Tadalafil and tamsulosin in the management of lower urinary tract symptoms due to benign prostatic hyperplasia: A prospective, randomized, open-label, comparative study

Background: Benign prostatic hyperplasia (BPH) commonly presents with lower urinary tract symptoms (LUTS), which can significantly impair quality of life in aging men. Tamsulosin, a selective alpha-1 blocker, is widely used for symptom relief. Tadalafil, a phosphodiesterase-5 inhibitor, offers dual benefit for LUTS and erectile dysfunction (ED). However, limited comparative data exist from African populations. Objective: To compare the efficacy and safety of tadalafil and tamsulosin monotherapy in the management of LUTS due to BPH in men attending a tertiary hospital in Ghana. Methods: This prospective, randomized, open-label study was conducted over 12 weeks at the Korle-Bu Teaching Hospital. Eighty-two men aged ⩾40 years with moderate to severe LUTS due to BPH were randomized to receive either tadalafil 5 mg or tamsulosin 0.4 mg daily. Baseline, 4-week, and 12-week evaluations included International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), post-void residual urine (PVR), and International Index of Erectile Function (IIEF-5). Statistical analyses included t-tests and linear regression. Results: Both groups showed significant improvement in IPSS, QoL, Qmax, and PVR over time. At 12 weeks, Qmax was significantly higher in the tadalafil group compared to tamsulosin (18.7 ± 4.5 vs 16.9 ± 2.6 mL/s, p = 0.045). IPSS improvement was similar across both arms (Tadalafil: −9.3; Tamsulosin: −7.8). Tadalafil significantly improved IIEF-5 scores from 14.0 to 21.0 ( p < 0.001), whereas tamsulosin showed minimal change. Subgroup analysis showed tadalafil’s erectile function benefit was consistent across demographic and clinical subgroups except in diabetics. Side effects were mild (5.1%) and equally distributed between groups. Conclusion: Tadalafil and tamsulosin are both effective in alleviating LUTS due to BPH. Tadalafil provides additional benefits in erectile function and superior improvement in urinary flow, making it a suitable first-line option, especially for patients with coexisting ED. These findings support individualized treatment decisions based on patient profile and symptom burden in resource-limited settings.