Editing Benign prostatic hyperplasia (section)

====Phosphodiesterase inhibitors (PDE)====

A 2018 Cochrane review of studies on men over 60 with moderate to severe [[lower urinary tract symptoms]] analyzed the impacts of [[phosphodiesterase inhibitor]]s (PDE) in comparison to other drugs.<ref>{{cite journal | vauthors = Pattanaik S, Mavuduru RS, Panda A, Mathew JL, Agarwal MM, Hwang EC, Lyon JA, Singh SK, Mandal AK | title = Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 11 | pages = CD010060 | date = November 2018 | pmid = 30480763 | pmc = 6517182 | doi = 10.1002/14651858.CD010060.pub2 | collaboration = Cochrane Urology Group }}</ref> These drugs may improve urinary symptoms slightly and reduce urinary bother but may also cause more side effects than placebo. The evidence in this review found that there is probably no difference between PDE and [[alpha blocker]]s, however when used in combination they may provide a greater improvement in symptoms (with more side effects). PDE also likely improves symptoms when used with [[5-alpha reductase inhibitors]].

Several phosphodiesterase-5 inhibitors are also effective but may require multiple doses daily to maintain adequate urine flow.<ref>{{cite journal | vauthors = Wang Y, Bao Y, Liu J, Duan L, Cui Y | title = Tadalafil 5 mg Once Daily Improves Lower Urinary Tract Symptoms and Erectile Dysfunction: A Systematic Review and Meta-analysis | journal = Lower Urinary Tract Symptoms | volume = 10 | issue = 1 | pages = 84–92 | date = January 2018 | pmid = 29341503 | doi = 10.1111/luts.12144 | s2cid = 23929021 }}</ref><ref name="Pattanaik CD010060">{{cite journal | vauthors = Pattanaik S, Mavuduru RS, Panda A, Mathew JL, Agarwal MM, Hwang EC, Lyon JA, Singh SK, Mandal AK | title = Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 11 | pages = CD010060 | date = November 2018 | pmid = 30480763 | pmc = 6517182 | doi = 10.1002/14651858.CD010060.pub2 }}</ref> [[Tadalafil]], a phosphodiesterase-5 inhibitor, was considered then rejected by NICE in the UK for the treatment of symptoms associated with BPH.<ref name="guidance.nice.org.uk">{{cite web |title = Hyperplasia (benign prostatic) – tadalafil (terminated appraisal) (TA273) |url = http://guidance.nice.org.uk/TA273 |work = National Institute for Health and Clinical Excellence (NICE) |date = 23 January 2013 |access-date = 27 January 2013 |url-status = live |archive-url = https://web.archive.org/web/20130224050938/http://guidance.nice.org.uk/TA273 |archive-date = 24 February 2013}}</ref> In 2011, the U.S. Food and Drug Administration approved tadalafil to treat the signs and symptoms of benign prostatic hyperplasia, and for the treatment of BPH and erectile dysfunction (ED), when the conditions occur simultaneously.<ref name="fda.gov">{{cite web |title = FDA approves Cialis to treat benign prostatic hyperplasia |url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm |work = U.S. Food and Drug Administration (FDA) |access-date = 7 May 2013 |url-status = dead |archive-url = https://web.archive.org/web/20170118091151/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm |archive-date = 18 January 2017}}</ref>