Phosphodiesterase-5 inhibitors and benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is prevalent in old men and often results in lower urinary tract symptoms (LUTS). Phosphodiesterase-5 (PDE5) inhibitors increase intracellular concentrations of cyclic guanosine monophosphate. PDE5 inhibitors (sildenafil, tadalafil, vardenafil, etc.) are first-line treatments for erectile dysfunction. Recently, PDE5 inhibitors have been found to regulate smooth muscle tone in human prostate. This article focuses on the use of PDE5 inhibitors for BPH/LUTS treatment and highlights the clinical significance.

Preclinical and clinical studies have provided promising evidence that PDE5 inhibitors may be an effective and well tolerated treatment option for BPH/LUTS. Combination therapy using PDE5 inhibitors and alpha1-adrenergic blockers resulted in greater improvements in BPH/LUTS than did either drug alone.

There has been increasing interest in the use of PDE5 inhibitors to treat BPH/LUTS. Combination of PDE5 inhibitors and alpha1-adrenergic blockers may have an additive beneficial effect on BPH/LUTS compared with monotherapy. Mechanisms of action of nitric oxide/cyclic guanosine monophosphate/PDE5 pathway in the treatment of BPH/LUTS deserve further investigations. Larger-scale, well designed clinical trials in future are needed to ascertain the safety, efficacy and cost-effectiveness of PDE5 inhibitors in the treatment of LUTS secondary to BPH.