Erectile dysfunction, or impotence, is very frequent in men with benign prostatic hyperplasia (BPH) and urinary symptoms. The former is a type of sexual dysfunction in which the patient cannot develop or maintain an erection of the penis during sexual activity.
Phosphodiesterase type 5 (PDE5) inhibitors like sildenafil (Viagra) are used to treat these two conditions independently, but there is increasing evidence on their use in patients with both diseases. A recent review of previous studies about this issue was recently published in the Arab Journal of Urology. The paper entitled “Phosphodiesterase type 5 inhibitors for treating erectile dysfunction and lower urinary tract symptoms secondary to benign prostatic hyperplasia: A comprehensive review” was written by Dr. Albert Haddad from Dubai, Dr. Michel Jabbour and Dr. Muhammad Bulbul from Lebanon who reviewed the most recent evidence published on the subject.
Studies show there is a strong connection between erectile dysfunction and BPH linked to not only similar risk factors such as age and cardiovascular disease but also pathological processes at a molecular level. This shows that the physician must always keep in mind the treatment of both diseases when approaching the patient. PDE5 inhibitors have been recently included in the treatment arsenal for BPH and various medical associations state they are warranted in patients with moderate to severe urinary symptoms. Tadalafil 5 mg once daily has been approved for this indication.
Treatment with PDE5 inhibitors is usually well tolerated and its efficacy usually justifies the prescription. However, they are contraindicated in patients with severe cardiovascular disease such as heart failure, severe hypertension, angina or recent heart attack.
The authors conclude that in patients with both erectile dysfunction and BPH, PDE5 inhibitors should be prescribed early for a better and complete management of both diseases. These can be used alone or even in combination with finasteride, one of the most used BPH treatments, with very good results in both cases.