Current practice of the combination therapy of phosphodiesterase-5 inhibitors and alpha-1 adrenergic blockers in the treatment of BPH/LUTS in non-neurogenic bladder and the emerging issues in Saudi Arabia – a preliminary report.

Both ED and LUTS secondary to BPH are found to be increasingly prevalent as men age. The presence of PDE5 receptors within corpus cavernosal smooth muscle is well established. However, isoforms PDE1 and PDE4 have also been found distributed throughout the lower urinary tract mediating smooth muscle relaxation at the bladder neck, prostate, and proximal urethra. Recently, PDE5 inhibitors have been approved to treat LUTS/BPH patients with or without ED. Our objective was to report the highs and lows of doctors and patients preliminary experience surrounding the combination of PDE5 inhibitors and alpha-1 adrenergic blockers in the treatment of LUTS/BPH. We aim at highlighting the points necessary to come up with judicious recommendations and guidelines. In this review we have studied the up-to-date papers in PubMed published on the pharmacological effects of PDE5 inhibitors on LUTS/BPH. Furthermore, we focused on the papers ascribed to combining PDE5 inhibitors with alpha-1 adrenergic blockers to treat LUTS/BPH with or without ED. In addition, we presented our early experience in Saudi Arabia surrounding the pros and cons of the combination therapy along with the patients ‘experience. Clinical trials have shown a diversity of clinical applications of PDE5 inhibitors. One of which is in treating LUTS/BPH "patients’ experience" whether alone or in combination with alpha adrenergic blockers. Tadalafil 5 mg has gained the first licensure for the daily use for LUTS/BPH "patients’ concerns" with or without ED. This paper has presented our early experience on the combination therapy and expressed the patients ‘concerns in details. In current practice, the application of the combination therapy of PDE5 "inhibitors’ preparation" and alpha-1 adrenergic blockers fits better patients who complain of LUTS/BPH and ED simultaneously. Patients who have achieved a steady level of improvement on alpha blockers alone, and expect more, might benefit from the dual therapy. In addition, many BPH patients on 5-alpha reductase inhibitors choose to add on PDE5 inhibitors` preparation to their medications in attempt to overcome the sexual dysfunction drawbacks of the former drug. On the other hand, several issues have been encountered like the concomitant use of nitrate preparations with PDE5 inhibitors, the exorbitant cost of the uninsured daily dose, and the existing comorbidity that patients in Saudi Arabia often have.