Comparisons of regular and on-demand regimen of PED5-Is in the treatment of ED after nerve-sparing radical prostatectomy for Prostate Cancer

Abstract

Phosphodiesterase type-5 inhibitors (PDE5-Is) have been recommended as first line therapy for erectile dysfunction for patients received nerve-sparing radical prostatectomy for prostate cancer. We examed the efficiency of PDE5-Is and considered the optimal application. Systematic search of PubMed, Embase and the Cochrane Library was performed to identify all the studies. We identified 103 studies including 3175 patients, of which 14 were recruited for systematic review. Compared with placebo, PDE5-Is significantly ameliorated the International Index of Erectile Function-Erectile Function domain score (IIEF) scores (MD 4.89, 95% CI 4.25–5.53, p < 0.001). By network meta-analysis, sildenafil seems to be the most efficiency with a slightly higher rate of treatment-emergent adverse events (TEATs), whereas tadalafil had the lowest TEATs. In terms of IIEF scores, regular regimen was remarkably better than on-demand (MD 3.28, 95% CI 1.67–4.89, p < 0.001). Regular use was not associated with higher proportion of patients suffering TEATs compared with on-demand (RR 1.02, 95% CI 0.90–1.16, p = 0.72). Compared with placebo, PDE5-Is manifested significantly improved treatment outcomes. Overall, regular regimen demonstrated statistically pronounced better potency than on-demand. Coupled with the comparable rate of side effects, these findings support the regular delivery procedure to be a cost-effective option for patients.

Erectile function recovery in men treated with phosphodiesterase type 5 inhibitor administration after bilateral nerve‐sparing radical prostatectomy: a systematic review of placebo‐controlled randomized trials with trial sequential analysis

“…The superiority of on‐demand treatment modality in improving a less stringent outcome, such as the IIEF score, has been already demonstrated in a previous systematic review (Wang et al ., ). Surprisingly, another recent systematic review (Qiu et al ., ) reached opposite results, showing the superiority of regular regimens of treatment. Although the authors adduced some arguments to explain this pattern of results, some doubts on the accuracy of analysis of single trials cast uncertainties on the quality of conclusions drawn.…”

“…7 of Qiu's et al . () systematic review. In fact, in the original trial, Pavlovich concluded that there was a similar efficacy of both nightly and on‐demand treatment modality on recovery of EF, as assessed by absolute IIEF‐EF scores (Pavlovich et al ., ).…”

Erectile dysfunction and penile rehabilitation after pelvic fracture: a systematic review and meta-analysis

“…67 68 The effect seems to be ameliorated with a regular treatment regime compared with on-demand use of PDE-5-I in patients with ED after radical prostatectomy. 69 The current limited evidence demonstrates, that daily oral intake of PDE-5-I seems to have also a relevant positive effect on ED in 55%-88% of patients after PRF with or without associated PFUI. [70][71][72][73] Furthermore, the efficacy of pharmacological therapy can also be supported with mechanical aids, such as the use of vacuum erection devices or low-intensity shock-wave therapy.…”

Comparison of three different tadalafil regimens for erectile dysfunction treatment in patients with diabetes mellitus microvascular complications

“…Tadalafil inhibits the formation of cyclic guanosine monophosphate and prolongs nitric oxide (NO), thereby increasing NO availability in the endothelial area (Lasker et al, 2013). Previous studies have compared different doses of tadalafil, that is, 5 mg daily versus 20 mg when required, and have reported favourable results for either dosage (Burns et al, 2015; Hatzichristou et al, 2015; Qiu et al, 2016). DM leads to long‐term microvascular complications, causing severe ED (Aslan et al, 2009).…”

“…Previous studies have compared different doses of tadalafil, that is, 5 mg daily versus 20 mg when required, and have reported favourable results for either dosage (Burns et al, 2015;Hatzichristou et al, 2015;Qiu et al, 2016). DM leads to long-term microvascular complications, causing severe ED (Aslan et al, 2009).…”