A Systematic Review and Meta-analysis on the Use of Phosphodiesterase 5 Inhibitors Alone or in Combination with 伪-Blockers for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia

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• 作者：Mauro Gacci^a ; ^{maurogacci@yahoo.it} ; Giovanni Corona^b ; ^c ; Matteo Salvi^a ; Linda Vignozzi^c ; Kevin T. McVary^d ; Steven A. Kaplan^e ; Claus G. Roehrborn^f ; Sergio Serni^a ; Vincenzo Mirone^g ; Marco Carini^a ; Mario Maggi^c
• 关键词：Benign prostatic hyperplasia ; Lower urinary tract symptoms ; Erectile dysfunction ; Prostate ; BPH ; LUTS ; ED ; PDE5 ; PDE5-I ; IPSS ; IIEF
• 刊名：European Urology
• 出版年：2012
• 期刊代码：289_03022838
• 类别：med
• 出版时间：May, 2012
• 卷：61
• 期：5
• 页码：994-1003
• 文件大小：451 K

摘要

Context

Several randomized controlled trials (RCTs) on phosphodiesterase type 5 inhibitors (PDE5-Is) have showed significant improvements in both lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men affected by one or both conditions, without a significant increase in adverse events. However, the results are inconsistent.

Objective

Perform a systematic review and meta-analysis of available prospective and cross-sectional studies on the use of PDE5-Is alone or in combination with 伪1-adrenergic blockers in patients with LUTS/benign prostatic hyperplasia (BPH).

Evidence acquisition

A systematic search was performed using the Medline, Embase, and Cochrane Library databases through September 2011 including the combination of the following terms: LUTS, BPH, PDE5-Is, sildenafil, tadalafil, vardenafil, udenafil, 伪-blockers, and 伪1-adrenergic blocker. The meta-analysis was conducted according to the guidelines for observational studies in epidemiology.

Evidence synthesis

Of 107 retrieved articles, 12 were included in the present meta-analysis: 7 on PDE5-Is versus placebo, with 3214 men, and 5 on the combination of PDE5-Is with 伪1-adrenergic blockers versus 伪1-adrenergic blockers alone, with 216 men. Median follow-up of all RCTs was 12 wk.

Combining the results of those trials, the use of PDE5-Is alone was associated with a significant improvement of the International Index of Erectile Function (IIEF) score (+5.5; p < 0.0001) and International Prostate Symptom Score (IPSS) (鈭?.8; p < 0.0001) but not the maximum flow rate (Q_max) (鈭?.00; p = not significant) at the end of the study as compared with placebo. The association of PDE5-Is and 伪1-adrenergic blockers improved the IIEF score (+3.6; p < 0.0001), IPSS score (鈭?.8; p = 0.05), and Q_max (+1.5; p < 0.0001) at the end of the study as compared with 伪-blockers alone.

Conclusions

The meta-analysis of the available cross-sectional data suggests that PDE5-Is can significantly improve LUTS and erectile function in men with BPH. PDE5-Is seem to be a promising treatment option for patients with LUTS secondary to BPH with or without ED.