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Published in: World Journal of Urology 1/2010

01-02-2010 | Original Article

Sildenafil citrate and tamsulosin combination is not superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction

Authors: Altug Tuncel, Varol Nalcacioglu, Kemal Ener, Yilmaz Aslan, Omur Aydin, Ali Atan

Published in: World Journal of Urology | Issue 1/2010

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Abstract

Purpose

To evaluate the efficacy of sildenafil citrate only, 25 mg. Four times/week, tamsulosin only, 0.4 mg once daily, and the combination of both on lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (BPH) and erectile dysfunction.

Methods

A total of 60 men with BPH-related LUTS were randomized to receive sildenafil citrate only (n = 20), tamsulosin only (n = 20), and the combination of both (n = 20) for 8 weeks. Changes from baseline in International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q max), post voiding residual urine volume (PRV), Sexual Health Inventory for Male (SHIM) score, 3rd and 4th questions of International Index of Erectile Function (IIEF) were assessed at the end of the treatment.

Results

The mean age was 58 years. IPSS, Q max, PRV, SHIM scores, and 3rd and 4th questions in IIEF significantly improved in each group. Improvement of IPSS was more remarkable in combination (40.1%) and tamsulosin only (36.2%) groups in comparison with sildenafil citrate only group (28.2%; p < 0.001). Improvement of Q max and PRV were greater in tamsulosin only and combination than sildenafil citrate only group. SHIM scores significantly improved in sildenafil citrate only (65%) and combination (67.4%) than tamsulosin only (12.4%; p < 0.001). Increases in the 3rd and 4th questions of IIEF were greater in sildenafil only and combination than tamsulosin only (p < 0.001).

Conclusions

Treatment with the combination of tamsulosin only and sildenafil citrate only was not superior to tamsulosin only to enhance voiding symptoms. Also, sexual function improvement was similar for both the combination and sildenafil citrate only treatments.
Literature
1.
go back to reference Reynard JM, Peters TJ, Lamond E, Abrams P (1995) The significance of abdominal straining in men with lower urinary tract symptoms. Br J Urol 75:148–153CrossRefPubMed Reynard JM, Peters TJ, Lamond E, Abrams P (1995) The significance of abdominal straining in men with lower urinary tract symptoms. Br J Urol 75:148–153CrossRefPubMed
2.
go back to reference Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, Lieber MM (1997) Natural history of prostatism: risk factors for acute urinary retention. J Urol 158:481–487CrossRefPubMed Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, Lieber MM (1997) Natural history of prostatism: risk factors for acute urinary retention. J Urol 158:481–487CrossRefPubMed
3.
go back to reference Norman RW, Nickel JC, Fish D, Pickett SN (1994) ‘Prostate-related symptoms’ in Canadian men 50 years of age or older: prevalence and relationships among symptoms. Br J Urol 74:542–550CrossRefPubMed Norman RW, Nickel JC, Fish D, Pickett SN (1994) ‘Prostate-related symptoms’ in Canadian men 50 years of age or older: prevalence and relationships among symptoms. Br J Urol 74:542–550CrossRefPubMed
4.
go back to reference Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB (1994) Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 151:54–61PubMed Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB (1994) Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 151:54–61PubMed
5.
go back to reference Girman CJ, Jacobsen SJ, Tsukamato T, Richard F, Garraway WM, Sagnier PP, Guess HA, Rhodes T, Boyle P, Lieber MM (1998) Health-related quality of life associated with lower urinary tract symptoms in four countries. Urology 51:428–436CrossRefPubMed Girman CJ, Jacobsen SJ, Tsukamato T, Richard F, Garraway WM, Sagnier PP, Guess HA, Rhodes T, Boyle P, Lieber MM (1998) Health-related quality of life associated with lower urinary tract symptoms in four countries. Urology 51:428–436CrossRefPubMed
6.
go back to reference Baniel J, Israilov S, Shmueli J, Segenreich H, Livne PM (2000) Sexual function in 131 patients with benign prostatic hyperplasia before prostatectomy. Eur Urol 38:53–58CrossRefPubMed Baniel J, Israilov S, Shmueli J, Segenreich H, Livne PM (2000) Sexual function in 131 patients with benign prostatic hyperplasia before prostatectomy. Eur Urol 38:53–58CrossRefPubMed
7.
go back to reference Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U (2000) Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res 12:305–311CrossRefPubMed Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U (2000) Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res 12:305–311CrossRefPubMed
8.
go back to reference Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, O’Leary MP, Puppo P, Robertson C, Giuliano F (2003) Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 44:637–649CrossRefPubMed Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, O’Leary MP, Puppo P, Robertson C, Giuliano F (2003) Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 44:637–649CrossRefPubMed
9.
go back to reference Elliott SP, Gulati M, Pasta DJ, Spitalny GM, Kane CJ, Yee R, Lue TF (2004) Obstructive lower urinary tract symptoms correlate with erectile dysfunction. Urology 63:1148–1152CrossRefPubMed Elliott SP, Gulati M, Pasta DJ, Spitalny GM, Kane CJ, Yee R, Lue TF (2004) Obstructive lower urinary tract symptoms correlate with erectile dysfunction. Urology 63:1148–1152CrossRefPubMed
10.
go back to reference Kaplan AS, Gonzales RR (2007) Phosphodiesterase type 5 inhibitors fort he treatment of male lower urinary tract symptoms. Rev Urol 9:73–77PubMed Kaplan AS, Gonzales RR (2007) Phosphodiesterase type 5 inhibitors fort he treatment of male lower urinary tract symptoms. Rev Urol 9:73–77PubMed
11.
go back to reference Namasivayam S, Minhas S, Brooke J, Joyce AD, Prescott S, Eardley I (1998) The evaluation of sexual function in men presenting with benign prostatic hyperplasia. Br J Urol 82:842–846PubMed Namasivayam S, Minhas S, Brooke J, Joyce AD, Prescott S, Eardley I (1998) The evaluation of sexual function in men presenting with benign prostatic hyperplasia. Br J Urol 82:842–846PubMed
12.
go back to reference Roehrborn CG (2008) Current medical therapies for men with lower urinary tract symptoms and benign prostatic hyperplasia: achievements and limitations. Rev Urol 10:14–25PubMed Roehrborn CG (2008) Current medical therapies for men with lower urinary tract symptoms and benign prostatic hyperplasia: achievements and limitations. Rev Urol 10:14–25PubMed
13.
go back to reference Kaminetsky JC (2006) Comorbid LUTS and erectile dysfunction: optimizing their management. Curr Med Res Opin 22:2497–2506CrossRefPubMed Kaminetsky JC (2006) Comorbid LUTS and erectile dysfunction: optimizing their management. Curr Med Res Opin 22:2497–2506CrossRefPubMed
14.
go back to reference Andersson KE (2001) Physiology of penile erection. Pharmacol Rev 53:417–450PubMed Andersson KE (2001) Physiology of penile erection. Pharmacol Rev 53:417–450PubMed
15.
go back to reference Becker AJ, Uckert S, Stief CG, Scheller F, Knapp WH, Hartmann U, Jonas U (2002) Cavernous and systemic plasma levels of norepinephrine and epinephrine during different penile conditions in healthy men and patients with erectile dysfunction. Urology 59:281–286CrossRefPubMed Becker AJ, Uckert S, Stief CG, Scheller F, Knapp WH, Hartmann U, Jonas U (2002) Cavernous and systemic plasma levels of norepinephrine and epinephrine during different penile conditions in healthy men and patients with erectile dysfunction. Urology 59:281–286CrossRefPubMed
16.
go back to reference Traish AM, Kim NN, Goldstein I, Moreland RB (1999) Alpha-adrenergic receptors in the penis. Identification, characterization, and physiological function. J Androl 20:671–682PubMed Traish AM, Kim NN, Goldstein I, Moreland RB (1999) Alpha-adrenergic receptors in the penis. Identification, characterization, and physiological function. J Androl 20:671–682PubMed
17.
go back to reference Francis SH, Blount MA, Zoraghi R, Corbin JD (2005) Molecular properties of mammalian proteins that interact with cGMP: protein kinases, cation channels, phosphodiesterase, and multi-drug anion transporters. Front Biosci 10:2097–2117CrossRefPubMed Francis SH, Blount MA, Zoraghi R, Corbin JD (2005) Molecular properties of mammalian proteins that interact with cGMP: protein kinases, cation channels, phosphodiesterase, and multi-drug anion transporters. Front Biosci 10:2097–2117CrossRefPubMed
18.
go back to reference Uckert S, Kuthe A, Jonas U, Stief CG (2001) Characterization and functional relevance of cyclic nucleotide phosphodiesterase isoenzymes of the human prostate. J Urol 166:2484–2490CrossRefPubMed Uckert S, Kuthe A, Jonas U, Stief CG (2001) Characterization and functional relevance of cyclic nucleotide phosphodiesterase isoenzymes of the human prostate. J Urol 166:2484–2490CrossRefPubMed
19.
go back to reference Yassin A, Saad F, Hoesl CE, Traish AM, Hammadeh M, Shabsigh R (2006) Alpha-adrenoreceptors are a common denominator in the pathophysiology of erectile function and BPH/LUTS-implications for clinical practice. Andrologia 38:1–12CrossRefPubMed Yassin A, Saad F, Hoesl CE, Traish AM, Hammadeh M, Shabsigh R (2006) Alpha-adrenoreceptors are a common denominator in the pathophysiology of erectile function and BPH/LUTS-implications for clinical practice. Andrologia 38:1–12CrossRefPubMed
20.
go back to reference Andersson KE, Chapple CR, Hofner K (2002) Future drugs for he treatment of benign prostatic hyperplasia. World J Urol 19:436–442PubMed Andersson KE, Chapple CR, Hofner K (2002) Future drugs for he treatment of benign prostatic hyperplasia. World J Urol 19:436–442PubMed
21.
go back to reference Gradini R, Realacci M, Ginepri A, Naso G, Santangelo C, Cela O, Sale P, Berardi A, Petrangeli E, Gallucci M, Di Silverio F, Russo MA (1999) Nitric oxide synthases in normal and benign hyperplastic human prostate: immunohistochemistry and molecular biology. J Pathol 189:224–229CrossRefPubMed Gradini R, Realacci M, Ginepri A, Naso G, Santangelo C, Cela O, Sale P, Berardi A, Petrangeli E, Gallucci M, Di Silverio F, Russo MA (1999) Nitric oxide synthases in normal and benign hyperplastic human prostate: immunohistochemistry and molecular biology. J Pathol 189:224–229CrossRefPubMed
22.
go back to reference Bing W, Chang S, Hypolite JA, Di Santo ME, Zderic SA, Rolf L, Wein AJ, Chacko S (2003) Obstruction-induced changes in urinary bladder smooth muscle contractility: a role for Rho kinase. Am J Physiol Renal Physiol 285:F990–F997PubMed Bing W, Chang S, Hypolite JA, Di Santo ME, Zderic SA, Rolf L, Wein AJ, Chacko S (2003) Obstruction-induced changes in urinary bladder smooth muscle contractility: a role for Rho kinase. Am J Physiol Renal Physiol 285:F990–F997PubMed
23.
go back to reference Deedwania PC (2003) Mechanisms of endothelial dysfunction in the metabolic syndrome. Curr Diabetes Rep 3:289–292CrossRef Deedwania PC (2003) Mechanisms of endothelial dysfunction in the metabolic syndrome. Curr Diabetes Rep 3:289–292CrossRef
24.
go back to reference Roehrborn CG, McVary KT, Elion-Mboussa A, Viktrup L (2008) Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a dose finding study. J Urol 180:1228–1234CrossRefPubMed Roehrborn CG, McVary KT, Elion-Mboussa A, Viktrup L (2008) Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a dose finding study. J Urol 180:1228–1234CrossRefPubMed
25.
go back to reference McVary KT, Monnig W, Camps JL, Young JM, Tseng LJ, van den Ende G (2007) 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 177:1071–1077CrossRefPubMed McVary KT, Monnig W, Camps JL, Young JM, Tseng LJ, van den Ende G (2007) 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 177:1071–1077CrossRefPubMed
26.
go back to reference Stief CG, Porst H, Neuser D, Beneke M, Ulbrich E (2008) A randomised, placebo-controlled study to assess the efficacy o twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Eur Urol 53:1236–1244CrossRefPubMed Stief CG, Porst H, Neuser D, Beneke M, Ulbrich E (2008) A randomised, placebo-controlled study to assess the efficacy o twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Eur Urol 53:1236–1244CrossRefPubMed
27.
go back to reference Kaplan A, Gonzales RR, Te AE (2007) Combination of alfuzosin and sildenafil superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. Eur Urol 51:1717–1723CrossRefPubMed Kaplan A, Gonzales RR, Te AE (2007) Combination of alfuzosin and sildenafil superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. Eur Urol 51:1717–1723CrossRefPubMed
28.
go back to reference Bechara A, Romano S, Casabe A, Haime S, Dedola P, Hernandez C, Rey H (2008) Comparative efficacy assessment of tamsulosin vs. tamsulosin plus tadalafil in the treatment of LUTS/BPH. Pilot study. J Sex Med 5:2170–2178CrossRefPubMed Bechara A, Romano S, Casabe A, Haime S, Dedola P, Hernandez C, Rey H (2008) Comparative efficacy assessment of tamsulosin vs. tamsulosin plus tadalafil in the treatment of LUTS/BPH. Pilot study. J Sex Med 5:2170–2178CrossRefPubMed
29.
go back to reference McVary KT, Roehrborn CG, Kaminetsky JC, Auerbach SM, Wachs B, Young JM, Esler A, Sides GD, Denes BS (2007) Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 177:1401–1407CrossRefPubMed McVary KT, Roehrborn CG, Kaminetsky JC, Auerbach SM, Wachs B, Young JM, Esler A, Sides GD, Denes BS (2007) Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 177:1401–1407CrossRefPubMed
Metadata
Title
Sildenafil citrate and tamsulosin combination is not superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction
Authors
Altug Tuncel
Varol Nalcacioglu
Kemal Ener
Yilmaz Aslan
Omur Aydin
Ali Atan
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
World Journal of Urology / Issue 1/2010
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-009-0484-z

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