Review
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World J Clin Urol. Nov 24, 2014; 3(3): 249-257
Published online Nov 24, 2014. doi: 10.5410/wjcu.v3.i3.249
Phosphodiesterase inhibitors for treatment of voiding dysfunction: An overview of experimental and clinical evidence
Ricardo Reges, Rommel Prata Regadas, João Batista Gadelha Cerqueira, Lúcio Flávio Gonzaga-Silva
Ricardo Reges, Rommel Prata Regadas, João Batista Gadelha Cerqueira, Lúcio Flávio Gonzaga-Silva, Division of Urology, Universidade Federal of Ceara, Fortaleza, Ceara 60160-070, Brazil
Author contributions: Reges R and Regadas RP substantially contributed to conception and design, acquisition of data, analysis and interpretation of data; Reges R and Regadas RP drafted the article and revised it critically for important intellectual content; Reges R, Cerqueira JBG and Gonzaga-Silva LF approved the final version to be published.
Correspondence to: Ricardo Reges, MD, PhD, Division of Urology, Universidade Federal of Ceara, Antonele Bezerra st. Ap 1501. Meireles, Fortaleza, Ceara 60160-070, Brazil. consultoriodeurologia@gmail.com
Telephone: +55-85-32623730
Received: April 28, 2014
Revised: June 14, 2014
Accepted: July 17, 2014
Published online: November 24, 2014
Processing time: 204 Days and 19.3 Hours
Abstract

Recently, the focus of the origin of lower urinary tract symptoms (LUTS) has change from the prostate to the bladder. Regardless of the underlying mechanism associated with the origin of LUTS, alpha-blockers continue to be the most common medicine prescribed to treat LUTS due to benign prostatic obstruction (BPO). The newest class of drug introduced to treat LUTS/BPO is phosphodiesterase inhibitors (PDEi) and the aim of this study was to review the role of PDEi in the treatment of LUTS/BPO. In this review, the first evidence was evaluated based on epidemiological studies followed by randomized clinical trials which provide evidence on the administration of PDEi in patients with LUTS/BPO. Experimental studies were also assessed to tentatively elucidate the association between LUTS and erectile dysfunction, and to elucidate the underlying mechanism. There is still controversy regarding the administration of PDEi due to the fear of detrusor impairment, response to acute administration, and the effects of PDEi combined with alpha-blockers. Following this review, we conclude that treatment of BPO/LUTS with PDEi is beneficial, based on experimental studies, strong evidence and the large number of randomized clinical trials confirming their efficiency.

Keywords: Benign prostatic hyperplasia; Lower urinary tract symptoms; Phosphodiesterase inhibitor; Mechanism of action; Urodynamics

Core tip: In this study, an extensive review was performed on the use of phosphodiesterase inhibitors to treat lower urinary symptoms due to benign prostatic obstruction. This study explored experimental and recent clinical evidence in order to assist in the decision-making process in daily practice.