The efficacy of PDE5 inhibitors alone or in combination with alpha-blockers for the treatment of erectile dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and meta-analysis

J Sex Med. 2014 Jun;11(6):1539-45. doi: 10.1111/jsm.12499. Epub 2014 Mar 13.

Abstract

Introduction: Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) are both highly prevalent in aging men. Alpha-blockers and PDE-5 inhibitors are widely used for the treatment of LUTS/benign prostatic hyperplasia (BPH) and ED.

Aim: The purpose of this meta-analysis was to evaluate the efficacy of phosphodiesterase type 5 (PDE5) inhibitors alone or in combination with alpha-blockers for the treatment of ED and LUTS.

Methods: The databases MEDLINE, EMBASE, PubMed, the Cochrane Controlled Trial Register of Controlled Trials, and the Chinese Biological Medical Database were searched to identify randomized controlled trials that referred to the use of a combination of PDE5 inhibitors and alpha-blockers for the treatment of ED and LUTS associated with BPH. A systematic review and meta-analysis was conducted.

Main outcome measures: International Prostate Symptom Score (IPSS), the maximum flow rate (Qmax), and International Index of Erectile Function-Erectile Function (IIEF-EF) domain score were used in this meta-analysis.

Results: Seven publications involving 515 patients were included in the meta-analysis. In the analysis, we found significantly improved IIEF, IPSS, and Qmax values in the combination use group compared with the use of PDE5 inhibitors alone (P = 0.04, 0.004, 0.007, respectively).

Conclusions: The combined use of PDE5 inhibitors and alpha-blockers results in additive favorable effects in men with ED and LUTS suggestive of BPH compared with PDE5 inhibitor monotherapy. The alpha-blockers may enhance the efficacy of the PDE5 inhibitors, which is beneficial for the treatment of ED and LUTS.

Keywords: Alpha-Blockers; Benign Prostatic Hyperplasia; Erectile Dysfunction; Lower Urinary Tract Symptoms; Meta-Analysis; Obstructive Urinary Symptoms; PDE5 Inhibitors; Randomized Controlled Trials.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adrenergic alpha-Antagonists / therapeutic use*
  • Drug Therapy, Combination
  • Erectile Dysfunction / drug therapy*
  • Erectile Dysfunction / etiology
  • Humans
  • Lower Urinary Tract Symptoms / drug therapy*
  • Male
  • Phosphodiesterase 5 Inhibitors / therapeutic use*
  • Prostatic Hyperplasia / complications*
  • Randomized Controlled Trials as Topic

Substances

  • Adrenergic alpha-Antagonists
  • Phosphodiesterase 5 Inhibitors