PHARMACOTHERAPY IN PATIENTS WITH ERECTILE DYSFUNCTION AND BENIGN PROSTATIC HYPERPLASIA IN THE ABSENCE OF RISK OF DISEASE PROGRESSION
https://doi.org/10.17709/2409-2231-2018-5-1-2
Abstract
Purpose. Evaluation of the effectiveness and safety of various pharmacotherapy options in patients with erectile dysfunction (ED) in combination with benign prostatic hyperplasia (BPH).
Materials and methods. In 127 men with BPH and ED, pharmacotherapy was performed for 3–12 months. Inclusion criteria: IPSS ≥8 points, IIEF-5 ≤21 points, prostate volume ≤40 cm3, prostatic specific antigen (PSA) level <1.5 ng/ml. In patients who are interested in improving erectile function, the following treatment options have been performed: monotherapy with tamsulosin 0.4 mg daily (n = 30), sildenafil monotherapy 25 mg daily (n = 31), tamsulosin 0.4 mg daily and sildenafil 25 mg daily (n = 34).
Results. With combined therapy, statistically significant and most pronounced improvement occurred at all time points for all 5 parameters: IPSS, QoL, IIEF-5, maximum urination rate (Qmax), residual urine volume. Monotherapy with α1-adrenoblocker at all times led to a significant improvement in 4 parameters (IPSS, QoL, Qmax, residual urine volume), but had no effect on erectile function. Monotherapy with a phosphodiesterase type 5 inhibitor (PDE-5) improved IIEF-5 from the very beginning, and the remaining parameters (IPSS, QoL, Qmax, residual urine volume) after 6 months.
Conclusions. The combination of α1-adrenoblocker and PDE-5 inhibitor can be considered as an optimal treatment option in patients with LUTS and ED with prostate volume <40 cm3 and PSA level <1.5 ng/ml.
About the Authors
A. A. Kamalov
Lomonosov Moscow State University
Russian Federation
Russian Federation
Armais A. Kamalov - Academician of RAS, MD, PhD, DSc, head of the department of urology and andrology of the faculty of fundamental medicine.
GSP-1, Leninskie Gory, Moscow 119991
A. M. Tahirzade
Lomonosov Moscow State University
Russian Federation
Russian Federation
Anar M. Tahirzade - postgraduate student of the department of urology and andrology of the faculty of fundamental medicine.
GSP-1, Leninskie Gory, Moscow 119991
References
1. Verhamme KM, Dieleman JP, Bleumink GS, van der Lei J, Sturkenboom MC, Artibani W, et al. Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care — the Triumph project. Eur Urol. 2002 Oct;42 (4):323–8. DOI: https://doi.org/10.1016/S0302–2838(02)00354–8
2. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the‘Cologne Male Survey’. Int J Impot Res. 2000 Dec;12 (6):305–11. DOI: 10.1038/sj.ijir.3900622
3. Korneev IA, Alekseeva TA, Kogan MI, Pushkar’ DYu. Epidemiology of urinary disorders in men in the Russian Federation. Urology. 2016;2 (S2):70–5. (In Russian).
4. Pushkar DYu, Kamalov AA, Al-Shukri SKh, Erkovich AA, Kogan MI, Pavlov VN, et al. Analysis of the results of epidemiological study on prevalence of erectile dysfunction in the Russian Federation. Urology. 2012;6:5–9. (In Russian).
5. Corona G, Gacci M, Maseroli E, Rastrelli G, Vignozzi L, Sforza A, et al. Clinical correlates of enlarged prostate size in subjects with sexual dysfunction. Asian J Androl. 2014 Sep-Oct;16 (5):767–73. DOI: 10.4103/1008–682X.126382
6. Gacci M, Eardley I, Giuliano F, Hatzichristou D, Kaplan SA, Maggi M, et al. Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2011 Oct;60 (4):809–25. DOI: 10.1016/j.eururo.2011.06.037
7. Kardasevic A, Milicevic S. The Correlation Between Prostate Volume in Patients with Benign Prostatic Hyperplasia in Relation to Erectile Dysfunction. Med Arch. 2016 Dec;70 (6):449– 452. DOI: 10.5455/medarh.2016.70.449–452
8. Kirby M, Chapple C, Jackson G, Eardley I, Edwards D, Hacke™ G, et al. Erectile dysfunction and lower urinary tract symptoms: a consensus on the importance of co-diagnosis. Int J Clin Pract. 2013 Jul;67 (7):606–18. Doi: 10.1111/ijcp.12176
9. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol. 2003 Dec;44 (6):637–49. DOI:htt ps://doi.org/10.1016/j.eururo.2003.08.015
10. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999 Feb 10;281 (6):537–44. DOI:10.1001/jama.281.6.537
11. Blanker MH, Bohnen AM, Groeneveld FP, Bernsen RM, Prins A, Thomas S, Bosch JL. Correlates for erectile and ejaculatory dysfunction in older Dutch men: a community-based study. J Am Geriatr Soc. 2001 Apr;49 (4):436–42. DOI: 10.1046/j.1532–5415.2001.49088.x
12. Glina S, Glina FP. Pathogenic mechanisms linking benign prostatic hyperplasia, lower urinary tract symptoms and erectile dysfunction. Ther Adv Urol. 2013 Aug;5 (4):211–8. DOI: 10.1177/1756287213488236
13. Shimizu S, Tsounapi P, Shimizu T, Honda M, Inoue K, Dimitriadis F, Saito M. Lower urinary tract symptoms, benign prostatic hyperplasia/benign prostatic enlargement and erectile dysfunction: are these conditions related to vascular dysfunction? Int J Urol. 2014 Sep;21 (9):856–64. DOI: 10.1111/iju.12501.
14. Volkov AA, Petrichko MI, Budnik NV. Daily intake of phosphodiesterase type 5 inhibitors — correction of erectile dysfunction and lower urinary tract symptoms in patients with BPH. Urology. 2014;4:64–68. (In Russian).
15. Kamalov AA, Okhobotov DA, Takhirzade AM, Osmolovskii BE, Takhirzade TB, Gevorkyan AR. Combination therapy of patients with lower urinary tract symptoms and erectile dysfunction. Natural and Technical Sciences. 2013;1 (63):105–113. (In Russian).
16. Kamalov AA, Osmolovsky BE, Okhobotov DA, Khodyreva LA, Takhirzade TB, Takhirzade AM, Gevorkyan AR. Combined treatment of patients with erectile dysfunction and urination disorders. Urology. 2013;3:29–33. (In Russian).
17. Casabé A, Roehrborn CG, Da Pozzo LF, Zepeda S, Henderson RJ, Sorsaburu S, et al. Effi cacy and safety of the coadministration of tadalafi l once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia. J Urol. 2014 Mar;191 (3):727–33. DOI: 10.1016/j.juro.2013.09.059
18. Choi H, Kim HJ, Bae JH, Kim JH, Moon du G, Cheon J, Yeo JK. A Meta-Analysis of Long- Versus Short-Acting Phosphodiesterase 5 Inhibitors: Comparing Combination Use With α-Blockers and α-Blocker Monotherapy for Lower Urinary Tract Symptoms and Erectile Dysfunction. Int Neurourol J. 2015 Dec;19 (4):237–45. DOI: 10.5213/inj.2015.19.4.237
19. Lee LK, Goren A, Boytsov NN, Donatucci CF, McVary KT. Treatment satisfaction among men with concurrent benign prostatic hyperplasia and erectile dysfunction treated with tadalafi l or other phosphodiesterase type-5 inhibitor combinations. Patient Prefer Adherence. 2016 Jul 12;10:1205–15. DOI: 10.2147/PPA.S105241
20. Wang XH, Wang X, Shi MJ, Li S, Liu T, Zhang XH. Systematic review and meta-analysis on phosphodiesterase 5 inhibitors and α-adrenoceptor antagonists used alone or combined for treatment of LUTS due to BPH. Asian J Androl. 2015 Nov-Dec;17 (6):1022–32. DOI: 10.4103/1008–682X.154990
Review
For citations:
Kamalov A.A., Tahirzade A.M. PHARMACOTHERAPY IN PATIENTS WITH ERECTILE DYSFUNCTION AND BENIGN PROSTATIC HYPERPLASIA IN THE ABSENCE OF RISK OF DISEASE PROGRESSION. Research and Practical Medicine Journal. 2018;5(1):20-29. (In Russ.) https://doi.org/10.17709/2409-2231-2018-5-1-2
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