Pharmacologic and clinical considerations of phosphodiesterase type 5 inhibitors and β-adrenergic receptor type 3 agonists for lower urinary tract symptoms and benign prostatic hyperplasia

INTRODUCTION: Benign prostatic hyperplasia (BPH) is among the most common conditions affecting aging men, with resulting lower urinary tract symptoms (LUTS) impeding on quality of life. While many medication classes exist for treatment of LUTS secondary to BPH, their increasing prevalence in a growing and aging population begs the need for novel therapeutic avenues. AREAS COVERED: This review covers the rationale for use of phosphodiesterase type 5 inhibitors and β-adrenergic receptor type 3 agonists in LUTS secondary to BPH. We evaluate their efficacy, pharmacokinetics, and safety, as well as potential drug-drug interactions. Finally, we evaluate their use in combination with standard-of-care medications, as well as their use in vulnerable populations. Included studies in this literature review and expert opinion were found using PubMed. EXPERT OPINION: Mirabegron, vibegron, and tadalafil appear to be safe and efficacious medications in treatment of LUTS. Studies generally show favorable pharmacokinetics, and they can be used in combination with other BPH medications. Further studies are needed to understand the role of pharmacogenetics and use of these medications after surgical treatment. Thus, phosphodiesterase type 5 inhibitors and β-adrenergic receptor type 3 agonists are important tools in the urologist's toolbox for treatment of BPH.