4 mg once daily[19] compared with doxazosin 0.8 mg once daily.[19] Alfuzosin could enhance the NO-mediated relaxant influence of PDE5 inhibitor on the same smooth muscle targets by blocking α-1 adrenergic receptors and reducing the sympathetic tone in penile, prostatic, bladder neck smooth muscles.[20] Both experimental and clinical evidence support this concept. In spontaneously hypertensive rats, alfuzosin showed no proerectile effect by itself but enhanced the number and amplitude of erections induced by apomorphine.[21] The addition of alfuzosin 10 mg once daily to tadalafil has

been shown to improve ED in 71% of patients who were initially considered to be non-responders to tadalafil.[22] Thus, a combination of alfuzosin and tadalafil could enhance the beneficial effects of these drugs on Dabrafenib order LUTS and ED without increasing the side-effects. In our study, combination therapy was found to be superior to monotherapy with alfuzosin or tadalafil for treating BPH with LUTS, in terms of efficacy on IPSS including quality of life and PVR. The efficacy of combination therapy on Qmax was similar to that of alfuzosin but better

than that of tadalafil. Likewise, the efficacy of combination therapy on EDS was PARP inhibitor similar to that of tadalafil but better than that of alfuzosin. Monotherapy also had a modest benefit in improving LUTS and sexual function. In our study, two patients in the tadalafil group developed occasional headache. Three patients developed occasional headache and two patients developed dizziness (in whom tadalafil dose was reduced to 5 mg/day) in the combination group and all the patients completed

the follow-up in the study. In the study by Liguori et al.[23] six patients out of 66 dropped out of the study because of adverse effects: three in the alfuzosin group (dizziness, constipation), one in the tadalafil group (back pain and headache), and two in combination group (myalgia, dizziness, sensation of heaviness). Incidence of adverse effects in our study was more with combination Guanylate cyclase 2C therapy but not severe enough to withdraw from the trial. Thus, combination therapy can be considered safe for use in patients with LUTS provided specific contraindications for use of alpha-blockers and PDE5 inhibitors are followed properly. The limitation of our study was the fact that we did not include a placebo arm. Another limitation was the relatively short-term follow-up of the patients. However, 3 months duration has generally been used as a reasonable follow up to study the efficacy and safety profile of drugs used for LUTS.