[Approaches to medical management of patients with high risk of progressing of benign prostatic hyperplasia depending on concomitant erectile dysfunction]

To investigate the efficacy and safety of various medical treatment schemes in the management of patients at high risk of progression of benign prostatic hyperplasia (BPH), depending on concomitant erectile dysfunction (ED).

The study comprised 247 men with an I-PSS score of 8 or more, a prostate volume of more than 40 cm3, and a prostate specific antigen level of 1.5-4.0 ng/ml. Patients were divided into 2 groups: group 1 included patients without ED (IIEF-5 score >21); patients of group 2 had ED (IIEF-5 score less or equal 21). Within the groups, two subgroups of patients with a maximum flow rate (Qmax) >10 ml/s were identified (subgroup A), and with Qmax less or equal 10 ml/s (subgroup B). Patients of subgroup A of group 1 received a 5-reductase inhibitor, subgroup B of group 1received an 1-adrenoblocker, and 5-reductase inhibitor, subgroup A of group 2 were treated with a 5-reductase inhibitor and a phosphodiesterase type 5 inhibitor (PDE-5), subgroup B of group 2 received an 1-adrenoblocker, 5-reductase inhibitor, and PDE-5 inhibitor. The results were evaluated at 3, 6, and 12 months.

All schemes of combination therapy showed a significant improvement in I-PSS, QoL, Qmax and residual urine volume after three months of treatment, while in patients receiving monotherapy with 5-reductase inhibitor improvement occurred at six months after treatment initiation. There were no significant differences in the incidence of side effects between these treatment options. The use of the PDE-5 inhibitor can successfully compensate the negative effect of the 5-reductase inhibitor on male sexual function.

The most effective treatment option for BPH patients without ED is a combination of 1-adrenoblocker and 5-reductase inhibitor. In BPH patients with ED, a two- and a three-component combination including a PDE-5 inhibitor provides a significant improvement in both erectile function and lower urinary tract symptoms secondary to BPH. Multicomponent therapy schemes are not accompanied by a significant increase in the incidence of adverse reactions.

Urologiia (Moscow, Russia : 1999). 2018 Jul [Epub]

A A Kamalov, A M Takhirzade

Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov MSU, Moscow, Russia.