Re: The Risk of Sexual Dysfunction and Effectiveness of Treatment of Benign Prostatic Hyperplasia with Severe Lower Urinary Tract Dysfunction with Combination of Dutasteride and Solifenacin
Abstract
available at http://www.ncbi.nlm.nih.gov/pubmed/30415813 Editorial Comment: Challenges associated with long-term use of medications to alleviate lower urinary tract symptoms secondary to benign prostatic hyperplasia and/or overactive bladder include compliance, costs and adverse effects such as sexual dysfunction. The 5a-reductase inhibitors (5ARIs) finasteride and dutasteride are most challenged by issues related to ejaculation, erection, libido and sexual satisfaction. Smart folks have conducted studies looking to combine 5ARIs with agents that enhance erectile function, such as tadalafil. It makes intuitive sense to use the best aspects of therapies and augment them to combat adverse events. This article is interesting in that it analyzes the potential positive sexual salvage effects of the antimuscarinic agent solifenacin used in combination with the 5ARI dutasteride. In this series 10 mg or 20 mg solifenacin in combination with dutasteride helped preserve erectile function as well as increase sexual satisfaction. Ejaculatory function declined throughout the study. Does this make sense? Why would an antimuscarinic agent preserve erectile function and improve sexual satisfaction? The authors hypothesize that increased oxygenation and trophism of smooth muscle in the pelvis may improve sexual function. In general, agents used for overactive bladder symptoms have not been evaluated for downstream changes in sexual function. There have been hints that these agents may…
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