Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Feb 6, 2015; 4(1): 138-147
Published online Feb 6, 2015. doi: 10.5527/wjn.v4.i1.138
Are phosphodiesterase type 5 inhibitors effective for the management of lower urinary symptoms suggestive of benign prostatic hyperplasia?
Li Tao Zhang, Jong Kwan Park
Li Tao Zhang, Jong Kwan Park, Department of Urology, Chonbuk National University of Medical School, Jeonju-si 561-180, South Korea
Jong Kwan Park, Department of Urology, Biomedical Research Institute and Clinical Trial Center for Medical Devices of Chonbuk National University Hospital, Jeonju-si 561-180, South Korea
Author contributions: Zhang LT and Park JK contributed to this paper.
Supported by The Korea Health Technology R and D Project through the Korea Health Industry Development Institute (KHIDI); by the Ministry of Health and Welfare, South Korea, No. HI13C0104.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jong Kwan Park, MD, PhD, Department of Urology, Biomedical Research Institute and Clinical Trial Center for Medical Devices of Chonbuk National University Hospital, Gungiro, deokjin-gu, Jeonju-si 516-180, Jeollabuk-do, South Korea. rain@chonbuk.ac.kr
Telephone: +82-63-2501510 Fax: +82-63-2501564
Received: April 18, 2014
Peer-review started: April 19, 2014
First decision: July 10, 2014
Revised: September 15, 2014
Accepted: October 1, 2014
Article in press: October 10, 2014
Published online: February 6, 2015
Processing time: 294 Days and 18.4 Hours
Abstract

AIM: To review the efficacy of phosphodiesterase type 5 inhibitors (PDE5-Is) in lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (LUTS/BPH).

METHODS: A comprehensive research was conducted to identify all publications relating to benign prostate hyperplasia and treatment with sildenafil, vardenafil and tadalafil. To assess the efficacy, the changes in total international prostate symptom score (IPSS), IPSS subscore including voiding, storage and quality of life (QoL), Benign prostatic hyperplasia Impact Index (BII), maximum urinary flow rate (Qmax) and the International Index of Erectile Function (IIEF) were extracted. A meta-analytical technique was used for the analysis of integrated data from the included studies to evaluate the mean difference in the results.

RESULTS: Total IPSS score, IIEF and BII showed a significant improvement in trials in which LUTS/BPH with or without erectile dysfunction (ED) were compared with the placebo. For LUTS/BPH, the mean differences of total IPSS score, IIEF and BII are -2.17, 4.88 and -0.43, P < 0.00001, respectively. For LUTS/BPH with comorbid ED, the mean difference are -1.97, 4.54 and -0.52, P < 0.00001, respectively. PDE5-Is appear to improve IPSS storage, voiding and QoL subscore (mean difference = -0.71, -1.23 and -0.33, P < 0.00001, respectively). Although four doses of tadalafil (2.5, 5, 10 and 20 mg) failed to reach significance in Qmax (mean difference = 0.22, P = 0.10), the 5 mg dose of tadalafil significantly improved the Qmax (mean difference = 0.33, P = 0.03).

CONCLUSION: PED5-Is demonstrated efficacy for improving LUTS in BPH patients with or without ED and could be considered to be the first line treatment for LUTS/BPH.

Keywords: Phosphodiesterase type 5; Inhibitor; Lower urinary tract symptoms; Benign prostate hyperplasia; Tadalafil

Core tip: The efficacy of phosphodiesterase type 5 inhibitor (PDE5-I) in patients with lower urinary tract symptoms (LUTS) and benign prostate hyperplasia (BPH) has been evaluated and prescribed. Regardless of the significant improvement of total International Prostate Symptom Score and storage subscore, there are controversies about the urine flow rate. Also, we do not know the exact mechanism of how it works in the lower urinary tract. From the meta-analytical data, PDE5-I could be an alternative therapy for LUTS/BPH patients whether or not they have erectile dysfunction. Therefore, well designed large scale clinical trials are required to clarify the efficacy and action mechanisms of PDE5-Is in the management of LUTS/BPH.