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Vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

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Abstract

α-Blockers, the current common treatment for lower urinary tract symptoms (LUTS), are also used to treat bladder outlet obstruction (BOO), but the effect is not as clinically significant as in LUTS. All currently marketed phosphodiesterase type 5 (PDE5) inhibitors have recently been shown to significantly affect LUTS, although BOO-related efficacy has not been determined. Therefore, the extent of a causal relationship between LUTS and underlying benign prostatic enlargement (BPE) is questionable. LUTS may also be interpreted as symptoms related to detrusor overactivity, especially when no significant BOO is associated with BPE. Research is required to understand the efficacy of PDE5 inhibitors in LUTS but not in BOO. For vardenafil, nonclinical experiments and initial, preliminary clinical data suggest that the underlying effect may occur on the detrusor and not the prostate.

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References and Recommended Reading

  1. Abrams P: New words for old: lower urinary tract symptoms for “prostatism”. BMJ 1994, 308:929–930.

    PubMed  CAS  Google Scholar 

  2. Roehrborn CG: Reducing the risk of benign prostatic hyperplasia progression. Rev Urol 2002, 5:29–38.

    Google Scholar 

  3. Guess HA: Epidemiology and natural history of benign prostatic hyperplasia. Urol Clin North Am 1995, 22:247–261.

    PubMed  CAS  Google Scholar 

  4. Thorpe A, Neal D: Benign prostatic hyperplasia. Lancet 2003, 361:1359–1367.

    Article  PubMed  CAS  Google Scholar 

  5. Chiricos TN, Sanford E: Cost consequences of surveillance, medical management or surgery for benign prostatic hyperplasia. J Urol 1996, 155:1311–1316.

    Article  Google Scholar 

  6. Jacobsen SJ, Guess HA, Panser L, et al.: A population-based study of health care-seeking behavior for treatment of urinary symptoms. Arch Fam Med 1993, 2:729–735.

    Article  PubMed  CAS  Google Scholar 

  7. Abrams P, Cardozo L, Fall M, et al.: The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Neururol Urodyn 2002, 21:167–178.

    Article  Google Scholar 

  8. Caine M, Raz S, Zeigler M: Adrenergic and cholinergic receptors in the human prostate, prostatic capsule, and bladder neck. Br J Urol 1975, 47:193–202.

    Article  PubMed  CAS  Google Scholar 

  9. Rasmusson GH, Reynolds GF, Utre T, et al.: Azasteroids as inhibitors of rat 5-alpha reductase. J Med Chem 1984, 27:1690–1701.

    Article  PubMed  CAS  Google Scholar 

  10. Kirby RS, Vale J, Bryan J, et al.: Long-term urodynamic effects of finasteride in benign prostatic hyperplasia: a pilot study. Eur Urol 1993, 24:20–26.

    PubMed  CAS  Google Scholar 

  11. Andersen, JT, Ekman P, Wolf H, et al.: Can finasteride reverse the progress of benign prostatic hyperplasia? A two-year placebo-controlled study. Urology 1995, 46:631–637.

    Article  PubMed  CAS  Google Scholar 

  12. McVary KT: A review of combination therapy in patients with benign prostatic hyperplasia. Clin Ther 2007, 29:387–398.

    Article  PubMed  CAS  Google Scholar 

  13. Drescher P, Eckert RE, Madsen PO: Smooth muscle contractility in prostatic hyperplasia: rote of cyclic adenosine monophosphate. Prostate 1994, 25:76–80.

    Article  PubMed  CAS  Google Scholar 

  14. Loughney K, Hill TR, Florio VA, et al.: Isolation and characterization of cDNAs encoding PDE5A, a human cGMP-binding, cGMP-specific 3′,5′-cyclic nucleotide phosphodiesterase. Gene 1998, 216:139–147.

    Article  PubMed  CAS  Google Scholar 

  15. Yanaka N, Kotera J, Ohtsuka A, et al.: Expression, structure and chromosomal localization of the human cGMP-binding cGMP-specific phosphodiesterase PDE5A gene. Eur J Biochem 1998, 255:391–393.

    Article  PubMed  CAS  Google Scholar 

  16. Stacey P, Rulten S, Dapling A, Phillips SC: Molecular cloning and expression of human cGMP-binding cGMP-specific phosphodiesterase (PDE5). Biochem Biophys Res Commun 1998, 247:249–254.

    Article  PubMed  CAS  Google Scholar 

  17. Ueckert S, Kuethe A, Jonas U, et al.: Characterization and functional relevance of cyclic nucleotide phosphodiesterase isoenzymes of the human prostate. J Urol 2001, 166:2484–2490.

    Article  Google Scholar 

  18. Ueckert S, Oelke M, Stief CG, et al.: Immunohistochemical distribution of cAMP-and cGMP-phosphodiesterase (PDE) isoenzymes in the human prostate. Eur Urol 2006, 49:740–745.

    Article  CAS  Google Scholar 

  19. Stief CG, Porst H, Ulbrich E: Vardenafil in the treatment of symptomatic benign prostatic hyperplasia [abstract]. J Urol 2007, 177(Suppl):517.

    Google Scholar 

  20. McVary KT, Roehrborn CG, Kaminetsky JC, et al.: Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 2007, 177:1401–1407.

    Article  PubMed  CAS  Google Scholar 

  21. McVary KT, Monnig W, Camps JL, et al.: Sildenafil citrate improves erectile function and urinary symptoms in men with erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, double-blind trial. J Urol 2007, 177:1071–1077.

    Article  PubMed  CAS  Google Scholar 

  22. Guh JH, Hwang TL, Ko FN, et al.: Antiproliferative effect in human prostatic smooth muscle cells by nitric oxide donor. Mol Pharmacol 1998, 53:467–474.

    PubMed  CAS  Google Scholar 

  23. Adolfsson PI, Ahlstrand C, Varenhorst E, et al.: Lysophosphatidic acid stimulates proliferation of cultured smooth muscle cells from human BPH tissue: sildenafil and papaverin generate inhibition. Prostate 2002, 51:50–58.

    Article  PubMed  CAS  Google Scholar 

  24. Cook AL, Haynes JM: Protein kinase G II-mediated proliferative effects in human cultured prostatic stromal cells. Cell Signal 2004, 16:253–261.

    Article  PubMed  CAS  Google Scholar 

  25. Tinel H, Stelte-Ludwig B, Hüetter J, Sandor P: Pre-clinical evidence for the use of phosphodiesterase-5 inhibitors for treating benign prostatic hyperplasia and lower urinary tract symptoms. BJU Int 2006, 96:1259–1263.

    Article  CAS  Google Scholar 

  26. Truss MC, Ueckert S, Stief CG, et al.: Porcine detrusor cyclic nucleotide phosphodiesterase isoenzymes: characterization and functional effects of various phosphodiesterase inhibitors in vitro. Urology 1995, 45:893–901.

    Article  PubMed  CAS  Google Scholar 

  27. Truss MC, Ueckert S, Stief CG, et al.: Cyclic nucleotide phosphodiesterase (PDE) isoenzymes in the human detrusor smooth muscle. Identification and characterization. Urol Res 1996, 24:123–128.

    Article  PubMed  CAS  Google Scholar 

  28. Truss MC, Ueckert S, Stief CG, et al.: Cyclic nucleotide phosphodiesterase (PDE) isoenzymes in the human detrusor smooth muscle. Effects of various PDE inhibitors on smooth muscle tone and cyclic nucleotide levels in vitro. Urol Res 1996, 24:129–134.

    Article  PubMed  CAS  Google Scholar 

  29. Qiu Y, Kraft P, Craig EC, et al.: Identification and functional study of phosphodiesterases in rat urinary bladder. Urol Res 2001, 29:388–392.

    Article  PubMed  CAS  Google Scholar 

  30. Qui Y, Kraft P, Craig EC, et al.: Cyclic nucleotide phosphodiesterases in rabbit detrusor smooth muscle. Urology 2002, 59:145–149.

    Article  Google Scholar 

  31. Filippi S, Morelli AM, Sandner P, et al.: Characterization and functional role of androgen-dependent PDE5 activity in the bladder. Endocrinology 2007, 148:1019–1029.

    Article  PubMed  CAS  Google Scholar 

  32. Gu B, Reiter JP, Schwinn DA, et al.: Effects of alpha 1-adrenergic receptor subtype selective antagonists on lower urinary tract function in rats with bladder outlet obstruction. J Urol 2004, 172:758–762.

    Article  PubMed  CAS  Google Scholar 

  33. Conners W, Whitebeck C, Chicester P, et al.: L-NAME, a nitric oxide synthase inhibitor, diminishes oxidative damage in urinary bladder partial outlet obstruction. Am J Physiol 2005, 290:357–363.

    Google Scholar 

  34. Matsumoto S, Watanabe E, Nakata Y, et al.: Bladder protective effects of PDE5 inhibition: efficacy of vardenafil on rat bladder with outlet obstruction. J Urol 2007, 177:446.

    Google Scholar 

  35. Beamon C, Salkini M, Mazur C, et al.: The effect of sildenafil citrate on bladder outlet obstruction in a mouse model. J Urol 2007, 177:140.

    Google Scholar 

  36. Gacci M, Del Popolo G, Macchiarella A, et al.: Vardenafil improves urodynamic parameters in men with spinal cord injury: results from a single dose, pilot study. J Urol 2007, 178:2040–2043.

    Article  PubMed  CAS  Google Scholar 

  37. Porst H, Sharlip ID, Hatzichristou D, et al.: Extended duration of efficacy of vardenafil when taken 8 hours before intercourse: a randomized, double-blind, placebo-controlled study. Eur Urol 2006, 50:1086–1095.

    Article  PubMed  CAS  Google Scholar 

  38. Porst H, Lungimayr G, Deutsch-Öesterreichische STEADY-Studiengruppe: Efficacy and tolerability of vardenafil within the time window of 6 hours after administration and beyond. MMW-Fortschr Med Originalien 2005, 50:27–32.

    Google Scholar 

  39. Athanasopoulos A, Gyftopoulos K, Giannitsas K, et al.: Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol 2003, 169:2253–2256.

    Article  PubMed  CAS  Google Scholar 

  40. Lee KS, Choo MS, Kim DY, et al.: Combination treatment with propiverine hydrochloride plus doxazosin controlled release gastrointestinal therapeutic system formulation for overactive bladder and coexisting benign prostatic obstruction: a prospective, randomized, controlled multicenter study. J Urol 2005, 174:1334–1338.

    Article  PubMed  CAS  Google Scholar 

  41. Kaplan SA, Walmsley K, Te AE: Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol 2005, 174:2273–2276.

    Article  PubMed  Google Scholar 

  42. Abrams P, Kaplan SA, De Koning Gans HJ, Millard R: Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 2006, 175:999–1004.

    Article  PubMed  CAS  Google Scholar 

  43. Harrison SC, Hunnam GR, Farman P, et al.: Bladder instability and denervation in patients with bladder outflow obstruction. Br J Urol 1987, 60:519–522.

    PubMed  CAS  Google Scholar 

  44. Mirone V, Imbimbo C, Sessa G, et al.: Correlation between detrusor collagen content and urinary symptoms in patients with prostatic obstruction. J Urol 2004, 172:1386–1389.

    Article  PubMed  CAS  Google Scholar 

  45. Laschke S, Carl S: Detrusor overactivity after prostate resection — preventing postoperative incontinence with darifenacin. 29th Congress Societé Internationale d’ Urologie, Paris, France, September 2–6, 2007. Urology 2007, 70:254.

    Article  Google Scholar 

  46. Nordling J: Efficacy and safety of two doses (10 and 15 mg) of alfuzosin or tamsulosin (0.4 mg) once daily for treating symptomatic benign prostatic hyperplasia. BJU Int 2005, 95:1006–1012.

    Article  PubMed  CAS  Google Scholar 

  47. Roehrborn CG, Van Kerrebroeck P, Nordling J: Safety and efficacy of alfuzosin 10 mg once-daily in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a pooled analysis of three double-blind, placebo-controlled studies. BJU Int 2003, 92:257–261.

    Article  PubMed  CAS  Google Scholar 

  48. Costabile RA, Steers WD: How can we best characterize the relationship between erectile dysfunction and benign prostatic hyperplasia? J Sex Med 2006, 3:676–681.

    Article  PubMed  Google Scholar 

  49. Sak SC, Hussain C, Johnston C, et al.: What is the relationship between male sexual function and lower urinary tract symptoms (LUTS). Eur Urol 2004, 46:482–487.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Hartmut Porst.

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Porst, H., Sandner, P. & Ulbrich, E. Vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Curr Urol Rep 9, 295–301 (2008). https://doi.org/10.1007/s11934-008-0052-x

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