CAN EJACULATORY DYSFUNCTION BE RECOVERED BY LOW DOSE TAMSULOSIN WHILE TREATING SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA?

Purpose: To evaluate the use of low dose Tamsulosin in relieving lower urinary tract symptoms related to benign prostatic symptoms as a trial to increase the drug safety (in terms of reducing the drug full dose side effects especially retrograde ejaculation) while maintaining its efficacy in relieving the patients' symptoms. Material and Methods: This Prospective study was conducted in King Faisal University polyclinic between November 2013 and March 2014. Patients enrolled in this study were suffering from Lower urinary tract symptoms due to benign prostatic hyperplasia and were receiving 0.4 mg Tamsulosin for variable period and was complaining of ejaculatory dysfunction. Base line assessment involved medical history with evaluation of ejaculatory function, IPSS, abdominopelvic ultrasound with estimation of postvoid residual urine (PVR) and quality of life questionnaire. The patients were excluded whenever there is any significant aggravation of their symptom. During the course of this study, 0.2 mg Tamsulosin was given to patients and they were assessed by the same tools of base line assessment at the first and third month of the study. Drug compliance and adverse events were also recorded in all patients. Results: Before we started our treatment with the low dose, twenty one patients had mean IPSS of 7.00 +/- 0.948 and mean residual volume of 92.38 +/- 20.47 ml. At first month follow up, the mean IPSS and the mean residual volume became 7.47 +/- 0.67 and 104.76 +/- 21.82 ml respectively with a statistically significant difference as compared with that of the baseline (p-value <0.05). Out of 21 patients, 16 (76.2%) patients reported no ejaculation at all and 5 (23.8%) patients reported low ejaculatory volume. After treatment with low dose Tamsulosin i.e. 0.2 mg, out of 16 patients with no ejaculation, 12 (75%) had recovered and out of the 5 patients who reported low ejaculatory volume, 3 (60%) patients reported increased ejaculatory volume. All patients with improved ejaculatory function were fully satisfied as measured by quality of life score and want to continue on the low dose. None of our patients showed adverse effects with the low dose. Conclusion: For patients complaining from LUTS due to BPH, low dose Tamsulosin (0.2 mg/day) shows potential advantage for patients with bothering ejaculatory dysfunction. In spite of the significant change in IPSS after administration of the low-dose, most of patients show higher overall satisfaction rate as compared to the standard dose (0.4mg/day). A prospective study on a large scale is still needed to confirm our result.