Tadalafil and tamsulosin in the management of lower urinary tract symptoms due to benign prostatic hyperplasia: A prospective, randomized, open-label, comparative study.

BACKGROUND

Benign prostatic hyperplasia (BPH) commonly presents with lower urinary tract symptoms (LUTS), which can significantly impair quality of life in aging men. Tamsulosin, a selective alpha-1 blocker, is widely used for symptom relief. Tadalafil, a phosphodiesterase-5 inhibitor, offers dual benefit for LUTS and erectile dysfunction (ED). However, limited comparative data exist from African populations.

OBJECTIVE

To compare the efficacy and safety of tadalafil and tamsulosin monotherapy in the management of LUTS due to BPH in men attending a tertiary hospital in Ghana.

METHODS

This prospective, randomized, open-label study was conducted over 12 weeks at the Korle-Bu Teaching Hospital. Eighty-two men aged ⩾40 years with moderate to severe LUTS due to BPH were randomized to receive either tadalafil 5 mg or tamsulosin 0.4 mg daily. Baseline, 4-week, and 12-week evaluations included International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), post-void residual urine (PVR), and International Index of Erectile Function (IIEF-5). Statistical analyses included t-tests and linear regression.

RESULTS

Both groups showed significant improvement in IPSS, QoL, Qmax, and PVR over time. At 12 weeks, Qmax was significantly higher in the tadalafil group compared to tamsulosin (18.7 ± 4.5 vs 16.9 ± 2.6 mL/s, p = 0.045). IPSS improvement was similar across both arms (Tadalafil: -9.3; Tamsulosin: -7.8). Tadalafil significantly improved IIEF-5 scores from 14.0 to 21.0 (p < 0.001), whereas tamsulosin showed minimal change. Subgroup analysis showed tadalafil's erectile function benefit was consistent across demographic and clinical subgroups except in diabetics. Side effects were mild (5.1%) and equally distributed between groups.

CONCLUSION

Tadalafil and tamsulosin are both effective in alleviating LUTS due to BPH. Tadalafil provides additional benefits in erectile function and superior improvement in urinary flow, making it a suitable first-line option, especially for patients with coexisting ED. These findings support individualized treatment decisions based on patient profile and symptom burden in resource-limited settings.