This study directly compared two alpha-blockers, silodosin (Rapaflo) and naftopidil (Flivas), in treating benign prostatic hyperplasia (BPH) with overactive bladder symptoms. Researchers reported greater improvements in overactive bladder symptoms with silodosin. No differences in side effects were observed between the two treatments.

Men with BPH often experience urinary symptoms that can significantly affect quality of life. An enlarged prostate can put pressure on the bladder. This can cause overactive bladder symptoms (OABs) such as urinary urgency, frequency, and incontinence. It can also cause an obstruction in the base of the bladder. This can lead to voiding symptoms such as weak urine stream and incomplete bladder emptying.  

It has been estimated that 50 to 75% of men with BPH-related urinary symptoms have OABs. Drugs that are commonly prescribed for BPH include alpha-blockers such as silodosin and naftopidil. Alpha-blockers work by relaxing the muscles in the prostate and bladder, allowing urine to flow more easily. Which type of alpha-blocker is more effective at treating BPH with OABs is still being investigated.

The aim of this study was to compare the effects of silodosin and naftopidil in treating BPH with OAB.

314 men with BPH and OABs were included in this study. Men were randomly assigned to receive either silodosin or naftopidil. Changes in urinary symptoms were measured using questionnaires and physical exams. These were recorded before treatment and up to 12 weeks after the start of treatment.

Urinary symptoms, OABs, and quality of life improved significantly following both types of treatment. Improvements at 12 weeks were significantly greater among men receiving silodosin compared to naftopidil. While complete bladder emptying was similarly improved in both treatment groups, silodosin increased urinary flow rate significantly more than naftopidil.

No significant differences in the rate of side effects was observed between treatment groups. 3.2% (naftopidil) and 9.6% (silodosin) of men reported ejaculatory dysfunction. 4% (silodosin) to 4.6% (naftopidil) of men discontinued treatment due to side effects.

Researchers concluded that silodosin is more effective than naftopidil in treating BPH with OABs.

Larger studies comparing the long-term effectiveness of alpha-blockers are needed to confirm these results.

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