Association of lower urinary tract symptoms and erectile dysfunction: Pathophysiological aspects and implications for clinical management

International Journal of Impotence Research

Volumn 23, Issue 3, 2011, Pages 99-108

  Orabi, H ^a,b   Albersen, M ^a,c   Lue, T F ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b Assiut University Faculty of Medicine   (Egypt)

^c UNIVERSITY HOSPITALS LEUVEN   (Belgium)

Author keywords

1 adrenergic receptors; erectile dysfunction; lower urinary tract symptoms; nitrous oxide; phosphodiesterase inhibitors; testosterone

Indexed keywords

ALFUZOSIN; DOXAZOSIN; FINASTERIDE; PLACEBO; SEX HORMONE; SILDENAFIL; TADALAFIL; TAMSULOSIN; TERAZOSIN; TESTOSTERONE; VARDENAFIL;

ATHEROSCLEROSIS; DISEASE ASSOCIATION; DRUG DOSE ESCALATION; ERECTILE DYSFUNCTION; HOLMIUM LASER; HUMAN; HYPOGONADISM; LOWER URINARY TRACT SYMPTOM; PATHOPHYSIOLOGY; PRIORITY JOURNAL; PROSTATE HYPERTROPHY; PSYCHOLOGICAL ASPECT; REVIEW; SMOOTH MUSCLE CONTRACTILITY; TRANSURETHRAL MICROWAVE THERMOTHERAPY; TRANSURETHRAL NEEDLE ABLATION; TRANSURETHRAL RESECTION;

5-ALPHA REDUCTASE INHIBITORS; ADRENERGIC ALPHA-ANTAGONISTS; ADULT; AGED; ATHEROSCLEROSIS; ERECTILE DYSFUNCTION; GONADAL STEROID HORMONES; HUMANS; MALE; MIDDLE AGED; MUSCLE CONTRACTION; MUSCLE, SMOOTH; NITRIC OXIDE; PELVIS; PHOSPHODIESTERASE 5 INHIBITORS; PROSTATIC HYPERPLASIA; RECEPTORS, ADRENERGIC, ALPHA-1; TESTOSTERONE; UROLOGIC DISEASES;

EID: 79959242500     PISSN: 09559930     EISSN: 14765489     Source Type: Journal    
DOI: 10.1038/ijir.2011.14     Document Type: Review

References (101)

1. Saigal CS, Wessells H, Pace J, Schonlau M, Wilt TJ, Urologic Diseases in America Project. Predictors and prevalence of erectile dysfunction in a racially diverse population. Arch Intern Med 2006; 166: 207-212. (Pubitemid 43144945)
2. Kupelian V, Wei JT, OLeary MP, Kusek JW, Litman HJ, Link CL,, et al., BACH Survery Investigators. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey. Arch Intern Med 2006; 166: 2381-2387. (Pubitemid 44833365)
3. DaSilva FC. Benign prostatic hyperplasia. Natural evolution versus medical treatment. Eur Urol 1997; 32(suppl 2): 34-37.
4. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the cologne male survey. Int J Impot Res 2000; 12: 305-311. (Pubitemid 32175951)
5. Braun MH, Sommer F, Haupt G, Mathers MJ, Reifenrath B, Engelmann UH. Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical aging male symptoms? results of the cologne male survey. Eur Urol 2003; 44: 588-594. (Pubitemid 37336515)
6. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 2003; 44: 637-649. (Pubitemid 37542920)
7. McVary KT, Foley J, Slawin K, Kusek J, MTOPS Study Group. The long term effects of doxazosin, finasteride, and the combination on sexual function in men participating in the MTOPS Trial. J Urol 2004; 171. Abstract 1194.
8. Mondul AM, Rimm EB, Giovannucci E, Glasser DB, Platz EA. A prospective study of lower urinary tract symptoms and erectile dysfunction. J Urol 2008; 179: 2321-2326.
9. Li MK, Garcia LA, Rosen R. Lower urinary tract symptoms and male sexual dysfunction in Asia: a survey of ageing men from five Asian countries. BJU Int 2005; 96: 1339-1354. (Pubitemid 41743935)
10. Elliott SP, Gulati M, Pasta DJ, Spitalny GM, Kane CJ, Yee R et al. Obstructive lower urinary tract symptoms correlate with erectile dysfunction. Urology 2004; 63: 1148-1152. (Pubitemid 38746821)
11. Ponholzer A, Temml C, Obermayr R, Madersbacher S. Association between lower urinary tract symptoms and erectile dysfunction. Urology 2004; 64: 772-776. (Pubitemid 39446060)
12. Khan MA, Dashwood MR, Thompson CS, Auld J, Morgan RJ, Mikhailidis DP. Downregulation of endothelin-B receptor sites in cavernosal tissue of a rabbit model of partial bladder outlet obstruction: potential clinical relevance. World J Urol 1999; 17: 290-295.
13. Albersen M, Shindel AW, Mwamukonda KB, Lue TF. The future is today: emerging drugs for the treatment of erectile dysfunction. Expert Opin Emerg Drugs 2010; 15: 467-480.
14. Kedia GT, Ückert S, Jonas U, Kuczyk MA, Burchar M. The nitric oxide pathway in the human prostate: clinical implications in men with lower urinary tract symptoms. World J Urol 2008; 26: 603-609.
15. Richter K, Heuer O, Ückert S, Stief CG, Jonas U, Wolf G. Immunocytochemical distribution of nitric oxide synthases in the human prostate. J Urol 2004; 171(Suppl 4): 347 (abstract).
16. Bloch W, Klotz T, Loch C, Schmidt G, Engelmann U, Addicks K. Distribution of nitric oxide synthase implies a regulation of circulation, smooth muscle tone, and secretory function in the human prostate by nitric oxide. Prostate 1997; 33: 1-8. (Pubitemid 27381587)
17. Cai H, Harrison DG. Endothelial dysfunction in cardiovascular diseases: the role of oxidant stress. Circ Res 2000; 87: 840-844.
18. Barton M, Cosentino F, Brandes RP, Moreau P, Shaw S, Luscher TF. Anatomic heterogeneity of vascular aging: role of nitric oxide and endothelin. Hypertension 1997; 30: 817-824. (Pubitemid 27441107)
19. Guh JH, Hwang TL, Ko FN, Chueh SC, Lai MK, Teng CM. Antiproliferative effect in human prostatic smooth muscle cells by nitric oxide donor. Mol Pharmacol 1998; 53: 467-474.
20. Burnett AL, Calvin DC, Chamness SL, Liu JX, Nelson RJ, Klein SL, et al. Urinary bladder-urethral sphincter dysfunction in mice with targeted disruption of neuronal nitric oxide synthase models idiopathic voiding disorders in humans. Nat Med 1997; 3: 571-574. (Pubitemid 27198659)
21. Persson K, Igawa Y, Mattiasson A, Andersson KE. Effects of inhibition of the L-arginine/nitric oxide pathway in the rat lower urinary tract in vivo and in vitro. Br J Pharmacol 1992; 107: 178-184.
22. Uckert S, Kuthe A, Jonas U, Stief CG. Characterization and functional relevance of cyclic nucleotide phosphodiesterase isoenzymes of the human prostate. J Urol 2001; 166: 2484-2490. (Pubitemid 33065340)
23. Filippi S, Morelli A, Sandner P, Fibbi B, Mancina R, Marini M, et al. Characterization and functional role of an androgendependent PDE5 activity in the bladder. Endocrinology 2007; 148: 1019-1029.
24. Tinel H, Stelte-Ludwig B, Hutter J, Sandner P. Pre-clinical evidence for the use of phosphodiesterase-5 inhibitors for treating benign prostatic hyperplasia and lower urinary tract symptoms. BJU Int 2006; 98: 1259-1263. (Pubitemid 44721238)
25. Lin G, Huang YC, Wang G, Lue TF, Lin CS. Prominent expression of phosphodiesterase 5 in striated muscle of the rat urethra and levator ani. J Urol 2010; 184: 769-774.
26. Price DT, Schwinn DA, Lomasney JW, Allen LF, Caron MG, Lefkowitz RJ. Identification, quantification, and localization of mRNA for three distinct alpha 1 adrenergic receptor subtypes in human prostate. J Urol 1993; 150: 546-551. (Pubitemid 23215921)
27. Walden PD, Gerardi C, Lepor H. Localization and expression of the alpha1A-1, alpha1B and alpha1D-adrenoceptors in hyperplastic and non-hyperplastic human prostate. J Urol 1999; 161: 635-640.
28. Rudner XL, Berkowitz DE, Booth JV, Funk BL, Cozart KL, DAmico EB, et al. Subtype specific regulation of human vascular alpha(1)-adrenergic receptors by vessel bed and age. Circulation 1999; 100: 2336-2343.
29. Malloy BJ, Price DT, Price RR, Bienstock AM, Dole MK, Funk BL, et al. Alpha1-adrenergic receptor subtypes in human detrusor. J Urol 1998; 160: 937-943. (Pubitemid 29479558)
30. Andersson KE, Wagner G. Physiology of penile erection. Physiol Rev 1995; 75: 191-236.
31. Reilly CM, Stopper VS, Mills TM. Androgens modulate the alphaadrenergic responsiveness of vascular smooth muscle in the corpus cavernosum. J Androl 1997; 18: 26-31. (Pubitemid 27114460)
32. Christ GJ, Stone B, Melman A. Age-dependent alterations in the efficacy of phenylephrine-induced contractions in vascular smooth muscle isolated from the corpus cavernosum of impotent men. Can J Physiol Pharmacol 1991; 69: 909-913.
33. Trussell JC, Kunselman AR, Legro RS. Epinephrine is associated with both erectile dysfunction and lower urinary tract symptoms. Fertil Steril 2010; 93: 837-842.
34. Medina JJ, Parra RO, Moore RG. Benign prostatic hyperplasia (the aging prostate). Med Clin North Am 1999; 83: 1213-1229. (Pubitemid 29430375)
35. McVary KT, Razzaq A, Lee C, Venegas MF, Rademaker A, McKenna KE. Growth of the rat prostate gland is facilitated by the autonomic nervous system. Biol Reprod 1994; 51: 99-107. (Pubitemid 24179226)
36. Chitaley K, Wingard CJ, ClintonWebb R, Branam H, Stopper VS, Lewis RW, et al. Antagonism of Rhokinase stimulates rat penile erection via a nitric oxide-independent pathway. Nat Med 2001; 7: 119-122. (Pubitemid 32095651)
37. Chitaley K, Bivalacqua TJ, Champion HC, Usta MF, Hellstrom WJ, Mills TM, et al. Adeno-associated viral gene transfer of dominant negative RhoA enhances erectile function in rats. Biochem Biophys Res Commun 2002; 298: 427-432. (Pubitemid 35333724)
38. Rees RW, Foxwell NA, Ralph DJ, Kell PD, Moncada S, Cellek S. Y-27632, a Rho-kinase inhibitor, inhibits proliferation and adrenergic contraction of prostatic smooth muscle cells. J Urol 2003; 170: 2517-2522. (Pubitemid 37414047)
39. Chang S, Hypolite JA, Zderic SA,Wein AJ, Chacko S, DiSanto ME. Enhanced force generation by corpus cavernosum smooth muscle in rabbits with partial bladder outlet obstruction. J Urol 2002; 167: 2636-2644. (Pubitemid 34533193)
40. Bing W, Chang S, Hypolite JA, DiSanto ME, Zderic SA, Rolf L, et al. Obstruction-induced changes in urinary bladder smooth muscle contractility: a role for Rho kinase. Am J Physiol Renal Physiol 2003; 285: F990-F997. (Pubitemid 37288645)
41. Hale TM, Okabe H, Bushfield TL, Heaton JP, Adams MA. Recovery of erectile function after brief aggressive antihypertensive therapy. J Urol 2002; 168: 348-354. (Pubitemid 34640855)
42. Tarcan T, Azadzoi KM, Siroky MB, Goldstein I, Krane RJ. Age related erectile and voiding dysfunction: the role of arterial insufficiency. Brit J Urol 1998; 82(Suppl. 1): 26-33.
43. Ponholzer A, Temml C, Wehrberger C, Marszalek M, Maderbacher S. The association between LUTS and vascular risk factors in both sexes. Eur Urol 2006; 50: 581-586. (Pubitemid 44189048)
44. Kim SO, Son KC, Im CM, Jung SI, Kwon DD, Park KS, et al. The effects of risk factors for vascular disease on LUTS and erectile dysfunction. Eur Urol Suppl 2008; 7: 131.
45. El-Sakka AI. Lower urinary tract symptoms in patients with erectile dysfunction: is there avascular association? Euro Urol 2005; 48: 319-325. (Pubitemid 40973319)
46. Azadzoi KM, Tarcan T, Siroky MB, Krane RJ. Atherosclerosisinduced chronic ischemia causes bladder fibrosis and noncompliance in the rabbit. J Urol 1999; 161: 1626-1635. (Pubitemid 29420853)
47. Kozlowski R, Kershen RT, Siroky MB, Krane RJ, Azadzoi KM. Chronic ischemia alters prostate structure and reactivity in rabbits. J Urol 2001; 165: 1019-1026. (Pubitemid 32156342)
48. Azadzoi KM, Babayan RK, Kozlowski R, Siroky MB. Chronic ischemia increases prostatic smooth muscle contraction in the rabbit. J Urol 2003; 170: 659-663. (Pubitemid 36870279)
49. McVary K. Erectile dysfunction and lower urinary tract symptoms secondary to BPH. Eur Urol 2005; 47: 838-845. (Pubitemid 40745354)
50. Yassin AA, El-Sakka AI, Saad F, Gooren LJG. Lower urinarytract symptoms and testosterone in elderly men. World J Urol 2008; 26: 359-364.
51. Rosenzweig BA, Bolina PS, Birch L, Moran C, Marcovici I, Prins GS. Location and concentration of estrogen, proges terone, and androgen receptors in the bladder and urethra of the rabbit. Neurourol Urodyn 1995; 14: 87-96.
52. Salmi S, Santti R, Gustafsson JA, Makela S. Co-localization of androgen receptor with estrogen receptor beta in the lower urinary tract of the male rat. J Urol 2001; 166: 674-677. (Pubitemid 32655035)
53. Keast JR. The autonomic nerve supply of male sex organs-an important target of circulating androgens. Behav Brain Res 1999; 105: 81-92. (Pubitemid 29447614)
54. Holmquist F, Persson K, Bodker A, Anderson KE. Some pre and post-junctional effects of castration in rabbit isolated corpus cavernosum and urethra. J Urol 1994; 152: 1011-1016. (Pubitemid 24246004)
55. Chamness SL, Ricker DD, Crone JK, Dembeck CL, Maguire MP, Burnett AL, et al. The effect of androgen on nitric oxide synthase in the male reproductive tract of the rat. Fertil Steril 1995; 63: 1101-1107.
56. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54-61. (Pubitemid 24046934)
57. Koritsiadis G, Stravodimos K, Mitropoulos D, Doumanis G, Fokitis I, Koritsiadis S, et al. Androgens and bladder outlet obstruction: a correlation with pressure-flow variables in a preliminary study. BJU Int 2008; 101: 1542-1546. (Pubitemid 351704027)
58. Frankel SJ, Donovan JL, Peters TI, Abrams P, Dabhoiwala NF, Osawa D, et al. Sexual dysfunction in men with lower urinary tract symptoms. J Clin Epidemiol 1998; 51: 677-685. (Pubitemid 28404362)
59. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: diagnosis and treatment recommendations. J Urol 2003; 170: 530-547.
60. Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med 1995; 332: 75-79.
61. Brookes ST, Donovan JL, Peters TJ, Abrams P, Neal DE. Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial. BMJ 2002; 324: 1059-1061. (Pubitemid 34492811)
62. Kabalin JN, Gill HS, Bite G, Wolfe V. Comparative study of laser versus electocautery prostatic resection: 18-month follow up with complex urodynamic assessment. J Urol 1995; 153: 94-97.
63. Anson K, Nawrocki J, Buckley J, Fowler C, Kirby R, Lawrence W, et al. A multicentre, randomized, prospective study of endoscopic 74-Larson TR. Current treatment options for benign prostatic hyperplasia and their impact on sexual function. Urology 2003; 61: 692-698.
64. Briganti A, Naspro R, Gallina A, Salonia A, Vavassori I, Hurle R, et al. Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomized trial. J Urol 2006; 175: 1817-1821.
65. Hamann MF, Naumann CM, Seif C, van der Horst C, Jünemann K-P, Braun PM. Functional outcome following photoselective vaporisation of the prostate (PVP): uro dynamic findings within 12months follow up. Eur Urol 2008; 54: 902-908.
66. Kavoussi PK, Hermans MR. Maintenance of erectile function after photoselective vaporization of the prostate for obstructive benign prostatic hyperplasia. J Sex Med 2008; 5: 2669-2671.
67. Bouchier-Hayes DM, Van Appledorn S, Bugeja P, Crowe H, Challacombe B, Costello AJ. A randomized trial of photoselective vaporization of the prostate using the 80-W potassium-titanylphosphate laser vs transurethral prostatectomy, with a 1-year follow-up. BJU Int 2010; 105: 964-969.
68. Paick JS, Um JM, Kim SW, Ku JH. Influence of high-power potassiumtitanyl-phosphate photoselective vaporization of the prostate on erectile function: a short-term follow-up study. J Sex Med 2007; 4: 1701-1707. (Pubitemid 47616862)
69. Bruyère F, Puichaud A, Pereira H, Faivre dArcier B, Rouanet A, Paule Floch A, et al. Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up. Euro Urol 2010; 58: 207-211.
70. Reich O. What do we know (or think we know) about erectile dysfunction following laser treatments for lower urinary tract symptoms? Euro Urol 2010; 58: 212-213.
71. Miner M, Rosenberg M, Perelman M. Treatment of lower urinary tract symptoms in benign prostatic hyperplasia and its impact on sexual function. Clin Ther 2006; 28: 13-25. (Pubitemid 43254986)
72. Gacci M, Bartoletti R, Figlioli S, Sarti E, Eisner B, Boddi V, et al. Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study. BJU Int 2003; 91: 196-200. (Pubitemid 36232834)
73. Schulman C. Impact of treatment of BPH on sexuality. Prostate Cancer Prostatic Dis 2001; 4(S1): S12-S16. (Pubitemid 33752826)
74. Jung JH, Jae SU, Kam SC, Hyun JS. Correlation between lower urinary tract symptoms (LUTS) and sexual function in benign prostatic hyperplasia: impact of treatment of LUTS on sexual function. J Sex Med 2009; 6: 2299-2304.
75. van Moorselaar RJ, Hartung R, Emberton M, Harving N, Matzkin H, Elhilali M, et al. Alfuzosin 10mg once daily improves sexual function in men with lower urinary tract symptoms and concomitant sexual dysfunction. BJU Int 2005; 95: 603-608. (Pubitemid 40311481)
76. Kumar R, Nehra A, Jacobson DJ, McGree ME, Gades NM, Lieber MM, et al. Blocker use is associated with decreased risk of sexual dysfunction. Urology 2009; 74: 82-88.
77. Cantrell MA, Bream-Rouwenhorst HR, Hemerson P, Magera Jr JS. Silodosin for benign prostatic hyperplasia. Ann Pharmacother 2010; 44: 302-310.
78. McConnell JD, Bruskewitz R, Walsh P, Andriole G, Lieber M, Holtgrewe HL, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. N Engl J Med 1998; 338: 557-563. (Pubitemid 28114643)
79. McConnell JD, Roehrborn CG, Bautista OM, Andriole Jr GL, Dixon CM, Kusek JW, et al. The longterm effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003; 349: 2387-2398. (Pubitemid 37542987)
80. Roehrborn CG, Boyle P, Nickel JC, Hoefner K, Andriole G. Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 2002; 60: 434-441. (Pubitemid 35292169)
81. Debruyne F, Barkin J, van Erps P, Reis M, Tammela TL, Roehrborn C, et al. Efficacy and safety of long-term treatment with the dual 5a-reductase inhibitor dutasteride in men with symptomatic benign prostatic hyperplasia. Eur Urol 2004; 46: 488-495. (Pubitemid 39200858)
82. Debruyne FM, Jardin A, Colloi D, Resel L, Witjes WP, Delauche-Cavallier MC, et al. Sustained-release alfuzosin, finasteride and the combination of both in the treatment of benign prostatic hyperplasia. European ALFIN Study Group. Eur Urol 1998; 34: 169-175. (Pubitemid 28432911)
83. Jardin A, Debruyne F, McCarthy C. Sexual function in men with BPH treated either with an alpha adrenergic blocker alfuzosin or the 5-alpha reductase inhibitor finasteride or the combination. J Urol 1998; 159: 331A.
84. Mouli S, McVary KT. PDE5 inhibitors for LUTS. Prostate Cancer Prostatic Dis 2009; 12: 316-324.
85. McVary KT, Monnig W, Camps Jr JL, Young JM, Tseng LJ, van den Ende G. Sildenafil citrate improves erectile function and urinary symptoms in men with erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, double-blind trial. J Urol 2007; 177: 1071-1077. (Pubitemid 46216352)
86. Stief CG, Porst H, Neuser D, Beneke M, Ulbrich E. A randomised placebo-controlled study to assess the efficacy of twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Eur Urol 2008; 53: 1236-1244.
87. McVary KT, Roehrborn CG, Kaminetsky JC, Auerbach SM, Wachs B, Young JM, et al. Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 2007; 177: 1401-1407. (Pubitemid 46435965)
88. Roehrborn CG, McVary KT, Elion-Mboussa A, Viktrup L. Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a dose finding study. J Urol 2008; 180: 1228-1234.
89. Andersson K-E, de Groat WC, McVary KT, Lue TF, Roehrborn CG, Maggi M, et al. Tadalafil for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: pathophysiology and mechanism(s) of action. Neurourol Urodyn 2010; 26: 1-10.
90. Köhler TS, McVary KT. The relationship between erectile dysfunction and lower urinary tract symptoms and the role of phosphodiesterase type 5 inhibitors. Euro Urol 2009; 55: 38-48.
91. Gacci M, Del Popolo G, Macchiarella A, Celso M, Vittori G, Lapini A, et al. Vardenafil improves urodynamic parameters in men with spinal cord injury: results from a single dose, pilot study. J Urol 2007; 178: 2040-2043.
92. Dmochowski R, Roehrborn C, Klise S, Xu L, Kaminetsky J, Kraus S. Urodynamic effects of once daily tadalafil in men with lower urinary tract symptoms secondary to clinical benign prostatic hyperplasia: a randomized, placebo-controlled 12-week clinical trial. J Urol 2010; 183: 1092-1097.
93. Salem EA, Kendirci M, Hellstrom WJ. Udenafil, a long-acting PDE5 inhibitor for erectile dysfunction. Curr Opin Investig Drugs 2006; 7: 661-669. (Pubitemid 44018351)
94. Chung BH, Lee JY, Lee SH, Yoo SJ, Lee SW, Oh CY. Safety and efficacy of the simultaneous administration of udenafil and an alpha-blocker in men with erectile dysfunction concomitant with BPH/LUTS. Int J Impot Res 2009; 21: 122-128.
95. Kaplan SA, Gonzalez RR, Te AE. Combination of lfuzosin and sildenafil is superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. Euro Urol 2007; 51: 1717-1723. (Pubitemid 46634750)
96. Liguori G, Trombetta C, De Giorgi G, Pomara G, Maio G, Vecchio D, et al. Efficacy and safety of combined oral therapy with tadalafil and alfuzosin: an integrated approach to the management of patients with lower urinary tract symptoms and erectile dysfunction. Preliminary report. J Sex Med 2009; 6: 544-552.
97. Saad F, Gooren L, Haider A, Yassin A. An exploratory study of the effects of 12 month administration of the novel long-acting testosterone undecanoate on measures of sexual function and the metabolic syndrome. Arch Androl 2007; 53: 353-357.
98. Saad F, Gooren LJ, Haider A, Yassin A. A dose-response study of testosterone on sexual dysfunction and features of the metabolic syndrome using testosterone gel and parenteral testosterone undecanoate. J Androl 2008; 29: 102-105.
99. Kalyani RR, Dobs AS. Androgen deficiency, diabetes, and the metabolic syndrome in men. Curr Opin Endocrinol Diabetes Obes 2007; 14: 226-234. (Pubitemid 46684478)
100. Zhang XH, Melman A, DiSanto ME. Update on corpus cavernosum smooth muscle contractile pathways in erectile function: a role for testosterone? J Sex Med; published online February 2011; doi:10.1111/j.1743-6109.2011.02218x (e-pub ahead of print).
101. Haider A, Gooren LJ, Padungtod P, Saad F. Concurrent improvement of the metabolic syndrome and lower urinary tract symptoms upon normalisation of plasma testosterone levels in hypogonadal elderly men. Andrologia 2009; 41: 7-13.