2009 Update on Phosphodiesterase Type 5 Inhibitor Therapy Part 1: Recent Studies on Routine Dosing for Penile Rehabilitation, Lower Urinary Tract Symptoms, and Other Indications (CME)

Introduction. Highly selective inhibitors of phosphodiesterase type 5 (PDE5I) have been commercially available for over a decade. Our knowledge of these drugs continues to expand. Aims. To review developments within the past 18 months on the utilization of PDE5I in preclinical studies and clinical practice. The focus of this article is on updates on regular dosing regimens of PDE5I other than the newly approved daily dose tadalafil. Methods. PubMed search utilizing the terms phosphodiesterase type 5 inhibitor, PDE5 inhibitor, sildenafil, vardenafil, and tadalafil. Articles were screened based on whether or not they addressed issues of routine dosing of PDE5I. Manuscripts on the newly approved daily dose tadalafil for erectile dysfunction (ED) were deferred for analysis in a separate manuscript in this series. Main Outcome Measures. Peer reviewed publications on routine dosing of PDE5I published in the medical literature since 2007. Results. There have been numerous publications in the past 2 years regarding routine dosing of PDE5I for three major urological indications; penile rehabilitation, stuttering priapism, and management of lower urinary tract symptoms (LUTS). Evidence from basic science investigations has indicated that daily dose PDE5I may improve erectile function and exert a number of beneficial tissue effects on the penis. Unfortunately, data from human series of routine dose PDE5I for penile rehabilitation after radical prostatectomy are conflicting, with the two largest studies showing no benefit to daily dose therapy in the post-radical prostatectomy and the general ED populations. PDE5I are generally helpful at reducing symptoms of LUTS, particularly when given in conjunction with alpha blockers. Routine dosing of PDE5I has also been utilized successfully for management of stuttering ischemic priapism and several other medical indications. Conclusions. PDE5I given as routine doses have clinical promise. Further research is required to clarify their safety and efficacy for various indications. Shindel AW. 2009 update on phosphodiesterase type 5 inhibitor therapy part 1: Recent studies on routine dosing for penile rehabilitation, lower urinary tract symptoms, and other indications. J Sex Med 2009;6:1794-1808.