Effects of daily tadalafil on lower urinary tract symptoms in young men with multiple sclerosis and erectile dysfunction. a pilot study

Purpose: Men affected by multiple sclerosis (MS) often experience neurogenic overactive bladder (OAB), lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Aim of the study was to investigate modifications of urinary and sexual functions after administration of daily tadalafil (TAD) 5 mg. Methods: 30 men were enrolled in a single blind, 4-weeks prospective study while 10 men without treatment served as controls. Primary outcomes were changes from baseline of International Prostate Symptom (IPSS), OAB questionnaire (OAB-q) and International Index of Erectile Function (IIEF-5) scores. To evaluate the influence of bladder filling on somatic reflexes, we studied variations of the H-reflex evoked by electrical stimuli applied to the tibial nerve at the popliteal fossa and recorded from the soleus muscle. Also testosterone/estradiol (T/E) ratio was measured before and after treatment. Results: In TAD group, an improvement of IPSS (p<0.001), OAB-q (p<0.001) and IIEF-5 (p<0.001) scores were found. Also, an increase in Qmax (p<0.01) and T/E ratio (p<0.01) were found with a concomitant reduction of post-void residual volume (p<0.001) without any changes in the H-reflex. Conclusions: The study demonstrates for the first time that daily TAD in patients with multiple sclerosis improves storage symptoms, post-void residual volume, steroid hormone pattern and ED without urodynamic changes.