Tuesday, September 18, 2012

Medical Management of Comorbid BPH/LUTS and ED: Defining the Current Treatment Algorithm part 5

Which of the following has been shown to improve BPH/LUTS?
All of the above

In systematic data analyses, symptoms improved with agents from all 3 classes approved for BPH/LUTS treatment, with 30% to 45% improved symptom scores with α1-adrenoceptor antagonists. Greater improvements in urinary flow rates were observed with α1-adrenoceptor antagonists (15% to 30%) and 5α-reductase inhibitors (5ARIs). PDE5 inhibitors did not produce statistically significant increases in flow rates compared to placebo, and 5ARIs resulted in reduced risk of BPH-related surgery (48% to 57%) and acute urinary retention (55% to 57%).
In systematic reviews with α1-adrenoceptor antagonists and 5ARIs, sexual AEs were reported most commonly, including abnormal ejaculation greatly associated with α1-adrenoceptor antagonists (particularly tamsulosin) and diminished libido, impotence, and ejaculatory disorder in 2% to 14% with 5ARI treatment. PDE5 inhibitors were associated with headache (3.7%) and back pain (3.1%).

Treatment Plan

Initiate daily PDE5 inhibitor therapy (tadalafil 5 mg) to improve concomitant BPH/LUTS and ED symptoms.


By the 3-month follow-up visit, the patient's ED and BPH had responded to daily tadalafil.



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