Current guidelines for the treatment of benign prostatic hyperplasia (BPH) in several countries recommend the use of α₁-adrenoceptor antagonists (α1-blockers) or 5-alpha-reductase inhibitors (5ARIs), or phosphodiesterase 5 (PDE5) inhibitors for patients with lower urinary tract symptoms (LUTS) suggestive of BPH (LUTS/BPH). α1-blockers, such as tamsulosin and silodosin which are popular and frequently prescribed α1-blockers, improve LUTS/BPH by relaxing the smooth muscle tone of the prostate and bladder neck. 5ARIs, such as dutasteride and finasteride, were reported to improve LUTS by decreasing prostate size through inhibition of 5-AR. Meanwhile, tadalafil is the only PDE5-inhibitor approved for patients with LUTS/BPH. Smooth muscle relaxation in the bladder, urethra, and prostate due to increased nitric oxide/cGMP pathway activity via inhibition of PDE5 isoenzymes was reported to be the mechanism of LUTS improvement with tadalafil. Additionally, The use of an anticholinergic agent or a β3-adrenergic receptor agonist should be considered in patients with overactive bladder symptoms (overactive bladder symptom score ≥6).
In this symposium, I would like to introduce most recent findings of these curative drugs for LUTS in clinical practice.