs caused only 1 significant change in that diastolic arterial pressure was significantly higher (-2.7 vs -8.0 mm Hg, p = 0.04) in the placebo group than in the tamsulosin plus sildenafil group.. Tamsulosin does not disturb hemodynamics in patients with benign prostatic enlargement. Sildenafil decreases blood pressure with the patient supine but not during head-up tilt. The combination treatment also decreases the systemic vascular resistance index in the supine position.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Adrenergic alpha-Antagonists; Aged; Algorithms; Blood Pressure; Cardiography, Impedance; Cross-Over Studies; Double-Blind Method; Drug Therapy, Combination; Heart Rate; Humans; Male; Middle Aged; Piperazines; Prostatic Hyperplasia; Purines; Sildenafil Citrate; Sulfonamides; Sulfones; Tamsulosin; Tilt-Table Test; Vascular Resistance

To explore the possible relationship between erectile dysfunction (ED) and benign prostate hyperplasia (BPH) in men, and to assess the positive effect of Sildenafil on the lower urinary tract symptoms (LUTS) from BPH while treating ED.. Thirty-two patients with ED and BPH were offered oral Sildenafil and reviewed before and six months after the administration of Sildenafil by the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS) questionnaires. Scores were tested by chi-square.. IIEF-5 scores were increased by 42.36% and IPSS scores declined by 20.14%, with statistical significance (P < 0.01).. Treatment of ED with Sildenafil appears to improve urinary symptom scores. A lower IPSS at baseline seems to predict a better response to Sildenafil therapy for ED.

Topics: Aged; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Urination Disorders

The aim of this study was to investigate whether concomitant treatment of dutasteride and sildenafil could prevent structural changes in the penis of a BPH rodent model.. Thirty-two adult male rats were divided into the following groups: Ctrl, untreated control rats; BPH, untreated spontaneously hypertensive rats (SHRs); BPH + D, SHRs treated with dutasteride; and BPH + DS, SHRs treated with dutasteride and sildenafil. All treatments were performed during 40 days, following which the penises were collected for histomorphometrical analysis. The results were compared via one-way ANOVA with Bonferroni's post-test, considering. The smooth muscle density decreased by 28.6% and 21.4% in BPH + D and BPH + DS, respectively, when compared to the BPH group. The sinusoid space density reduced by 32.2% in BPH, when compared to the Ctrl group; this density was also reduced by 22.6% in BPH + D, when compared to the BPH group. The density of the elastic fibers increased 51.6% and 65.6% in BPH + D and BPH + DS, when compared to the BPH group.. Treatment with dutasteride promoted morphological changes in the corpus cavernous of this BPH model. Concomitant treatment with sildenafil did not prevent the morphological changes caused by dutasteride; on the contrary, it also promoted a further increase in elastic fibers.

Topics: 5-alpha Reductase Inhibitors; Animals; Disease Models, Animal; Dutasteride; Humans; Male; Penis; Prostatic Hyperplasia; Rats; Sildenafil Citrate

Drug therapy for lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) is a major and popular method. However, the therapeutic strategy is still not clear enough up to now. The purpose of this study was to compare the relative safety and efficacy of different types of phosphodiesterase type 5 inhibitors (PDE5-Is) with tamsulosin for the treatment of LUTS secondary to BPH.. Databases including PubMed, OpenGrey, Embase, Cochrane Library, and Web of Science will be searched to identify qualified studies. We will use the Stata version 13.0 to conduct the network meta-analysis (NMA) with a random or fixed effects model of Bayesian framework. International prostate symptom score (IPSS), maximum urinary flow fate (Qmax) and their credible intervals (CI) will be used to compare every medical intervention with the efficacy and safety, including sildenafil plus tamsulosin, tadalafil plus tamsulosin, vardenafil plus tamsulosin. And the ranking of probability of different interventions will be estimated by comparing the surface under the cumulative ranking curve (SUCRA).. A high quality-synthesis of the current evidence for comparing with different doses or types of PDE5-Is combined with tamsulosin to the treatment of LUTS secondary to BPH will be provided.. This NMA and systematic review will generate evidence to help choose the best combination for treatment of LUTS secondary to BPH.PROSPERO registration number: PROSPERO CRD 42019139062.

Topics: Adrenergic alpha-1 Receptor Antagonists; Bayes Theorem; Drug Therapy, Combination; Humans; Male; Meta-Analysis as Topic; Network Meta-Analysis; Phosphodiesterase 5 Inhibitors; Prostatic Hyperplasia; Randomized Controlled Trials as Topic; Research Design; Sildenafil Citrate; Systematic Review as Topic; Tadalafil; Tamsulosin; Vardenafil Dihydrochloride

To study the efficacy and safety of using sildenafil in patients with erectile dysfunction (ED) and concomitant cardiovascular diseases (CVD) who underwent transurethral resection of the prostate (TURP).. A total of 59 patients (age from 50 to 75 years) with a diagnosis of benign prostatic hyperplasia (BPH), requiring surgical treatment due to inefficiency of drug therapy, I-PSS score more than 20 points), who were sexually active, but had erectile dysfunction (IIEF score < 21), coronary heart disease (NYHA class I) and stage 1-2 hypertension with stable blood pressure. All patients underwent bipolar TURP. From the first day after the TURP, therapy was prescribed as following: tamsulosin 0.4 mg once a day for 90 days, ciprofloxacin 500 mg twice a day for 10 days. In addition, the patients received treatment for comorbidities. In the main group (n=30), men additionally received sildenafil (EFFEX Sildenafil Evalar) 50 mg daily for 60 days, starting from the 30th day postoperatively. We have chosen this drug from an economic standpoint.. At baseline, all patients in both groups had hemodynamic and microcirculatory disorders in the prostate, which got worse in the early postoperative period. During the long-term follow-up, hemodynamic and microcirculatory impairments decreased. This effect was more pronounced in patients who received sildenafil. In addition, patients had an improvement in sexual function. During follow-up, there was no adverse effects of sildenafil on hemodynamic parameters (blood pressure, heart rate).. Our results allow to recommend sildenafil in order to restore sexual function postoperatively in patients with BPH, including those with concomitant cardiovascular disorders.

Topics: Erectile Dysfunction; Humans; Male; Microcirculation; Prostatic Hyperplasia; Sildenafil Citrate; Transurethral Resection of Prostate; Treatment Outcome

We present a case of priapism in a homeless patient with a psychiatric history of major depression, PTSD, polysubstance abuse (alcohol and cocaine) and past psychotropic medication use who was admitted to a local hospital for suicidal ideation. Priapism is a serious urological and a medical emergency which has often been associated with psychotropic medications (including the antidepressant trazodone), use of marijuana and alcohol, and other factors. This clinical case highlights the additive risks of medications and comorbid conditions in contributing to onset of priapism, emphasizing the importance of any pre-existing medical illness, diagnoses, and comorbid mental illnesses. Moreover, clinicians should consider potential side effects of all medications used and their drug interactions as they manage patients who develop this condition.

Topics: Adrenergic alpha-1 Receptor Antagonists; Depressive Disorder, Major; Hepatitis C; Humans; Male; Middle Aged; Phenylephrine; Phosphodiesterase 5 Inhibitors; Priapism; Prostatic Hyperplasia; Selective Serotonin Reuptake Inhibitors; Sildenafil Citrate; Sleep Initiation and Maintenance Disorders; Substance-Related Disorders; Sulfonamides; Tamsulosin; Trazodone; Vasoconstrictor Agents

This paper describes our recent efforts to design and synthesise potent and selective PDE5 inhibitors and the use of in vitro predictors of clearance, absorption and permeability to maximise the potential for dose-proportional pharmacokinetics and good oral bioavailability in man. Optimisation of the preclinical profile resulted in the identification of UK-369003 (19a) and its nomination as a clinical candidate. The clinical pharmacokinetic and safety profile has enabled us to progress the compound to test its efficacy in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and a paper describing its efficacy has recently been published.

Topics: Administration, Oral; Biological Availability; Cell Line; Cyclic Nucleotide Phosphodiesterases, Type 5; Drug Evaluation, Preclinical; Enzyme Activation; Humans; Lower Urinary Tract Symptoms; Male; Phosphodiesterase 5 Inhibitors; Prostatic Hyperplasia; Pyrimidinones; Sulfonamides

Topics: 5-alpha Reductase Inhibitors; Adrenergic alpha-1 Receptor Antagonists; Drug Synergism; Enzyme Inhibitors; Finasteride; Humans; Imidazoles; Male; Piperazines; Prostatic Hyperplasia; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Triazines; Vardenafil Dihydrochloride; Vasodilator Agents

To investigate the effect of sildenafil on uroflowmetry values of patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic enlargement (BPE).. Thirty-eight consecutive patients and 15 control subjects without voiding symptoms were enrolled in the study. All patients underwent uroflowmetry testing thrice on different occasions. The highest maximum urinary flow rate (Q(max)) values with a sufficient voided volume (> or =150 ml) were evaluated. The patients and controls were seen the day after the initial uroflowmetry measurements and were given 100 mg sildenafil. Afterwards uroflowmetry was repeated. The uroflowmetry values of both groups before and after sildenafil were compared.. Of the 38 patients, 29 (76%) showed improvement in flow rates. The mean Q(max) was 11.4 +/- 0.39 and 15.7 +/- 0.74 ml/s before and after sildenafil, respectively (p < 0.0001). The mean percentage difference in Q(max) was +38% higher after sildenafil. The mean average flow rate (Q(ave)) and the mean voiding time values were also significantly improved. The mean voided volumes of the patients before and after sildenafil were 241 +/- 78 and 264 +/- 72 ml, respectively (p = 0.07). There were no significant differences in the Q(max), Q(ave) and voided volumes of the control group.. Sildenafil exhibits a significant improvement in Q(max) and Q(ave) rates in men with LUTS.

Topics: Aged; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Pilot Projects; Piperazines; Prostatic Hyperplasia; Prostatism; Purines; Sildenafil Citrate; Sulfones; Urodynamics

Topics: Adrenergic alpha-Antagonists; Age Factors; Aged; Drug Therapy, Combination; Enzyme Inhibitors; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Prevalence; Prostatic Hyperplasia; Purines; Quality of Life; Quinazolines; Risk Factors; Sildenafil Citrate; Sulfones; Urination Disorders

Topics: Actins; Adrenergic alpha-Antagonists; Aged; Animals; Blotting, Western; Cyclic GMP; Cyclic GMP-Dependent Protein Kinases; Doxazosin; Humans; Immunohistochemistry; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostate; Prostatic Hyperplasia; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones

Topics: Erectile Dysfunction; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Randomized Controlled Trials as Topic; Sildenafil Citrate; Sulfones; Urination Disorders

Topics: Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Randomized Controlled Trials as Topic; Sildenafil Citrate; Sulfones; Urinary Bladder Neck Obstruction

New therapeutic targets in benign prostatic hyperplasia (BPH) mainly concern phosphodiesterase type 5 (PDE-5) inhibitors. The effects of PDE-5 inhibitors in the treatment of lower urinary tract symptoms (LUTS) related to BPH appear to be related to their pathophysiological action on detrusor and prostatic muscle cell contraction and relaxation. Several fundamental studies have been conducted to precisely investigate and describe the pharmacological mechanisms of PDE-5 inhibitors and have shown that they reduce the contraction of prostatic cells submitted to various types of contractile stimuli in vitro. These dose-dependent effects are increased in combination with an alpha1-blocker and may constitute an additional therapeutic solution for the treatment of LUTS in the near future.

Topics: Colforsin; Humans; Male; Muscle Contraction; Muscle, Skeletal; Phenylephrine; Piperazines; Prostatic Hyperplasia; Purines; Rolipram; Sildenafil Citrate; Sulfones

To evaluate the potential of sildenafil, vardenafil and tadalafil, all phosphodiesterase-5 (PDE-5) inhibitors used for treating erectile dysfunction, for treating benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS).. The mRNA expression of the PDE-5 was determined in rat LUT tissues. The PDE-5 inhibitors were also tested in organ-bath experiments and in a partial bladder outlet obstruction (BOO) rat model in vivo.. The highest PDE-5 mRNA expression was in the bladder, followed by the urethra and prostate. PDE-5 inhibitors dose-dependently reduced the contraction of the isolated bladder, urethral and prostate strips. The rank order of potency was vardenafil > sildenafil > tadalafil. In human prostate stromal cells vardenafil inhibited cell proliferation and was more effective than tadalafil and sildenafil. In the BOO model, there was a reduction in the non-voiding contractions after bolus intravenous administration of 3 mg/kg sildenafil and vardenafil.. These results show that PDE-5 is expressed in LUT tissues. PDE-5 inhibitors induced significant relaxation of these tissues, inhibited the proliferation of human prostate stromal cells and reduced the irritative symptoms of BPH/LUTS in vivo. Therefore, PDE-5 inhibitors could be used as an effective treatment for BPH/LUTS.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Animals; Carbolines; Cyclic Nucleotide Phosphodiesterases, Type 5; Imidazoles; Male; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Prostatism; Purines; Rats; Rats, Sprague-Dawley; RNA, Messenger; Sildenafil Citrate; Sulfones; Tadalafil; Treatment Outcome; Triazines; Vardenafil Dihydrochloride

To compare the direct relaxant effects of alfuzosin, phentolamine and sildenafil in rabbit isolated corpus cavernosum (CC) pre-contracted with phenylephrine or KCl.. Penile erectile tissue was obtained from male New Zealand White rabbits (22-26 weeks old). The CC was cut into longitudinal strips and mounted under 2 g resting tension in 5-mL jacketed organ baths containing a modified Krebs solution bubbled with 95% O2, 5% CO2 and maintained at 37 degrees C. Tissue strips were pre-contracted by 60 mmol/L KCl or 10 micro mol/L phenylephrine. After obtaining a stable plateau of contractions, test compounds were added to the organ bath. The relaxant potencies were expressed as the percentage of inhibition of the plateau of contraction induced by 10 micro mol/L phenylephrine.. Alfuzosin showed a concentration-dependent relaxing effect on rabbit CC pre-contracted by 10 micro mol/L phenylephrine, with a mean (sd) pIC50 of 7.64 (0.06). The relaxant effect was unaffected by pre-incubation with 100 micro mol/L Nomega-nitro-l-arginine methyl ester (L-NAME). Phentolamine had a potency similar to alfuzosin, with a pIC50 of 7.44 (0.08). Both alfuzosin and phentolamine were completely ineffective on the plateau of contraction induced by 60 mmol/L KCl. In contrast to alfuzosin, sildenafil was equipotent in relaxing the rabbit CC against each contractile agent, with pIC50 values of 7.25 (0.09) and 7.23 (0.22) with 10 micro mol/L phenylephrine and 60 mmol/L KCl, respectively. The relaxant response to sildenafil was partly blocked by pretreatment with 100 micro mol/L L-NAME, with pIC50 values of 7.94 (0.09) and 6.63 (0.32) without and with L-NAME, respectively. Sildenafil, incubated for 45 min at 10 micro mol/L, had no relaxant effect on the resting tension of the preparation or on the concentration-response curve to phenylephrine.. The direct relaxant effect of alfuzosin is mediated through alpha1-adrenoceptor blockade. The relaxations induced by phentolamine and alfuzosin are independent of nitric oxide, whereas those induced by sildenafil are, at least partly, sensitive to L-NAME and a selective soluble guanylate cyclase inhibitor, indicating the involvement of nitric oxide and soluble guanylate cyclase. Alfuzosin and phentolamine effectively counteract alpha1-adrenoceptor-mediated contractions of rabbit CC. If valid for human CC, such an effect may contribute to an improved erectile function in patients treated for benign prostatic hyperplasia.

Topics: Adrenergic alpha-Antagonists; Animals; Erectile Dysfunction; Male; Muscle Relaxation; Penile Erection; Phentolamine; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Quinazolines; Rabbits; Sildenafil Citrate; Sulfones

To assess the possible relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in men, and whether treatment of their ED with sildenafil influences their LUTS.. In all, 112 men with ED attending the andrology outpatient clinic were offered oral sildenafil and reviewed 1 and 3 months after treatment. They completed the International Index of Erectile Function and the International Prostate Symptom Score (IPSS) questionnaires at baseline and each review. Scores were designated to indicate the visit number and differences between the visits calculated.. A third of the men had an initial IPSS of > 7; there was no relationship between baseline urinary and sexual function scores. After treatment with sildenafil, the urinary scores at 3 months correlated strongly with the sexual function scores. There was a significant inverse relationship between the baseline IPSS and sexual function scores after treatment. The overall trend in the IPSS was towards improvement after treatment with sildenafil.. In men with ED there is no relationship between sexual function scores and urinary symptom scores before treating ED. Treatment with sildenafil appears to improve urinary symptom scores. A lower IPSS at baseline appears to predict a better response to ED therapy with sildenafil.

Topics: Administration, Oral; Erectile Dysfunction; Humans; Male; Piperazines; Prospective Studies; Prostatic Hyperplasia; Purines; Quality of Life; Sildenafil Citrate; Sulfones; Treatment Outcome; Urologic Diseases; Vasodilator Agents

The endogenous substance lysophosphatidic acid (LPA) has been found to generate proliferation of cultured smooth muscle cells (SMC). Therefore, the effect of LPA on human benign prostate hyperplasia (BPH) could be of interest.. The proliferative effect of LPA on cultured human prostatic SMC from specimens obtained at trans-urethral resection of the prostate (TURP) because of BPH, was analyzed by [3H]-thymidine and [35S]-methionine incorporation. In addition, LPA stimulated BPH SMC were treated with papaverin, forskolin, sildenafil or zaprinast, well known to increase the intracellular level of cAMP or cGMP.. LPA produced a dose-dependent increase in BPH SMC, both regarding DNA- and protein-synthesis with EC50 values of 3 and 10 microM, respectively. Furthermore, both papaverin, a general phosphodiesterase inhibitor regarding cAMP hydrolyzes, and forskolin, an adenylyl cyclase stimulating agent, inhibited the LPA-stimulated DNA replication in a dose dependent manner with IC50 = 2.5, and 0.35 microM, respectively. cGMP increasing agents, such as the NO-donors SIN-1 and SNAP, produced a weak anti-proliferative response. However, both phosphodiesterase 5 inhibitors sildenafil (Viagra) and zaprinast efficiently blocked DNA replication. In addition, when the protein synthesis was examined, we found that the LPA response was significantly inhibited by forskolin and papaverin.. The major conclusion of this investigation is that the endogenous serum component LPA, is able to promote human BPH SMC growth. In addition, our study indicates that cyclic nucleotides can inhibit this effect. Future clinical studies will be needed to determine if different specific phosphodiesterase inhibitors per se or in combination could represent a new therapeutic possibility for the treatment of BPH.

Topics: Cell Division; Cells, Cultured; Colforsin; Cyclic AMP; Cyclic GMP; DNA; Dose-Response Relationship, Drug; Growth Inhibitors; Humans; Lysophospholipids; Male; Muscle, Smooth; Papaverine; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Protein Biosynthesis; Proteins; Purines; Purinones; Sildenafil Citrate; Stimulation, Chemical; Sulfones

Topics: Circumcision, Male; Enzyme Inhibitors; Erectile Dysfunction; Finasteride; Humans; Male; Mass Screening; Pain; Piperazines; Plant Extracts; Prostatic Hyperplasia; Prostatic Neoplasms; Purines; Serenoa; Sildenafil Citrate; Sulfones; Urology