Comment to “Benign prostatic hyperplasia and lower urinary tract symptoms. A review of current evidence”

Alcántara Montero, A.

doi:10.1016/j.acuroe.2016.08.009

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A review of current evidence”" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "435" "paginaFinal" => "436" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "A. Alcántara Montero" "autores" => array:1 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Alcántara Montero" "email" => array:1 [ 0 => "a.alcantara.montero@hotmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro de Salud José María Álvarez, Don Benito, Badajoz, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario editorial a «Hiperplasia prostática benigna y síntomas del tracto urinario inferior. Revisión de las evidencias actuales»" ] ] "textoCompleto" => "Recently, a review article on current evidence on benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) has been published in this journal and deserves my recognition. In this paper, the authors described the options for medical treatment of LUTS based on the update of the European Association of Urology (EAU) guideline of 2015. In this review, as in the last update of the guideline of the LUTS/BPH of 2016, the following are included as combination therapies: alpha-blocker+5α-reductase inhibitor (5-ARI) and alpha-blocker+antimuscarinic.<a class="elsevierStyleCrossRef" href="#bib0030">1</a>However, it is striking that in the medical treatment algorithm of LUTS in the male, without indication of surgery, which is collected in the last update of the EAU of 2016, mention is made of a combination therapy that is not developed in the text of that guideline: combination therapy of a 5-ARI and a phosphodiesterase 5 inhibitor (I-PDE5).<a class="elsevierStyleCrossRef" href="#bib0035">2</a>Most of the available evidence on the efficacy and safety of tadalafil and finasteride combination therapy for the treatment of LUTS in men with BPH is based on an international, randomized, double-blind, parallel study evaluating men aged 45 or older with LUTS/BPH, who had not previously taken a 5-ARI (finasteride), with an international prostate symptom score (IPSS) ≥13 and prostate volume ≥30ml. Patients were randomized to placebo+5mg finasteride (PBO/FIN) and 5mg tadalafil+5mg finasteride (TAD/FIN) for 26 weeks. During this period, changes in IPSS, erectile function through IIEF-EF (erectile function domain of the International Index of Erectile Function) were evaluated in sexually active males as well as safety (adverse events). In this study, it was observed that patients taking TAD/FIN experienced an improvement in their LUTS (both emptying, filling and quality of life of the IPSS) compared to the PBO/FIN branch from the first visit (week 4); and this improvement was maintained throughout the treatment period of 26 weeks. In men who were sexually active and had erectile dysfunction (ED), IIEF-EF scores significantly improved with TAD/FIN. The TAD/FIN combination was well tolerated and most of the adverse events (back pain, headache, dyspepsia) were mild/moderate.<a class="elsevierStyleCrossRef" href="#bib0040">3</a> A subsequent study showed that the improvement and satisfaction of patients with this combination therapy was maintained at 6 months; and this improvement was independent of the presence/absence of DE at the start of treatment.<a class="elsevierStyleCrossRef" href="#bib0045">4</a>Therefore, there are studies that have shown that the combination of tadalafil and finasteride is a safe, effective and well-tolerated treatment for BPH. Evidence suggests that this combination would be ideal for men with moderate-severe LUTS/BPH and prostates >30ml, benefiting, also, those patients with associated ED.<a class="elsevierStyleCrossRef" href="#bib0050">5</a>The problem is that long-term studies, such as the MTOPS or CombAT studies, which can determine whether this combination therapy decreases the risk of acute urinary retention and long-term surgery, have not been published. On the other hand, to date no similar studies have been published with combination therapy of tadalafil and dutasteride, nor with other I-PDE5 and a 5-ARI." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Alcántara Montero A. Comentario editorial a «Hiperplasia prostática benigna y síntomas del tracto urinario inferior. Revisión de las evidencias actuales». Actas Urol Esp. 2017;41:435–436." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperplasia prostática benigna y síntomas del tracto urinario inferior. Revisión de las evidencias actuales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.M. Carrero-López" 1 => "J.M. Cózar-Olmo" 2 => "B. Miñana-López" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "288" "paginaFinal" => "294" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: http://www.uroweb.org [accessed 01.08.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Gravas" 1 => "T. Bach" 2 => "A. Bachmann" 3 => "M. Drake" 4 => "M. Gacci" 5 => "C. Gratzke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2016" "editorial" => "European Association of Urology (EAU)" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Casabé" 1 => "C.G. Roehrborn" 2 => "L.F. da Pozzo" 3 => "S. Zepeda" 4 => "R.J. Henderson" 5 => "S. Sorsaburu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2013.09.059" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2014" "volumen" => "191" "paginaInicial" => "727" "paginaFinal" => "733" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24096118" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment satisfaction and clinically meaningful symptom improvement in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia: secondary results from a 6-month, randomized, double-blind study comparing finasteride plus tadalafil with finasteride plus placebo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.G. Roehrborn" 1 => "A. Casabé" 2 => "S. Glina" 3 => "S. Sorsaburu" 4 => "C. Henneges" 5 => "L. Viktrup" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/iju.12741" "Revista" => array:6 [ "tituloSerie" => "Int J Urol" "fecha" => "2015" "volumen" => "22" "paginaInicial" => "582" "paginaFinal" => "587" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25827166" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combination of tadalafil and finasteride for improving the symptoms of benign prostatic hyperplasia: critical appraisal and patient focus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O.O. Elkelany" 1 => "R.C. Owen" 2 => "E.D. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/TCRM.S80353" "Revista" => array:6 [ "tituloSerie" => "Ther Clin Risk Manag" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "507" "paginaFinal" => "513" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25848297" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004100000007/v1_201708260050/S2173578617300896/v1_201708260050/en/main.assets" "Apartado" => array:4 [ "identificador" => "67921" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Comentario editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004100000007/v1_201708260050/S2173578617300896/v1_201708260050/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578617300896?idApp=UINPBA00004N"]

ISSN: 2173-5786

Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided. It has high visibility and accessibility and is found in the most important data bases, Medline/Pubmed, Emabase, JCR, Ïndice Médico Español, Índice bibliográfico Español en Ciencias de la Salud (IBECS), Cuiden, Dialnet, Hinari, Scopus, Google Scholar.

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