Alpha-adrenoceptors are a common denominator in the pathophysiology of erectile function and BPH/LUTS--implications for clinical practice.
A literature search of PubMed documented publications and abstracts from proceedings of scientific meetings was made to review the available data on benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) and erectile dysfunction (ED) with a special focus on the role of alpha-adrenoceptors as critical mediators of pathophysiology. The reader is introduced to clinical results on the therapeutic potential of alpha-blockers alone and in combination with phosphodiesterase type 5 (PDE-5) inhibitors in the treatment of ED associated with LUTS/BPH. Epidemiological studies clearly show that an association exists between ED and LUTS/BPH. The severity of LUTS is correlated with the risk for ED. A significant number of LUTS/BPH patients are nonresponsive to the common ED treatment with PDE-5 inhibitors. As smooth muscle contractility is regulated by adrenoceptors in the corpus cavernosum, prostate and detrusor, the alpha-adrenoceptor system may be considered a common pathophysiological mediator in the development of ED and LUTS/BPH. Blockade of alpha-adrenoceptors for the treatment of BPH/LUTS may have the potential of improving sexual function. Conversely, PDE-5 inhibitors may exhibit positive effects in LUTS patients. Pilot studies on combination regimens of alpha-adrenoceptor antagonists and PDE-5 inhibitors have yielded encouraging results in LUTS patients with persistent ED. On the basis of pharmacological and clinical evidence, it is established that the alpha-adrenoceptor system plays an important role in the pathophysiology of ED and LUTS secondary to BPH. Larger trials on the combination of alpha-adrenoceptor antagonists with PDE-5 inhibitors are necessary to develop an integrated treatment approach for BPH/LUTS patients with comorbid ED.
Yassin
A
A
Clinic of Urology and Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany. yassin@t-online.de
Saad
F
F
Hoesl
C E
CE
Traish
A M
AM
Hammadeh
M
M
Shabsigh
R
R
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000375:Aging / Q000502:physiology; D004359:Drug Therapy, Combination; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009131:Muscle, Smooth, Vascular / Q000737:chemistry; D010410:Penile Erection / Q000502:physiology; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011470:Prostatic Hyperplasia / Q000188:drug therapy / Q000503:physiopathology*; D011942:Receptors, Adrenergic, alpha / Q000032:analysis / Q000502:physiology*; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy / Q000503:physiopathology; D014570:Urologic Diseases / Q000188:drug therapy / Q000503:physiopathology*
D000317:Adrenergic alpha-Antagonists; D010726:Phosphodiesterase Inhibitors; D011942:Receptors, Adrenergic, alpha