PARIS — Indications for phosphodiesterase-5 inhibitors will likely go beyond treatment of erectile dysfunction to include a range of vascular disorders, Dr. Peter Hedlund said at the annual congress of the European Association of Urology.
Promising uses include treatment of pulmonary hypertension, digital ischemia, lower urinary tract symptoms in benign prostatic hyperplasia, and female sexual response, according to Dr. Hedlund of the department of clinical and experimental pharmacology at Lund University Hospital in Sweden.
For erectile dysfunction patients, he cited studies showing better outcomes when tadalafil and sildenafil are taken daily as opposed to as needed. Prophylactic treatment with a phosphodiesterase-5 (PDE-5) inhibitor also may improve erectile function after nerve-sparing procedures, Dr. Hedlund added. He emphasized that larger randomized controlled trials are necessary before definitive statements can be made about postprostatectomy patients.
“Endothelial dysfunction is probably the common denominator between erectile dysfunction and vascular disease,” Dr. Hedlund said. He noted that endothelial dysfunction is linked to vascular disease and risk factors for vascular disease, such as hypercholesterolemia, diabetes, and hypertension.
All three PDE-5 inhibitors—tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra)—caused pulmonary vasorelaxation in a small study, he noted, but sildenafil was the only one to improve arterial oxygenation.
Sildenafil is the only PDE-5 inhibitor approved for treatment of pulmonary hypertension in the United States and in Europe.
In another presentation at the congress, Dr. Piero Montorsi cited growing evidence that erectile dysfunction is a vascular disorder. Dr. Montorsi of the Institute of Cardiology at the University of Milan spoke at a symposium sponsored by Lilly ICOS LLC, maker of tadalafil.
Outlining the “reconditioning endothelium concept,” he suggested that PDE-5 inhibitors may be effective in treating erectile dysfunction because they improve endothelial function.
“The goal of chronic therapy should be to achieve a sustained improvement of both erectile function and systemic vascular function through an improvement of endothelial function,” Dr. Montorsi said.
“Beneficial effect of concomitant treatment of risk factors is a crucial step and should always be a part of the [erectile dysfunction] treatment strategy.”