Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
Eur Urol. 2011 Sep;60(3):527-35. doi: 10.1016/j.eururo.2011.05.054. Epub 2011 Jun 12.
A large body of epidemiologic data suggests a causal relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Recently reported studies on phosphodiesterase type 5 inhibitors (PDE5-Is) and LUTS have further contributed to the understanding of mechanisms involved in this relationship and of potential treatment options.
A nonsystematic descriptive review was performed to summarize the literature concerning the role of PDE5-Is in men with LUTS, particularly looking at data derived from clinical trials in relation to the different PDE5-Is or their association with α-blockers.
A comprehensive electronic search was conducted in October 2010 using the Medline database to identify all publications relating to ED and BPH and treatment with sildenafil, vardenafil, tadalafil, udenafil, UK-369003, and combination therapy with alfuzosin and tamsulosin.
In studies in which either ED or LUTS was the entry criterion, sildenafil appears to improve both erectile function and LUTS in subjects with ED. Placebo-controlled trials of tadalafil and vardenafil showed improvement of LUTS secondary to benign prostatic hyperplasia (BPH), but none of the studies showed a significant effect on urodynamic measures. Exploratory studies with UK-369003 showed improvements in LUTS and ED. Sildenafil or tadalafil associated with alfuzosin or tamsulosin showed greater benefits for the combination therapy for both LUTS and ED. The coadministration of udenafil and an α-blocker in patients with BPH and ED also appeared to improve both LUTS and ED severity.
Consistent evidence of improvements in LUTS has been shown with PDE5-Is, either alone or in combination with α-blockers. However, effects on urodynamics or objective measures of urinary flow are lacking. Further areas of research include investigation of mechanism of PDE5-Is, urodynamic studies, identification of new efficacy end points, head-to-head comparison with standard of care, potential benefit of add-on treatment, and long-term outcomes.
大量的流行病学数据表明，下尿路症状（LUTS）与勃起功能障碍（ED）之间存在因果关系。最近关于磷酸二酯酶 5 抑制剂（PDE5-Is）和 LUTS 的报告研究进一步加深了我们对这种关系的机制以及潜在治疗方法的理解。
进行了非系统性描述性综述，以总结有关 PDE5-Is 在 LUTS 男性中的作用的文献，特别是查看临床试验数据中得出的与不同 PDE5-Is 或它们与 α 阻滞剂的关联相关的数据。
2010 年 10 月，使用 Medline 数据库进行了全面的电子搜索，以确定与 ED 和 BPH 相关以及与西地那非、伐地那非、他达拉非、乌地那非、UK-369003 治疗和与阿夫唑嗪和坦索罗辛联合治疗相关的所有出版物。
在以 ED 或 LUTS 为入选标准的研究中，西地那非似乎可改善 ED 患者的勃起功能和 LUTS。他达拉非和伐地那非的安慰剂对照试验显示良性前列腺增生（BPH）继发的 LUTS 改善，但没有研究显示对尿动力学指标有显著影响。UK-369003 的探索性研究显示 LUTS 和 ED 改善。西地那非或他达拉非联合阿夫唑嗪或坦索罗辛显示对 LUTS 和 ED 的联合治疗有更大益处。在患有 BPH 和 ED 的患者中联合应用乌地那非和 α 阻滞剂似乎也改善了 LUTS 和 ED 的严重程度。
已经证明 PDE5-Is 单独或与 α 阻滞剂联合使用可改善 LUTS，但是缺乏对尿动力学或客观尿流测量的影响。进一步的研究领域包括 PDE5-Is 机制的研究、尿动力学研究、新疗效终点的确定、与标准治疗的头对头比较、附加治疗的潜在益处以及长期结果。
