PDE5 inhibitors can also treat urinary symptoms

This study evaluated the use of PDE5 inhibitors for the treatment of benign prostatic hyperplasia (BPH) related urinary symptoms.

Researchers concluded that PDE5 inhibitors are effective at improving urinary symptoms as well as erectile function in men with BPH.

Phosphdiesterase-5 (PDE5) inhibitors, such as sildenafil (Viagra) or tadalafil (Cialis), are a well-recognized treatment for erectile dysfunction. Recent studies have suggested that PDE5 inhibitors also help regulate blood flow to the prostate and the urinary tract. Drug therapy with PDE5 inhibitors could, therefore, reduce urinary symptoms associated with BPH without the sexual dysfunction side-effects seen with other BPH treatments. The aim of this study is to review recent evidence of PDE5 inhibitors as a treatment option for BPH.

Eight separate systematic reviews (analyses of several studies), involving a total of 85 randomized trials, were included in this study. A further nine recent randomized trials were added to analysis. Overall, a combined total of 23,383 men with BPH were included in this study. Most trials included in this analysis followed treatment outcomes for an average of 12 weeks.

All systematic reviews included in this study reported positive treatment outcomes with PDE5 inhibitors. In addition to the established effect of on erectile function, four reviews reported significant improvements of urinary symptoms and quality of life scores after PDE5 inhibitor treatment, when compared to before treatment. The other four systematic reviews compared treatment with PDE5 inhibitors to a placebo (sham treatment with no active effect). Erectile function as well as urinary symptoms (including complete emptying of the bladder, urinary urgency, and urine flow rate) were significantly improved when compared to placebo. Similar results were noted for the nine additional randomized trials included in analysis. Taken together, approximately 70% of men reported meaningful improvements in urinary symptoms after about 4 weeks of treatment with PDE5 inhibitors.

Importantly, men benefited from PDE5 inhibitors regardless of whether or not they also had erectile dysfunction. Analysis also showed that other factors, such as prostate size, additional medical conditions or severity of urinary symptoms, had no effect on treatment outcome. However, some of the results suggest that younger men (aged less than 65 years) may be particularly good candidates for treatment with PDE5 inhibitors.

A daily dose of PDE5 inhibitors (most trials investigated 5 mg tadalafil once daily) was well-tolerated among men. Flushing, indigestion, headache and dizziness were the most commonly reported side-effects (in less than 5% of men). 

This large analysis of multiple studies concluded that PDE5 inhibitors are a safe and effective treatment option for urinary symptoms in men with BPH, with or without erectile dysfunction.