Penile blood pressure is useful to identify candidates for tadalafil treatment in patients with lower urinary tract symptoms

The phosphodiesterase type 5 inhibitor tadalafil is one of the first-choice drugs for benign prostate hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS). However, tadalafil is not always equally beneficial to every patient. In order to determine whether penile blood pressure (PBP) can be used to identify patients who can benefit from tadalafil treatment, the correlation between PBP at baseline and changes in LUTS induced by tadalafil treatment was studied prospectively.

Patients with BPH who were poor responders to α1 blockers and took tadalafil instead of an α1 blocker were registered between 2014 and 2016. The patients were divided into two groups (low-PBP group and high-PBP group) by the median baseline PBP of 110 mmHg as the cut-off. The changes in the International Prostate Symptom Score (IPSS) between before and 4 and 12 weeks after tadalafil treatment were compared between the low- and high-PBP groups. Multivariate analysis was performed to identify parameters associated with IPSS improvement with tadalafil treatment.

A total of 51 patients were investigated. The IPSS in the low-PBP group decreased immediately after the start of treatment, and significant improvement of the IPSS from baseline was observed at 4 and 12 weeks after the start of treatment, while the IPSS in the high-PBP group did not show significant changes. On multivariate analysis, PBP at baseline, anticholinergic drug use and IPSS at baseline were significant predictors of a good IPSS response to tadalafil treatment.

This study demonstrated that PBP could reliably identify BPH patients who could benefit from tadalafil treatment. Cases with low PBP could be better responders to tadalafil.

BJU international. 2018 Jun 19 [Epub ahead of print]

Juntaro Koyama, Yasuhiro Kaiho, Yoshihide Kawasaki, Tomonori Sato, Taro Fukushi, Atsushi Kyan, Yoichi Arai

Shirakawa Kousei General Hospital., Tohoku Medical and Pharmaceutical University., Tohoku University Graduate School of Medicine.