Every year, the number of patients with chronic prostatitis (CP) in the world is increasing and improving the effectiveness of treatment of this pathology is becoming a priority topic in modern urology. One of the complications of CP is sexual dysfunction, primarily premature ejaculation, as well as erectile dysfunction (ED). Treatment of CP and its sexual complications is an individual and complex complication. It is undeniable that sildenafil citrate plays an important role in the treatment of ED as a complication of CP.
The hypothetical mechanism of the effectiveness of PDE-5 in CP is mediated by the relaxation of the smooth muscles of the ducts of the software, the effect of increasing the drainage of the components that are formed due to reflux in the interstitial tissue. The above phenomenon can suppress inflammation and cause a reduction in prostatic symptoms. Increased activity of NO-synthetase and PDE-5 in the tissues of PO promotes the formation of muscle relaxant effects, drainage of the acinus, reduced activity of the autonomic nervous system and activation of vascular circulation in the PVC and structures of the lower urinary tract.
Current scientific evidence indicates that PDE-5 inhibitors can improve lower urinary tract symptoms by relaxing bladder smooth muscle fibers and PO, by signaling NO / cGMPc, or by improving RhoA / Rho kinase. Some results suggest that in addition to the effects of reducing the hyperactivity of the autonomic nervous system, dilation of cavernous vessels and antiproliferative effect, PDE-5 have a direct anti-inflammatory effect, increasing the level of cGMP. The accumulation of the latter can inhibit inflammation and can be a potential mechanism for preventing the development of diseases in which inflammation plays a central role.
Given that inflammation is a major factor in the progression of CP, sildenafil citrate is able to restore PO function because they act as potent anti-inflammatory drugs.
Thus, PDE-5 inhibitors can not only mediate smooth muscle relaxation, but can also directly reduce inflammation in the software by increasing cGMP levels.
Based on theoretical data on the positive effect of sildenafil on the erectile component and symptoms of the lower urinary tract in persons with CP with complications such as ED, it can be considered that the inclusion of sildenafil citrate in sequential standard therapy for CP reduces indicators of erectile function. The appointment of sildenafil citrate in patients with complications of CP in the form of ED improves the quality of erections in patients, and also has a positive effect on various other indicators of male sexual function (enhances orgasm, increases the duration of sexual intercourse).
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright and grant the journal the first publication of original scientific articles under the Creative Commons Attribution 4.0 International License, which allows others to distribute work with acknowledgment of authorship and first publication in this journal.
Dennis L., Lynch C.F., Tornes J.C. Epidemiologic association between prostatitis and prostate cancer. Urology. 2002;60:78–83.
Horpynchenko Y.Y., Hurzhenko Yu.N. The use of suppositories Vitaprost forte and Vitaprost in the complex treatment of patients with chronic nonspecific prostatitis. Men’s health. 2011;4:86–8.
Elkahwaji J.E., Zhong W., Bushman W. Chronic bacterial infection and inflammation incite reactive hyperplasia in a mouse model of chronic prostatitis. Prostate. 2007;67:14–21.
Di Silverio F, Gentile V., De Matteis A., et al.. Distribution of inflammation, premalignant lesions, incidental carcinoma in histologically confirmed benign prostatic hyperplasia: a retrospective analysis. Eur. Urol. 2003;43:164–75.
Kramer G., Mitteregger D., Marberger M. Is benign prostatic hyperplasia (BPH) an immune inflammatory disease? Eur. Urol. 2007;51:1202–6.
Nickel J.C. Prostatic inflammation in BPH: the third component? Can J. Urol. 1994;1:1–4.
De Marzo A.M., Platz E.A., Sutcliffe S. et al. Inflammation in prostate carcinogenesis. Nat Rev. 2007;7:256–69.
De Marzo A.M., Marchi V.L., Epstein J.I., Nelson W.G. Proliferative inflammatory atrophy of the prostate. Am. J.Pathol. 1999;155:1985–92.
Nelson W.G., De Marzo A.M., Isaacs W.B. Prostate cancer. N. Engl. J. Med. 2003;349:366–81.
Platz E.A., De Marzo A.M. Epidemiology of inflammation and prostate cancer. J Urol. 2004;171:536–40.
Djavan B. Lower urinary tract symptoms benign prostatic hyperplasia: fast control of the patient’s quality of life. Urology. 2003;62(31):6–14.
Naber K., Weidner W. Chronic prostatitis: an infectious disease? J. Antimicrob. Chemother. 2000;46:157–61.
Zhou T, Yang Y, Zhang H et al. Serenoa Repens Induces Growth Arrest, Apoptosis and Inactivation of STAT3 Signaling in Human Glioma Cells. Technol Cancer Res Treat. 2014;16:12–6.
Martinon F., Petrilli V., Mayor A., Tardivel A., Tschopp J. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature. 2006;440:237–41.
Sugar L.M. Inflammation and prostate cancer. Can J Urol. 2006;13(1):46–7.
Baraboi V.A., Sutkova D.A. Redox homeostasis in health and safety K.: Chernobylinterinform., 1997. – 205 р.
Baltaci S., Orhan D., Cogus C., Turkolmez K., et al. Inducible nitric oxide synthase expression in BPH, low and high grade PIN and prostate carcinoma. BJU Int. 2001;88:100–3.
Gradini R., Realacci M., Petrangeli E. et al. Nitric oxide synthases in normal and benign hyperplastic human prostate: immunohistochemistry and molecular biology. J. Pathol. 1999;189:224–9.
Irani J., Levillian P., Gouion J.M., Bon D., et al.. Inflammation in benign prostatic hyperplasia: correlation with prostate specific antigen value. J Urol. 1997;157:1301–3.
Farapontov S.A. Combined therapy for psychogenic erectile disorders. Abstract of thesis. Ph.D., Moscow, 2008. – 26 р.
Hawton K. The behavioral treatment of sexual dysfunction, in Symposium on Sexual Dysfunction. Brit. J. of Psychiat. 1982;140:94–101.
Salerian A J., Deibler W.E., Vittone В .J., et al. Sildenafil for psychotropic-induced sexual dysfunction in 31 women and 61 men. J. Sex. Marital Ther. 2000;26(2):133–40.
Boolell M, Allen MJ, Ballard SA, Gepi-Attee S, Muirhead GJ, Naylor AM, et al. Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Int J Impot Res. 1996;8:47–52.
Galiè N, Ghofrani HA, Torbicki A, Barst RJ, Rubin LJ, Badesch D, et al. Sildenafil citrate therapy for pulmonary arterial hypertension. N Engl J Med. 2005;353:2148–57.
Galiè N, Brundage BH, Ghofrani HA, Oudiz RJ, Simonneau G, Safdar Z, et al. Tadalafil therapy for pulmonary arterial hypertension. Circulation. 2009;119:2894–903.
Evans JD, Hill SR. A comparison of the available phosphodiesterase-5 inhibitors in the treatment of erectile dysfunction: a focus on avanafil. Patient Prefer Adherence. Aug 2015;12(9):1159–64.
Boeri L, Capogrosso P, Ventimiglia E, Serino A, La Croce G, Russo A, Damiano R, Montorsi F, Salonia A. Avanafil – a further step to tailoring patient needs and expectations. Expert Rev Clin Pharmacol. 2016;9(9):1171–81.
Grimsley SJS, Khan MH, Jones GE. Mechanism of Phosphodiesterase 5 inhibitor relief of prostatitis symptoms Med Hypotheses. 2007;69(1):25–6.
Titus DJ, Oliva AA, Wilson NM, Atkins CM. Phosphodiesterase inhibitors as therapeutics for traumatic brain injury. Curr Pharm Des. 2014;21:332–42.
Alves Christina Peixoto C, Oliveira dos Santos Gomes F. The role of phosphodiesterase-5 inhibitors in prostatic inflammation: a review J Inflamm (Lond). 2015;12:54. Published online 2015 Sep 15. DOI: 10.1186/s12950-015-0099-7.
Oliveira dos Santos Gomes F, da Conceição Carvalho M, Lidianne Alcântara Saraiva K, Lima Ribeiro E, Soares E Silva AK, Aragão Matos Donato M, et al. Effect of chronic Sildenafil treatment on the prostate of C57Bl/6 mice. Tissue Cell. 2014 Dec;46(6):439–49. DOI: 10.1016/j.tice.2014.08.001. Epub 2014 Aug 11.
Yang Shaobo, Liu Yili, Kong Chuize, Li Ming. Investigation of sildenafil in the treatment of prostatitis-related sexual dysfunction. Zhonghua Nan Ke Xue. 2004 Jun;10(6):451–4.
Eryildirim B, Aktas F, Kuyumcuoglu U, Faydaci G, Tarhan F, Ozgül A. The effectiveness of sildenafil citrate in patients with erectile dysfunction and lower urinary system symptoms and the significance of asymptomatic inflammatory prostatitis. Int J Impot Res. Nov-Dec 2010;22(6):349–54. DOI: 10.1038/ijir.2010.26. Epub 2010 Oct 28.
Davydov M.Y, Lodatko D.Y., Tokarev M.V. Sildenafil for the treatment of erectile dysfunction in patients with prostate diseases. Clinical Pharmacology and Therapy 2009;18(3):55–9.
Boshchenko B.C., Hudkov A.V., Latypov V.R. Availabe from: http://au-health.ru/listview.php?part=18&offset=5&nid=53
Di Luigi L, Sansone M, Sansone A, Ceci R, Duranti G, Borrione P, Crescioli C, Sgrò P, Sabatini S. Phosphodiesterase Type 5 Inhibitors, Sport and Doping. Curr Sports Med Rep. 2017 Nov/Dec;16(6):443–7.