Sildenafil taken daily seems to improve urinary symptoms as much as alpha blockers and 5α-reductase inhibitors, a new trial indicates.

The multicenter, double-blind, placebo-controlled study enrolled 369 men aged 45 and older who had erectile dysfunction (ED) and moderate or severe lower urinary tract symptoms (LUTS) associated with BPH. Sildenafil 50 mg or matching placebo was taken daily.

After 12 weeks of treatment with sildenafil, the men with severe LUTS showed nearly a 75% improvement. In addition, many more men taking sildenafil progressed from severe to mild LUTS (16% vs. 4%) or moderate LUTS (57% vs. 36%).

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Kevin McVary, MD, professor of urology at Northwestern University in Chicago and the study’s lead investigator, said, “We saw LUTS improvement without changing the flow rate. The magnitude of the change was comparable to all the other drugs that we have come to know and love (alpha blockers and 5α-reductase inhibitors). I see phosphodiesterase type 5 inhibitors as a potentially new class of medications for LUTS. Obviously, though, it is an off-label use.”

Dr. McVary believes the agents may help dilate small blood vessels in the pelvis and in the prostate, reducing pelvic ischemia and thus relieving LUTS.