Alpha‐adrenoceptors are a common denominator in the pathophysiology of erectile function and BPH/LUTS – implications for clinical practice

Summary A literature search of PubMed documented publications and abstracts from proceedings of scientific meetings was made to review the available data on benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) and erectile dysfunction (ED) with a special focus on the role of α ‐adrenoceptors as critical mediators of pathophysiology. The reader is introduced to clinical results on the therapeutic potential of α ‐blockers alone and in combination with phosphodiesterase type 5 (PDE‐5) inhibitors in the treatment of ED associated with LUTS/BPH. Epidemiological studies clearly show that an association exists between ED and LUTS/BPH. The severity of LUTS is correlated with the risk for ED. A significant number of LUTS/BPH patients are nonresponsive to the common ED treatment with PDE‐5 inhibitors. As smooth muscle contractility is regulated by adrenoceptors in the corpus cavernosum, prostate and detrusor, the α ‐adrenoceptor system may be considered a common pathophysiological mediator in the development of ED and LUTS/BPH. Blockade of α ‐adrenoceptors for the treatment of BPH/LUTS may have the potential of improving sexual function. Conversely, PDE‐5 inhibitors may exhibit positive effects in LUTS patients. Pilot studies on combination regimens of α ‐adrenoceptor antagonists and PDE‐5 inhibitors have yielded encouraging results in LUTS patients with persistent ED. On the basis of pharmacological and clinical evidence, it is established that the α ‐adrenoceptor system plays an important role in the pathophysiology of ED and LUTS secondary to BPH. Larger trials on the combination of α ‐adrenoceptor antagonists with PDE‐5 inhibitors are necessary to develop an integrated treatment approach for BPH/LUTS patients with comorbid ED.