Skip to main content

Efficacy and safety of dutasteride with tadalafil add-on therapy in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia



To evaluate the efficacy and safety of add-on therapy with the phosphodiesterase type 5 inhibitor tadalafil in Japanese men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) treated with dutasteride.


Twenty-four patients were enrolled. The participants had a median age of 71.0 (64.8–73.0) years and a median prostate volume of 37.3 (29.7–41.8) mL as measured using transabdominal sonography. The efficacy indicators, such as International Prostate Symptom Score (IPSS), quality of life (QOL) score, night-time urinary frequency, and night-time maximum voided volume, improved significantly at 4 weeks, and the effects lasted until 24 weeks (IPSS: 9.5 vs. 17.0, QOL: 2.0 vs. 4.0, nocturia: 2.0 vs. 2.0, night-time maximum voided volume: 290.0 vs. 240.0 mL). Overactive bladder symptom score (OABSS) and sexual health inventory for men (SHIM) significantly improved at 12 weeks, and the effects lasted until 24 weeks (OABSS: 3.0 vs. 5.0, SHIM: 11.0 vs. 7.5). However, maximum urine flow and residual urine volume showed no improvement at any point. Adverse events occurred in two cases. Taken together, add-on therapy with tadalafil was effective for patients with LUTS/BPH resistant to dutasteride monotherapy. In addition, this therapy was not associated with severe adverse events.


The occurrence of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and overactive bladder (OAB) is common, and their prevalence increases with age [1, 2]. Benign prostatic hyperplasia is a progressive disease found in middle-aged and older men. Clinical progression risk factors include aging, prostate enlargement, high PSA, LUTS, quality of life (QOL) disorders, and low urinary flow. Prevalence depends on the presence of symptoms and findings. According to the results of a community-based study in Japan [3, 4], if the following conditions are met—IPSS > 7 points, prostate volume > 20 mL, and maximum urine flow rate < 10 mL/s—the prevalence is 6% in the sexagenarian age range and 12% in the septuagenarian age range. According to the European Association of Urology guidelines, both α1-blockers and PDE5-Is are suggested as first-line treatments for LUTS/BPH.

The use of 5-alpha reductase inhibitors (5-ARIs) as therapeutic agents has dramatically changed the application of medical therapy for BPH; 5-ARIs inhibit 5α reductase and reduce the prostate tissue by controlling dihydrotestosterone production. Thus, 5-ARIs reduce bladder outlet obstruction, thereby improving LUTS [5, 6]. Dutasteride inhibits both isoforms of 5α reductase, type 1 and type 2. Finasteride, an unlicensed drug in Japan, inhibits only type 2. The effectiveness of finasteride is comparable to that of dutasteride in reducing prostate tissue and improving LUTS [7]. The efficacy of the 5-ARI/α1 blocker combination therapy has also been determined, and its role has been examined by two large-scale studies (MTOPS [8] and CombAT [9]). Dutasteride was first utilized in Japan in 2009, leading to a considerable decrease in the total number of BPH-related surgeries from 20,413 (2009) to 14,152 (2014) [10].

The phosphodiesterase 5 inhibitor (PDE5-I) tadalafil was approved in Japan in 2014, and previous randomized studies have demonstrated that its efficacy is similar to that of the α1-blocker tamsulosin [11, 12]. Moreover, recent meta-analysis results have suggested that PDE5-Is can substantially improve LUTS as well as erectile dysfunction (ED) in men with BPH [13]. However, reports on the efficacy and safety of tadalafil add-on therapy for BPH treatment with dutasteride are currently insufficient.

Tadalafil is often administered as an add-on or combination treatment with dutasteride. However, there are only a few published studies that investigated the effect of this combination therapy [14,15,16,17]. Wada et al. demonstrated that dutasteride add-on is a reasonable treatment alternative for male patients with LUTS who are not satisfied with tadalafil monotherapy [17]. However, there is no publication reporting the efficacy of add-on treatment with tadalafil in patients with LUTS who are not satisfied with dutasteride monotherapy.

In this study, we examined the effect of tadalafil add-on treatment in patients with LUTS responding poorly to dutasteride monotherapy. We also subjectively and objectively evaluated the consequences of long-term prescription of add-on therapy with tadalafil for dutasteride treatment-resistant BPH.

The first-line therapy for BPH includes α1-blockers. However, with this therapy, some patients experience adverse events, such as ejaculatory disorder [18]. Due to said adverse events of α1-blocker (silodosin) and dutasteride combination treatment, we decided to avoid using silodosin. Withdrawal of the α1-blocker from the combination therapy was reasonable and tolerable considering the effect of dutasteride on lower urinary tract symptoms and bladder outlet obstruction [19]. However, in this study, this effect was poor and, consequently, tadalafil was added. This study investigated the possibility that additional treatment with tadalafil might be a treatment option if dutasteride alone is ineffective in patients who discontinued the α1-blocker from the combination of the α1-blocker and dutasteride.

Main text


This was a retrospective observational study. A total of 24 patients admitted to the Hirao Hospital were selected from the database of the electronic medical records system between April 2017 and December 2018. Tadalafil (5 mg) was subsequently administered to the patients. The inclusion criteria were as follows: patients were over 50 years of age, diagnosed as having LUTS/BPH, and showed poor response to dutasteride monotherapy for ≥ 6 months (International Prostate Symptom Score [IPSS] of ≥ 8 and/or IPSS-QOL index of ≥ 3). The exclusion criteria were as follows: patients with insufficient clinical data, additional use of β3-adrenoceptor agonist or anticholinergic drug within 3 months prior to the day of initial evaluation, a history of urinary retention or prostatic surgery, neurologic bladder, bladder stones, or a history or evidence of prostate cancer. For patients with a serum prostate-specific antigen concentration > 4 ng/mL, we performed appropriate magnetic resonance imaging and prostate biopsies as needed to rule out prostate cancer.

The efficacy measures included IPSS, QOL score, overactive bladder symptom score (OABSS), sexual health inventory for men (SHIM), maximum urine flow (Qmax), post-void residual urine volume, and frequency volume chart (FVC) at baseline and at 4, 12, and 24 weeks after the administration of tadalafil (Fig. 1). Safety was evaluated based on subject-reported adverse events during visits.

Fig. 1
figure 1

Illustration of the study protocol. The efficacy measures included IPSS, QOL score, OABSS, SHIM, UFM, and FVC at baseline and 4, 12, and 24 weeks after administration of tadalafil. Safety was evaluated based on the patient-reported adverse events during visits. IPSS, International Prostate Symptom Score; QOL, Quality of life; OABSS, overactive bladder symptom score; SHIM, sexual health inventory for men; UFM, uroflowmetry; FVC, frequency volume chart

IPSS score refers to the total IPSS and IPSS subscores, including Q1, incomplete emptying; Q2, daytime frequency; Q3, intermittency; Q4, urgency; Q5, weak stream; Q6, straining; Q7, nocturia; voiding symptom subscore (Q1 + Q3 + Q5 + Q6); storage symptom subscore (Q2 + Q4 + Q7); and QOL index. The OABSS is a four-item questionnaire that collectively expresses OAB symptoms in terms of a single score. The OABSS was initially developed and validated psychometrically in Japan. For FVC, we evaluated the nocturnal polyuria index and night-time maximum voided volume.

Statistical analysis

All values are expressed as the mean ± standard deviation. The Wilcoxon matched-pairs test was used to evaluate statistical differences. Prism software ver. 8.4.2 (GraphPad Software, San Diego, CA, USA) was used for statistical analyses and data plotting. Statistical significance was set at P < 0.05.



Twenty-four participants were enrolled in this study. Overall, the mean patient age was 71.0 (64.8–73.3) years, and the mean prostate volume examined by transabdominal sonography was 37.3 (29.9–42.9) mL (Table 1). Regarding comorbidities, 1 case of hypertension and 2 cases of diabetes were observed.

Table 1 Patient characteristics


The total IPSS was significantly lower at 4 weeks than at baseline (13.0 [10.3–16] vs. 17.0 [14.0–21.0], P = 0.0002) and continued to decrease for 24 weeks (9.5 [8.8–13.3] vs. 17.0 [14.0–21.0], P = 0.0004). The voiding symptom subscore was significantly lower at 4 weeks than at baseline (8.0 [4.0–10.0] vs. 9.0 [8.0–12.0], P = 0.0118) and continued to decrease for 24 weeks (5.5 [4.8–7.5] vs. 9.0 [8.0–12.0], P = 0.0009). Storage symptom subscore was significantly lower at 4 weeks than at baseline (5.0 [4.0–8.8] vs. 7.0 [6.0–9.0], P = 0.0008), and continued to decrease for 24 weeks (4.0 [3.0–5.3] vs. 7.0 [6.0–9.0], P = 0.0011). The QOL score was significantly lower at 4 weeks than at baseline (3.0 [2.0–3.8] vs. 4.0 [3.0–5.0], P = 0.0014) and continued to decrease for 24 weeks (2.0 [2.0–2.5] vs. 4.0 [3.0–5.0], P = 0.0021). Total OABSS was significantly lower at 12 weeks than at baseline (4.0 [2.3–6.0] vs. 5.0 [3.0–6.0], P = 0.0480) and continued to decrease for 24 weeks (3.0 [3.0–4.0] vs. 5.0 [3.0–6.0], P = 0.0248). SHIM was significantly higher at 12 weeks than at baseline (10.5 [5.0–16.3] vs. 7.5 [2.3–12.0], P = 0.0305) and continued to decrease for 24 weeks (11.0 [4.5–16.5] vs. 7.5 [2.3–12.0], P = 0.0187). Night-time urinary frequency (nocturia) was significantly lower at 4 weeks than at baseline (2.0 [1.0–2.0] vs. 2.0 [2.0–3.0], P = 0.0031) and continued to decrease for 24 weeks (2.0 [1.0–2.0] vs. 2.0 [2.0–3.0], P = 0.0103). Night-time maximum voided volume was significantly higher at 4 weeks than at baseline (270.0 [230.0–300.0] vs. 240.0 [157.5–275.0] mL, P = 0.0385) and continued to increase for 24 weeks (290.0 [240.0–310.0] vs. 240.0 [157.5–275.0] mL, P = 0.0248). However, nocturnal polyuria index, maximum urine flow rate, and residual urine volume showed no improvement at any point (Table 2).

Table 2 Comparison of subjective and objective parameters at baseline vs. at 4, 12, and 24 weeks


Adverse events occurred in two cases. Rash and muscle pain were observed within 2 weeks of tadalafil administration and were classified as grade 1 (Common Terminology Criteria for Adverse Events). However, symptoms improved with drug suspension.


This study demonstrated that add-on therapy with tadalafil might be effective for patients with LUTS/BPH resistant to dutasteride monotherapy. This study is vital because add-on therapy with tadalafil for LUTS/BPH treated with dutasteride monotherapy showed improvement in LUTS and sexual dysfunction after 24 weeks. Several studies have reported a combination therapy using PDE5-Is and 5-ARIs for LUTS [20, 21]; however, few studies also suggest using PDE5-I as an add-on therapy secondary to 5-ARI for LUTS.

Various medicinal options are now available for BPH treatment. However, any therapeutic method or medicine for BPH may lead to sexual dysfunction, such as ED or ejaculatory disorder, in patients due to adverse effects. α1-Blockers have been used extensively for BPH therapy for a long time. Adverse events with α1-blockers mainly include orthostatic hypotension, but ejaculatory disorders are also often detected [16]. Ejaculatory disorder at increased frequency is observed with silodosin, tamsulosin, and naftopidil treatment (24.4%, 16.7%, and 7.4%, respectively) [22, 23]. In addition, tamsulosin and dutasteride combination therapy has been reported to be associated with a decrease in sexual satisfaction [24].

In the evaluation of urodynamic studies, it has been reported that dutasteride improves LUTS even after 1 year [6]. However, sexual dysfunction can be caused by 5-ARIs. It is reported that erectile function should be assessed, and ED due to dutasteride should be treated in those whose erectile function is relatively maintained, especially in young individuals [25].

BPH/LUTS is an age-independent predictor of ED, and the severity of BPH/LUTS is associated with the intensity of ED [26]. Since the underlying mechanism is common to both BPH/LUTS and ED, hyperactivity of the sympathetic system, ischemia of the vascular bed in the pelvis, a decrease in nitric oxide, and the possibility of Rho-kinase activation have been suggested [27]. It is believed that ED is caused by 5-ARIs, including both finasteride and dutasteride. The frequency of ED was 1.7–11% with finasteride and 3.4–15.8% with dutasteride in an RCT, compared with those in the placebo [28]. Dutasteride has often been used during erectile insufficiency and in patients with prostate volume > 30 mL along with α1-blockers or PDE5-Is alone. The possibility of treating sexual dysfunction using dutasteride combined with PDE5-Is has been suggested [21].

In the present study, tadalafil was used as add-on therapy in dutasteride treatment-resistant BPH patients. Dutasteride was used in combination with an α1-blocker (silodosin) in all cases; however, silodosin was discontinued since it caused an ejaculatory disorder. Regarding sexual function, the SHIM score before the tadalafil combination was 7.5, owing to which, many severe cases were reported. This is because, as anticipated, most cases were elderly patients receiving dutasteride therapy. Improvement of subjective symptoms, such as LUTS and SHIM, was detected in patients. Tadalafil was reported to control a decrease in erectile function caused by dutasteride and possibly also improve LUTS. However, changes in objective findings, such as uroflowmetry, were not detected. It was anticipated that improvement in QOL and sexual dysfunction led to subjective improvement. Moreover, the night-time urinary frequency decreased. This is due to an increase in night-time urine volume. Furthermore, storage symptoms improved in patients receiving tadalafil add-on therapy.


Tadalafil add-on treatment for BPH patients during dutasteride treatment was effective in treating LUTS and sexual dysfunction and did not cause severe adverse events, suggesting that it can be safely used for combination therapy.


This study has some limitations. First, this was a retrospective, non-randomized study without placebo control. Second, our sample size was too small to draw a definitive conclusion. Studies with a significant number of patients are required to confirm our findings. Third, we did not perform a urodynamic study in almost all patients. It is necessary to measure the change in the bladder outlet obstruction index and voiding detrusor pressure at maximum flow rate in future studies.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.



International Prostate Symptom Score


Quality of life


Overactive bladder symptom score


Sexual health inventory for men


Frequency volume chart


Lower urinary tract symptoms


Benign prostatic hyperplasia


Overactive bladder


Erectile dysfunction


  1. Kupelian V, Wei JT, O’Leary MP, Kusek JW, Litman HJ, Link CL, et al. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey. Arch Intern Med. 2006;166:2381–7.

    Article  Google Scholar 

  2. Coyne KS, Sexton CC, Bell JA, Thompson CL, Dmochowski R, Bavendam T, et al. The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: results from OAB-POLL. Neurourol Urodyn. 2013;32:230–7.

    Article  Google Scholar 

  3. Tsukamoto T, Kumamoto Y, Masumori N, Miyake H, Rhodes T, Girman CJ, et al. Prevalence of prostatism in Japanese men in a community-based study with comparison to a similar American study. J Urol. 1995;154:391–5.

    CAS  Article  Google Scholar 

  4. Masumori N, Tsukamoto T, Kumamoto Y, Miyake H, Rhodes T, Girman CJ, et al. Japanese men have smaller prostate volumes but comparable urinary flow rates relative to American men: results of community based studies in 2 countries. J Urol. 1996;155:1324–7.

    CAS  Article  Google Scholar 

  5. Wada N, Kita M, Hashizume K, Matsumoto S, Kakizaki H. Urodynamic effects of dutasteride add-on therapy to alpha-adrenergic antagonist for patients with benign prostatic enlargement: prospective pressure-flow study. Neurourol Urodyn. 2013;32:1123–7.

    CAS  Article  Google Scholar 

  6. Matsukawa Y, Gotoh M, Kato M, Funahashi Y, Narita M, Mitsui K. Effects of dutasteride on storage and voiding symptoms in male patients with lower urinary tract symptoms as a result of benign prostatic obstruction: the 1-year outcomes from a prospective urodynamic study. Int J Urol. 2014;21:826–30.

    CAS  Article  Google Scholar 

  7. Nickel JC, Gilling P, Tammela TL, Morrill B, Wilson TH, Rittmaster RS. Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int. 2011;108:388–94.

    CAS  Article  Google Scholar 

  8. Kaplan SA, Roehrborn CG, McConnell JD, Meehan AG, Surynawanshi S, Lee JY, et al. Long-term treatment with finasteride results in a clinically significant reduction in total prostate volume compared to placebo over the full range of baseline prostate sizes in men enrolled in the MTOPS trial. J Urol. 2008;180:1030–2 (discussion 1032–1033).

    CAS  Article  Google Scholar 

  9. Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010;57:123–31.

    CAS  Article  Google Scholar 

  10. Takamori H, Masumori N, Kamoto T. Surgical procedures for benign prostatic hyperplasia: a nationwide survey in Japan, 2014 update. Int J Urol. 2017;24:476–7.

    Article  Google Scholar 

  11. Yokoyama O, Yoshida M, Kim SC, Wang CJ, Imaoka T, Morisaki Y, et al. Tadalafil once daily for lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a randomized placebo- and tamsulosin-controlled 12-week study in Asian men. Int J Urol. 2013;20:193–201.

    CAS  Article  Google Scholar 

  12. Oelke M, Giuliano F, Mirone V, Xu L, Cox D, Viktrup L. Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Eur Urol. 2012;61:917–25.

    CAS  Article  Google Scholar 

  13. Gacci M, Corona G, Salvi M, Vignozzi L, McVary KT, Kaplan SA, et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with alpha-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2012;61:994–1003.

    CAS  Article  Google Scholar 

  14. Watanabe D, Yamashita A, Miura K, Mizushima A. Effects on sexual function in Japanese patients with benign prostatic hyperplasia upon switching from combination therapy with α1 blocker and dutasteride to combination therapy with tadalafil and dutasteride. Aging Male. 2020;23:501–6.

    Article  Google Scholar 

  15. Kosilov KV, Kuzina IG, Kuznetsov V, Kosilova EK. Improvement of the symptoms of lower urinary tract and sexual dysfunction with tadalafil and solifenacin after the treatment of benign prostatic hyperplasia with dutasteride. Prostate Int. 2020;8:78–84.

    Article  Google Scholar 

  16. Kosilov K, Kuzina I, Kuznetsov V, Barabash O, Fedorishcheva E. Efficacy of a combination of dutasteride, tadalafil, and solifenacin in the treatment of previously unsuccessful patients. Asian J Urol. 2022;9:42–50.

    Article  Google Scholar 

  17. Wada N, Abe N, Miyauchi K, Ishikawa M, Makino S, Kakizaki H. Dutasteride add-on treatment to tadalafil for patients with benign prostatic enlargement is similarly effective as dutasteride add-on treatment to alpha blocker: a propensity-score matching analysis. Int Urol Nephrol. 2022;54:1193–8.

    CAS  Article  Google Scholar 

  18. Hisasue S-I, Furuya R, Itoh N, Kobayashi K, Furuya S, Tsukamoto T. Ejaculatory disorder caused by alpha-1 adrenoceptor antagonists is not retrograde ejaculation but a loss of seminal emission. Int J Urol. 2006;13:1311–6.

    CAS  Article  Google Scholar 

  19. Matsukawa Y, Takai S, Funahashi Y, Majima T, Kato M, Yamamoto T, Gotoh M. Effects of withdrawing alpha1-blocker from combination therapy with alpha1-blocker and 5alpha-reductase inhibitor in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a prospective and comparative trial using urodynamics. J Urol. 2017;198:905–12.

    CAS  Article  Google Scholar 

  20. Casabé A, Roehrborn CG, Da Pozzo LF, Zepeda S, Henderson RJ, Sorsaburu S, et al. Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia. J Urol. 2014;191:727–33.

    Article  Google Scholar 

  21. Watanabe D, Yamashita A, Miura K, Mizushima A. Effects on sexual function in Japanese patients with benign prostatic hyperplasia upon switching from combination therapy with alpha1 blocker and dutasteride to combination therapy with tadalafil and dutasteride. Aging Male. 2020;23:501–6.

    Article  Google Scholar 

  22. Masumori N, Tsukamoto T, Horita H, Sunaoshi K, Tanaka Y, Takeyama K, et al. alpha1-blocker tamsulosin as initial treatment for patients with benign prostatic hyperplasia: 5-year outcome analysis of a prospective multicenter study. Int J Urol. 2013;20:421–8.

    CAS  Article  Google Scholar 

  23. Yokoyama T, Hara R, Fukumoto K, Fujii T, Jo Y, Miyaji Y, et al. Effects of three types of alpha-1 adrenoceptor blocker on lower urinary tract symptoms and sexual function in males with benign prostatic hyperplasia. Int J Urol. 2011;18:225–30.

    CAS  Article  Google Scholar 

  24. Roehrborn CG, Manyak MJ, Palacios-Moreno JM, Wilson TH, Roos EPM, Santos JC, et al. A prospective randomised placebo-controlled study of the impact of dutasteride/tamsulosin combination therapy on sexual function domains in sexually active men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BJU Int. 2018;121:647–58.

    CAS  Article  Google Scholar 

  25. Maeda T, Kikuchi E, Hasegawa M, Ando T, Matsushima M, Yuge K, et al. A prospective longitudinal survey of erectile function status in symptomatic benign prostatic hyperplasia patients treated with dutasteride. Aging Male. 2016;19:111–6.

    Article  Google Scholar 

  26. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol. 2003;44:637–49.

    Article  Google Scholar 

  27. McVary KT, McKenna KE. The relationship between erectile dysfunction and lower urinary tract symptoms: epidemiological, clinical, and basic science evidence. Curr Urol Rep. 2004;5:251–7.

    Article  Google Scholar 

  28. La Torre A, Giupponi G, Duffy D, Conca A, Cai T, Scardigli A. Sexual dysfunction related to drugs: a critical review. Part V: α-blocker and 5-ARI drugs. Pharmacopsychiatry. 2016;49:3–13.

    CAS  PubMed  Google Scholar 

Download references


We would like to thank Editage ( for providing assistance with editing.


This study received no funding.

Author information

Authors and Affiliations



All authors participated in the design of the study. DG and KT designed the study. DG, YM, SH, YN, and MM collected the clinical data. DG performed the statistical analysis. DG drafted the paper. KT and KF revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kazumasa Torimoto.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Institutional Ethics Committee of our Institution. The study protocol and procedures were in accordance with the tenets of the Declaration of Helsinki and its later amendments. The requirement for informed consent was waived because of the retrospective nature of this study.

Consent for publication

Not applicable.

Competing interests

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gotoh, D., Torimoto, K., Morizawa, Y. et al. Efficacy and safety of dutasteride with tadalafil add-on therapy in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. BMC Res Notes 15, 288 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Dutasteride
  • Phosphodiesterase type 5 inhibitor
  • Tadalafil
  • Benign prostatic hyperplasia