臨床泌尿器科75巻7号

2021年06月発行

特集 前立腺肥大症（BPH）薬物治療のニューノーマル―“とりあえず”ではなくベストな処方を目指して 〈単剤療法：1stライン〉

第一選択薬としてのPDE5阻害薬

著者： 吉良聡¹ 澤田智史¹ 三井貴彦¹

所属機関： ¹山梨大学大学院医学工学総合研究部泌尿器科学・泌尿器科

ページ範囲：P.492 - P.496

▶ポイント

・PDE5阻害薬は，ガイドライン上，前立腺肥大症（BPH）の薬物療法のなかで推奨グレードAと判定されている．

・PDE5阻害薬は，比較的若年で性的活動期にある男性が至適対象と考えられる．

・PDE5阻害薬の1年以上の長期間における服用効果・安全性に関しては，今後の課題である．

参考文献

1） Giuliano F, et al : The mechanism of Action of Phosphodiesterase Type 5 Inhibitors in the Treatment of Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia. Eur Urol 63 : 506-516, 2013

Influx Via TRPV2 and TRPV4 in Primary Rat Bladder Urothelial Cell Cultures. Neurourol Urodyn 37 : 1541-1548, 2018

3） Andersson K-E, et al : Tadalafil for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia : Pathophysiology and Mechanism（s） of Action. Neurourol Urodyn 30 : 292-301, 2011

4） 日本泌尿器科学会 （編） : 男性下部尿路症状・前立腺肥大症診療ガイドライン2017年版. リッチヒルメディカル, 東京, 2017

5） Gravas S, et al : EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms （LUTS）, incl. Benign Prostatic Obstruction （BPO）, 2020　https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Non-Neurogenic-Male-LUTS-incl.-BPO-2020.pdf （2021年6月15日閲覧）

6） Nickel JC, et al : Proportion of Tadalafil-Treated Patients with Clinically Meaningful Improvement in Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia ― Integrated Data from 1,499 Study Participants. BJU Int 115 : 815-821, 2015

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8） Wang Y, et al : Tadalafil 5 mg Once Daily Improves Lower Urinary Tract Symptoms and Erectile Dysfunction : A Systematic Review and Meta-Analysis. Low Urin Tract Symptoms 10 : 84-92, 2018

9） Giuliano F, et al : Tadalafil Once Daily Improves Ejaculatory Function, Erectile Function, and Sexual Satisfaction in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia and Erectile Dysfunction : Results from a Randomized, Placebo- and Tamsulosin-Controlled, 12-Week Double-Blind Study. J Sex Med 10 : 857-865, 2013

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11） Yokoyama O, et al : Tadalafil Once Daily for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia : A Randomized Placebo- and Tamsulosin-Controlled 12-Week Study in Asian Men. Int J Urol 20 : 193-201, 2013

12） Roehrborn CG, et al : Effects of Tadalafil Once Daily on Maximum Urinary Flow Rate in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia. J Urol 191 : 1045-1050, 2014

13） Matsukawa Y, et al : Effects of Tadalafil on Storage and Voiding Function in Patients with Male Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia : A Urodynamic-Based Study. Int J Urol 25 : 246-250, 2018

14） Gacci M, et al : A Systematic Review and Meta-Analysis on the Use of Phosphodiesterase 5 Inhibitors Alone or in Combination with α-Blockers for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Eur Urol 61 : 994-1003, 2012

15） Porst H, et al : Efficacy and Safety of Tadalafil 5 mg Once Daily for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia : Subgroup Analyses of Pooled Data from 4 Multinational, Randomized, Placebo-Controlled Clinical Studies. Urology 82 : 667-673, 2013

16） Donatucci CF, et al : Tadalafil Administered Once Daily for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia : A 1-Year, Open-Label Extension Study. BJU Int 107 : 1110-1116, 2011

17） Oelke M, et al : Efficacy and Safety of Tadalafil 5 mg Once Daily in the Treatment of Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia in Men Aged ＞＝ 75 Years : Integrated Analyses of Pooled Data from Multinational, Randomized, Placebo-Controlled Clinical Studies. BJU Int 119 : 793-803, 2017

18） Nishizawa O, et al : Tadalafil 5 mg Once Daily for the Treatment of Asian Men with Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia : Analyses of Data Pooled from Three Randomized, Double-Blind, Placebo-Controlled Studies. Int J Urol 22 : 378-384, 2015