Mirabegron Versus Tolterodine in BPH Patients with ED and LUTS

Document Type : Original Article

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Department of Urology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt

https://doi.org/10.21608/aimj.2025.446481

Abstract

Background: Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) resulting from benign prostatic hyperplasia (BPH) share similar risk factors, suggesting that LUTS/BPH and ED may have similar pathophysiological and underlying mechanisms. Consequently, there are currently common therapeutic strategies being investigated for these two conditions.
Aim and objective: To assess the value of mirabegron over tolterodine on erectile function in patients having ED concomitant with irritative LUTS due to BPH.
Patients and methods: A prospective randomized study was conducted among 78 patients suffering from ED and irritative LUTS suggestive of BPH. It included sexually active patients above 50 years of age who were randomized into two groups in a 1:1 ratio of 39 participants each. Group (A): Patients were prescribed (mirabegron 50 mg) plus (doxazosin 2mg) orally once daily for 12 weeks. Group (B): Patients were prescribed (tolterodine 4 mg) plus (doxazosin 2mg) orally once daily for 12 weeks. A follow-up was done at the 4th and 12th weeks.
Results: Regarding sexual parameters, IIEF-15 total score median (IQR) improved from (median= 38 and IQR, 34 – 45) at baseline to reach (median= 52 and IQR, 47 – 56) and (median= 54 and IQR= 50 – 58) at 4th and 12th weeks (p < 0.001), respectively in mirabegron group, meanwhile in tolterodine group, IIEF-15 total score didn't show significant difference either at 4th or 12th weeks (P>0.05). Regarding urinary parameters, both groups achieved significant improvement in all urinary parameters.
Conclusion: Mirabegron, a β3 agonist, outperforms tolterodine in improving ED concomitant with irritative LUTS due to BPH.
 

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