title: Latest Evidence on the Use of Phosphodiesterase Type 5 Inhibitors for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.
abstract: Several preclinical reports, randomized controlled trials, systematic reviews, and posthoc analyses corroborate the role of phosphodiesterase type 5 inhibitors (PDE5-Is) in the treatment of men with lower urinary tract symptoms (LUTS) associated with benign prostatic enlargement (BPE).
  
  
  
  Update of the latest evidence on the mechanisms of action, evaluate the current meta-analyses, and emphasize the results of pooled data analyses of PDE5-Is in LUTS/BPE.
  
  
  
  Literature analysis of basic researches on PDE5-Is, systematic literature search in PubMed and Scopus until May 2015 on reviews of trials on PDE5-Is, and collection of pooled data available on tadalafil 5mg.
  
  
  
  Latest evidences on the pathophysiology of LUTS/BPE has provided the rationale for use of PDE5-Is: (1) improvement of LUT oxygenation, (2) smooth muscle relaxation, (3) negative regulation of proliferation and transdifferentiation of LUT stroma, (4) reduction of bladder afferent nerve activity, and (5) down-regulation of prostate inflammation are the proven mechanisms of action of PDE5-Is. Data from eight systematic reviews demonstrated that PDE5-Is allow to improve LUTS (International Prostate Symptom Score mean difference vs placebo: 2.35-4.21) and erectile function (International Index of Erectile Function mean difference vs placebo: 2.25-5.66), with negligible change in flow rate (Qmax mean difference vs placebo: 0.01-1.43). Pooled data analyses revealed that tadalafil 5mg once daily allows the clinically-meaningful improvement of LUTS and nocturnal voiding frequency independent of both erectile dysfunction severity and improvement.
  
  
  
  PDE5-Is are safe and effective in improving both LUTS and erectile function in appropriately selected men with LUTS/BPE. Data on the reduction of disease progression, long-term outcomes, and cost-effectiveness analyses are still lacking.
  
  
  
  We reviewed recent literature on phosphodiesterase type 5 inhibitors in men with lower urinary tract symptoms associated with prostatic enlargement. We found evidence to confirm that phosphodiesterase type 5 inhibitors are a valid treatment option for men affected by bothersome urinary symptoms with or without erectile dysfunction.
authors.affiliation: Department of Urology, University of Florence, Florence, Italy. Electronic address: maurogacci@yahoo.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.affiliation: AIAS, Aarhus Institute of Advanced Studies, Aarhus University, Aarhus C, Denmark.
authors.forename: Karl-Erik
authors.initials: KE
authors.lastname: Andersson
authors.affiliation: Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chapple
authors.affiliation: Sexual Medicine & Andrology, Department "Mario Serio", University of Florence, Florence, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
authors.affiliation: Department of Urology, University Federico II, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
authors.affiliation: Department of Urology, Hannover Medical School, Hannover, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Oelke
authors.affiliation: Private Institute for Urology,Andrology and Sexual Medicine, Hamburg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Porst
authors.affiliation: Department of Urology, UT Southwestern Medical Center at Dallas, TX, USA.
authors.forename: Claus
authors.initials: C
authors.lastname: Roehrborn
authors.affiliation: Department of Urology, Ludwig-Maximilians-Universität München, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.affiliation: Inserm U1179 Versailes - Saint Quentin University Montigny-le-Bretonneux, R. Poincaré Hospital - Assistance Publique-Hôpitaux de Paris, Garches, France.
authors.forename: François
authors.initials: F
authors.lastname: Giuliano
mesh_terms: D000344:Afferent Pathways / Q000187:drug effects; D000818:Animals; D049109:Cell Proliferation / Q000187:drug effects; D054338:Cell Transdifferentiation / Q000187:drug effects; D007172:Erectile Dysfunction / Q000188:drug therapy; D006801:Humans; D008297:Male; D009126:Muscle Relaxation / Q000187:drug effects; D009130:Muscle, Smooth / Q000187:drug effects; D010410:Penile Erection / Q000187:drug effects; D058986:Phosphodiesterase 5 Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D053448:Prostatism / Q000188:drug therapy*; D011472:Prostatitis / Q000188:drug therapy; D001743:Urinary Bladder / Q000294:innervation; D014553:Urinary Tract Physiological Phenomena / Q000187:drug effects
chemical_list: D058986:Phosphodiesterase 5 Inhibitors
keywords: Avanafil; Benign prostatic enlargement; Benign prostatic hyperplasia; Erectile dysfunction; Lower urinary tract symptoms; Phosphodiesterase type 5 inhibitors; Prostate; Sildenafil; Tadalafil; Vardenafil