UCO di Radiologia, Università di Trieste, Ospedale di Cattinara, Trieste, Italy.
Radiol Med. 2009 Oct;114(7):1106-14. doi: 10.1007/s11547-009-0449-8. Epub 2009 Aug 20.
Phosphodiesterase-5 (PDE-5) inhibitors have an established role in the treatment of erectile dysfunction, but there is increasing evidence that these drugs are effective also for the treatment of lower urinary tract symptoms and benign prostatic hyperplasia (BPH). The mechanism of action of PDE-5 inhibitors in the prostate, however, is poorly understood. It is conceivable that these drugs act by reducing the smooth muscle tone of the organ, but this effect could produce vascular changes as well. The aim of this study was to investigate whether administration of Tadalafil, a PDE-5 inhibitor, in patients with BPH produces haemodynamic changes in the prostate that can be assessed using contrast-enhanced US (CEUS).
Twelve consecutive patients with BPH underwent transrectal CEUS before and 90 min after administration of 20 mg Tadalafil. CEUS was performed during bolus injection of SonoVue (4.8 ml) using a nondestructive US mode. The same scan plane, imaging parameters and technique were used before and after Tadalafil administration. Digital clips were recorded and processed using dedicated software (QontraXt v.3.60. Signal intensity (SI) changes in a region of interest (ROI) encompassing the entire prostate were fitted to a gammavariate curve. Changes in enhancement peak, time to peak (TTP), sharpness of the bolus transit and area under the curve (AUC) were considered for further analysis.
After Tadalafil administration, the enhancement peak and AUC increased significantly (p<0.01), reflecting changes in prostate vascularity. TTP and sharpness did not change significantly.
In patients with BPH, vascular changes are observed in the prostate after Tadalafil administration, which can be detected with CEUS.
磷酸二酯酶-5（PDE-5）抑制剂在治疗勃起功能障碍方面已有明确的作用，但越来越多的证据表明，这些药物对治疗下尿路症状和良性前列腺增生（BPH）也有效。然而，PDE-5 抑制剂在前列腺中的作用机制知之甚少。可以想象，这些药物通过降低器官的平滑肌张力起作用，但这种作用也可能产生血管变化。本研究旨在探讨在 BPH 患者中给予 PDE-5 抑制剂他达拉非是否会导致前列腺产生可以使用对比增强超声（CEUS）评估的血液动力学变化。
12 例连续的 BPH 患者在给予 20mg 他达拉非之前和之后 90 分钟接受经直肠 CEUS。使用非破坏性超声模式在 SonoVue（4.8ml）推注期间进行 CEUS。在给予他达拉非之前和之后使用相同的扫描平面、成像参数和技术。使用专用软件（QontraXt v.3.60）记录和处理数字剪辑。记录包含整个前列腺的感兴趣区域（ROI）的信号强度（SI）变化拟合到伽马变量曲线。进一步分析增强峰值、达峰时间（TTP）、造影剂团注通过的锐利度和曲线下面积（AUC）的变化。
给予他达拉非后，增强峰值和 AUC 显著增加（p<0.01），反映了前列腺血管生成的变化。TTP 和锐利度没有显著变化。
在 BPH 患者中，给予他达拉非后观察到前列腺中的血管变化，可通过 CEUS 检测到。
