In Group B, the mean (± SD) Qmax preoperatively
| Condition | Caution/Advice |
|---|---|
| Nitrate Use | Do not combine; risk of severe hypotension |
| Cardiovascular Disease | Consult doctor before use |
| Liver Impairment | Dose adjustment may be necessary |
| Recent Stroke or Heart Attack | Seek medical advice before starting therapy |
| Hypotension | Avoid use; blood pressure should be stable |
was 8.27 ± 2.28, and postoperatively it was 15.22 ±
- Do not take tadalafil 5mg with nitrate medications.
- Alcohol may increase side effects or reduce effectiveness.
- Store at room temperature, away from moisture and heat.
2.0, 19.00 ± 2.1, and 21.56 ± 3.59 at 1, 3, and 6 months, respectively (P < 0.001) Fig.3.
17.9 Alcohol
Once-daily tadalafil 5 mg has been shown to be most effective in enhancing drug-assisted erectile function in men with ED following radical prostatectomy. It also facilitates early recovery of erectile function post-prostatectomy and may help protect against penile structural changes. However, unassisted erectile function does not improve after discontinuation of active therapy for nine months [18]. Tadalafil monotherapy significantly improves both storage and voiding lower urinary tract symptoms (LUTS) and enhances the International Prostate Symptom Score (IPSS) [12]. To determine the potential benefits of initiating tadalafil early after TURP, we conducted this study to evaluate the efficacy of daily tadalafil 5 mg in managing persistent storage symptoms and improving erectile function post-TURP.
Publisher’s Note
Following approval by the institutional ethics committee, this study was conducted at a tertiary care hospital between May 2021 and October 2022. Patients diagnosed with benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP), either monopolar or bipolar, were eligible for inclusion. Informed consent was obtained from all participants prior to enrollment. Patients were then randomized into two groups: Group A received tadalafil 5 mg once daily, while Group B received a placebo. All patients included in the study were sexually active prior to undergoing TURP.
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Patients who were sexually inactive were excluded from analyses related to sexual function, due to the recognized limitations of the International Index of Erectile Function (IIEF-5) in evaluating erectile function among sexually inactive men. A comprehensive medical history was obtained for each participant. Evaluations included the IIEF-5 questionnaire for erectile function, the International Prostate Symptom Score (IPSS), and the IPSS storage symptom subscore-15 for assessing storage symptoms. Additional assessments included uroflowmetry, pelvi-abdominal ultrasonography with post-void residual (PVR) urine measurement, and laboratory investigations (urinalysis, urine culture, renal function tests, complete blood count, coagulation buy tadalafil profile, and prostate-specific antigen [PSA] level). All evaluations were conducted at baseline (pre-TURP) and at 1, 3, and 6 months postoperatively. Both groups demonstrated a significant improvement in post-void residual urine (PVR),
- Some people may experience nasal congestion or dizziness.
- Use caution when combining with other erectile dysfunction drugs.
- Always keep medication out of reach of children.
with a reduction observed at 1, 3, and 6 months following TURP.
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However, the difference between the two groups was not statistically significant (P = 0.2) Fig.3.
17.6 Priapism
Both groups demonstrated a comparable improvement in IPSS, maximum urinary flow rate (Qmax), and post-void residual urine (PVR). However, there was a statistically significant difference between the two groups regarding the storage IPSS score (p value: 0.036). The mean (± SD) IPSS in Group A before transurethral resection of the prostate (TURP) was 24.18 ± 2.41, which improved to 7.31 ± 1.66, 4.46 ± 0.97, and 2.33 ± 0.69 at 1, 3, and 6 months post-TURP, respectively (P < 0.001). In Group B, the mean (± SD) IPSS before TURP was 24.08 ± 2.63, which improved to 9.62 ± 3.34, 5.4 ± 1.98, and 2.83 ± 1.27 at 1, 3, and 6 months post-TURP, respectively (P < 0.001) Fig.3. The mean (± SD) maximum urinary flow rate (Qmax) in Group A preoperatively was 7.54 ± 2.45, which improved to 16.05 ± 2.05, 20.32 ± 3.15, and 23.41 ± 3.38 at 1, 3, and 6 months postoperatively, respectively (P < 0.001). The improvement in the Voiding IPSS score was comparable
- Tadalafil 5mg has a duration of action up to 36 hours.
- It can improve spontaneous sexual activity.
- Dosage adjustments may be necessary for certain health conditions.
between the two groups, with no significant difference observed.
Materials and Methods
The underlying pathophysiological mechanisms linking LUTS secondary to BPH and ED remain incompletely understood, although both conditions share several common determinants [9, 16]. Transurethral resection of the prostate (TURP) remains the gold standard for managing benign prostatic hyperplasia (BPH), despite the introduction of newer minimally invasive surgical techniques [5, 22]. However, the impact of TURP on sexual function remains uncertain. While some studies report a negative effect, others suggest an improvement in sexual function among patients with ED [19, 26]. TURP may contribute to ED through various mechanisms, primarily due to thermal injury affecting the cavernous nerves during surgery.
Authors’ contributions
Additional factors include the psychological impact of the procedure and the temporary cessation of sexual activity in the postoperative period [24]. Previous studies have reported that some patients experience persistent irritative symptoms following TURP, requiring postoperative medication to manage ongoing urinary symptoms. These symptoms significantly impact patients'quality of life after surgery. When selecting candidates for TURP, predicting the persistence of irritative bladder symptoms is crucial; however, studies investigating prognostic factors for bladder irritation remain limited. According to recent research, severe preoperative irritative bladder symptoms or frequent nocturia may increase the likelihood of persistent postoperative symptoms [11].
Key takeaways
Phosphodiesterase type 5 inhibitors (PDE5-Is) were initially approved for the treatment of ED; however, they have also been shown to be highly effective in alleviating LUTS in men, regardless of the presence of ED [3, 17, 20, 23]. PDE5-Is promote relaxation of the bladder neck and prostate by increasing nitric oxide levels in smooth muscle, thereby directly influencing micturition phases in addition to their role in penile erection [6, 7]. Another study indicates that a once-daily dose of 5 mg tadalafil is erectile dysfunction pills tadalafil a potentially effective, well-tolerated, and safe treatment option for patients with LUTS [4]. Tadalafil 5 mg once daily is currently approved for the treatment of LUTS, regardless of the presence of coexisting ED [16]. Another study reported that Tadalafil 5 mg once daily improved LUTS in men without ED by a magnitude like that observed in men with ED [2]. A slight improvement in persistent storage symptoms was noted in Group A compared to Group B.
| Storage Aspect | Condition | Notes |
|---|---|---|
| Temperature | Below 30°C (86°F) | Keep away from heat and moisture |
| Light Exposure | Store in a dark place | Protect from light |
| Keep Out of Reach | Children and pets | Safety precaution |
| Packaging | Original container | Keep sealed and intact |
| Expiry Date | Refer to packaging | Do not use past expiration date |
The mean (± SD) preoperative storage symptom sub-score in
13.2 Animal Toxicology and/or Pharmacology
Patients were randomly assigned in a 1:1 ratio into two groups using simple randomization. Group A received early administration of tadalafil 5 mg once daily starting one week after TURP, while Group B (control group) received a placebo. The randomization process was double-blinded, with both patients and surgeons blinded to group allocation. The study was conducted and will be reported in accordance with the Consolidated Standards of Reporting Trials (CONSORT) guidelines. The sample size was calculated a priori using power analysis (G*Power, version 3.1.9.2).
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The analysis was conservatively based on three primary outcomes: resolution of storage symptoms post-TURP, improvement in erectile function, and alleviation of lower urinary tract symptoms (LUTS). Based on these parameters, a minimum sample size of 105 patients per group was estimated to achieve 80% statistical power, accounting for an anticipated dropout rate of 20%. The primary outcome of the study was to evaluate the effect of early administration of tadalafil 5 mg once daily on persistent storage lower urinary tract symptoms (LUTS) and erectile function following transurethral resection of the prostate (TURP). The secondary outcome was to assess patient compliance and any adverse effects associated with tadalafil use. Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS), version 26.
More common
Categorical variables were summarized using absolute frequencies and compared using the chi-square test or Fisher’s exact test, as appropriate. Quantitative variables were expressed as means and standard deviations for normally distributed data, or as medians and interquartile ranges for non-normally distributed data. Between-group comparisons of quantitative variables were performed using the independent samples t-test for normally distributed data and the Mann–Whitney U test for non-normally distributed data. Within-group comparisons over two time points were analyzed using the paired samples t-test for normally distributed data and the Wilcoxon signed-rank test for non-normally distributed data. A p-value of < 0.05 was considered statistically significant, while a p-value of ≤ 0.001 was considered highly significant. Group A was 8.63 ± 1.82, which improved to 3.05
5.1 Cardiovascular
Of the 270 patients assessed for eligibility, 195 were enrolled tadalafil online in the study. These patients were randomized into two groups: 103 patients (53%) were assigned to Group A, receiving tadalafil 5 mg once daily, and 92 patients (47%) to Group B, receiving a placebo. The allocation process is illustrated in the CONSORT flow diagram Fig.1. There is a statistically non-significant difference between the studied groups regarding age, BMI, medical comorbidities and prostate size Table 1. With regard to erectile function, there was no statistically significant difference in baseline IIEF-5 scores between the two groups (p = 0.131).
Additional file 5: (download PDF )
In Group A, a significant improvement in IIEF-5 scores was observed following TURP. The mean ± SD IIEF-5 score in Group A was 9.84 ± 2.6 at baseline, which increased to 11.59 ± 1.9, 19.8 ± 1.12, and 20.97 ± 0.72 at 1, 3, and 6 months postoperatively, respectively (P < 0.001), as shown in Fig.2. In contrast, Group B showed a significant decline in erectile function at 1 month post-TURP, with the IIEF-5 score decreasing from a baseline of 10.43 ± 2.81 to 4.88 ± 0.82. A gradual improvement was noted at 3 and 6 months, with scores of 12.86 ± 1.56 and 15.32 ± 1.28, respectively (P < 0.001) Table 2. Regarding overall lower urinary tract symptoms (LUTS), there was no statistically significant difference between the groups in terms of baseline International Prostate Symptom Score (IPSS), with a p-value of 0.779. ± 0.78, 1.63 ± 0.49, and 0.92 ± 0.67 at 1, 3, and 6 months post-TURP, respectively (P < 0.001).
