The Relationship between Erectile Dysfunction and Lower Urinary Tract Symptoms and the Role of Phosphodiesterase Type 5 Inhibitors

• Published in: European urology Vol. 55; no. 1; pp. 38 - 48
• Main Authors: Köhler, Tobias S, McVary, Kevin T
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier 01.01.2009
• Subjects: Autonomic Nervous System - physiopathology; Biological and medical sciences; Clinical Trials as Topic; Erectile Dysfunction - drug therapy; Erectile Dysfunction - etiology; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Nephrology. Urinary tract diseases; Nitric Oxide - physiology; Non tumoral diseases; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors - therapeutic use; Prostatism - complications; Prostatism - drug therapy; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology; Lower urinary tract symptoms; Erectile dysfunction; Phosphodiesterase inhibitors; Nephrology; Urinary system disease; 3',5'-Cyclic-nucleotide phosphodiesterase; Erection disorders; Enzyme; Impotence; Sexual dysfunction; Esterases; Urinary tract disease; Phosphoric diester hydrolases; Urology; Voiding dysfunction; Hydrolases; Inhibitor; Male genital diseases
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2008.08.062

Abstract Context The relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) and the potential interplay of phosphodiesterase type 5 inhibitors (PDE5-I) have clinical implications for both patient screening and treatment. Objective To describe the current literature assessing the LUTS–ED relationship and the role of PDE5-I from both a basic science and clinical intervention perspective. Evidence acquisition We focused on data recently published (1990–2008) describing epidemiologic and mechanistic manuscripts of the LUTS–ED relationship with emphasis on papers involving PDE5-I—particularly those using level 1 evidence clinical trials. Base key words used included BPH, LUTS, ED, and phosphodiesterase inhibitors in combination with such secondary key words as nitric oxide, autonomic hyperactivity, Rho-kinase, atherosclerosis, and mechanism. We abstracted >200 articles and reviewed >100. Evidence synthesis The large overlap of elderly men with both LUTS and ED likely stems from a cause-and-effect relationship. Thus far, four proposed mechanisms attempt to explain the relationship between LUTS and ED. Multiple studies showing that PDE5-I improved LUTS have been performed. Understanding the role of PDE5-I in the LUTS and ED relationship affects patient screening and treatment but also raises further research questions. Conclusions The future use of phosphodiesterase inhibitors as either prophylaxis or as a primary treatment for LUTS looms as a possibility and may not be limited to men.