Microvascular dysfunction and efficacy of PDE5 inhibitors in BPH-LUTS

Area of Science:

• Urology
• Andrology
• Vascular Biology

Background:

• Benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) frequently coexist in aging men.
• Both conditions have shown responsiveness to phosphodiesterase (PDE) 5 inhibitors, indicating a potential shared underlying pathophysiology.

Approach:

• This review synthesizes preclinical and clinical evidence supporting a unified hypothesis for BPH-LUTS and ED.
• The proposed mechanism centers on microvascular dysfunction within pelvic organs, encompassing both the penis and lower urinary tract.

Key Points:

• Microvascular dysfunction involves a cycle of endothelial and neural impairment, leading to hypoxia, vasoconstriction, and smooth muscle dysfunction.
• Autonomic neurons and ganglia degeneration is implicated in the progression of both BPH-LUTS and ED.
• This hypothesis provides a cohesive explanation for existing research findings on these prevalent conditions.

Conclusions:

• The shared pathophysiological basis of BPH-LUTS and ED, driven by pelvic microvascular dysfunction, warrants further investigation.
• Phosphodiesterase (PDE) 5 inhibitors represent a promising therapeutic avenue for addressing the complex interplay between these conditions.