Results of December survey 2005

A patient presenting with BPH-related LUTS warranting medical treatment, and ED responsive to PDE5 inhibitors, should preferentially be treated with:

1) Any alpha-blocker and any PDE5 inhibitor, chosen among those available in the market: Percentage of answers: 16%
2) Alpha-blocker and PDE5 inhibitor, chosen according with the EMEA restrictions regarding the co-administration of such drugs: Percentage of answers: 36%
3) PDE5 inhibitors and "prostatic" drugs other than alpha-blockers (e.g. 5ARI, Serenoa Repens etc.): Percentage of answers: 32%
4) Alpha-blockers and ED treatments other than PDE5 inhibitors (e.g. vacuum device, intracavernous injections of vasoactive drugs etc.): Percentage of answers: 5%
5) Alpha-blockers alone: relieving LUTS, a positive impact on sexual function too can be expected: Percentage of answers: 11%

Comments

Answer n. 2, as expected, has been the most frequent one. However it is worth noting that an almost comparable percentage of participants selected the answer n.3, i.e. would change the BPH treatment in order not to renounce to the “favourite” PDE5 inhibitor, while only a few participants would prefer alpha-blockers and second-line treatments for ED (answer n.4). Alpha-blockers are currently the most common first therapeutic line in BPH-related LUTS, but other oral drugs (5ARI) are known to be effective and safe, and provide a valid alternative. In opposition, PDE5 inhibitors are considered the only oral drugs highly effective in ED treatment, and alternatives are reputed either less efficacious or more invasive.
About 10% of participants would try to palliate the LUTS with alpha-blockers, expecting a consequent improvement in sexual function too. This position is supported by recent papers2-5, that have shown improvements of sexual function in patients in treatment with alpha-blockers. However this option should be regarded by the doctor, and presented to the patient, only as an attempt, whose modality and duration is still to be clarified.

References

1Auerbach SM, Gittelman M, Mazzu A, Cihon F, Sundaresan P, White WB. Simultaneous administration of vardenafil and tamsulosin does not induce clinically significant hypotension in patients with benign prostatic hyperplasia. Urology 2004; 64: 998–1004.

2 Höfner K, Claes H, De RHöfner K, Claes H, De Reijke TM, Folkestad B, Speakman MJ. Tamsulosin 0.4 mg once daily: effect on sexual function in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. Eur Urol 1999; 36:335–41.

3 Debruyne F, Narayan P. Tamsulosin improves sexual function with minimal abnormal ejaculation in patients treated for lower urinary tract symptoms suggestive of benign prostatic hyperplasia. BJU Int 2002; 90 (Suppl. 2): 12 (Abstract P–1.2.01).

4 Palacio A, Batista JE, Torrubia R et al. Tamsulosin: effect on sexual function in almost 3000 patients with LUTS managed in real life practice in Spain. BJU Int 2000; 86 (Suppl. 3): 32–3 (Abstract P1.4.20).

5 Lukacs B, Leplège A, Thibault P, Jardin A. Prospective study of men with clinical benign prostatic hyperplasia treated with alfuzosin by general practitioners: 1-year results. Urology 1996; 48: 731–40.