Intra-abdominal pressure, LUTS, and Tadalafil. Re: 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 2011;30:292-301

摘要

Worsening lower urinary tract symptoms (LUTS) are a major problem for older and aging men. The article by Andersson et al.1 provides a critical review of the pathophysi-ology, the mechanism(s) of action and the use of tadalafil for treatment. There are, however, other issues that deserve additional comment.First, the pathogenesis and treatment of BPH LUTS is complicated, multifactoral, and a multidimentional problem. Obesity and related states have long been connected with BPH. Aging, as well as abdominal/visceral obesity, in males, occurs with decreasing testosterone concentrations. This relationship has been viewed as paradoxical, since prostatic growth and enlargement continues while circulating testosterone levels are declining. These apparent contradictions, as well as, other pathophysiologic mechanisms and treatment strategies may allow for new approaches since the report by Gat et al.