Efficacy and safety of phosphodiesterase type 5 inhibitors on primary premature ejaculation in men receiving selective serotonin reuptake inhibitors therapy: a systematic review and meta-analysis

Abstract

We performed a systematic review and meta-analysis to assess whether selective serotonin reuptake inhibitors (SSRIs) and phosphodiesterase type 5 inhibitors (PDE5-Is) may have an additive therapeutic effect. A literature review was performed to identify all published randomised controlled trials (RCT) that used SSRIs combined with PDE5-Is therapy for the treatment of primary PE. The search included the following databases: EMBASE, MEDLINE and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. Five publications involving a total of 419 patients were used in the analysis, including 5 RCTs that compared PDE5-Is plus SSRIs with SSRIs treating primary PE. Primary efficacy endpoints: IELT (the standardised mean difference (SMD) = 1.07, 95% confidence interval (CI) = 1.00 to 1.14, P < 0.00001) indicated that utilisation of PDE5-Is and SSRIs was more effective than the SSRIs alone for a long time in patients with primary PE. Safety assessments included headache (odds ratio (OR) = 3.16, 95% CI = 1.63 to 6.11, P = 0.0006), and flushing indicated that PDE5-Is plus SSRIs were well tolerated. This meta-analysis indicates that PDE5-Is combined with SSRIs seem to provide significantly better ejaculatory latency time as compared with SSRIs alone in patients with primary PE.

Progresses in pharmaceutical and surgical management of premature ejaculation

“…This result was also consistent with other reports [50,61] [Table 3]. Some scholars found that tadalafil combined with other drugs such as lidocaine or SSRIs had better clinical efficacy than single-use, but the incidence of drug-related complications also increased [51,62,63] [Table 3]. Therefore, if the complications are well tolerated, combination therapy may be a better choice for PE, if the complications cannot be tolerated and cause distress to the patients or partners, a single drug can be considered.…”

Genetics of the human Y chromosome and its association with male infertility

“…While DAZ gene copies are deleted in men with complete and partial AZFc deletions, we and others have reported that individual DAZ copies can get deleted or duplicated even in absence of complete deletions [ 138 , 140 , 143 – 145 ]. While DAZ gene copy deletions/duplications are reported even in fertile men, deletion of DAZ and CDY1 copies results in reduced sperm count and motility [ 140 , 143 ].…”

“…It is shown that not all men with gr/gr deletions have identical amounts of DNA lost. Based on copy number estimates of DAZ and CDY1 genes, it is observed that only those men with two DAZ and one CDY1 copy deleted will have azoospermia or oligozoospermia, retention of any one of these genes will be almost always be associated with normozoospermia [ 139 , 140 , 143 , 145 , 149 ]. Along with DAZ and CDY1 , studies have also identified GOLGA2LY and BPY2 copy numbers have a protective effect on fertility of men with gr/gr deletions [ 138 , 143 , 157 ].…”

Ejaculatory dysfunction in the treatment of lower urinary tract symptoms

“…When used to treatment men with BPH, PDE5Is have shown improved IPSS scores, improved QOL scores with minimal effect on maximum urinary flow rate (59,60). While PDE5Is have been used for premature ejaculation, particularly in conjunction with SSRIs, at the current time there is no data measuring their impact upon ejaculatory function in patients with BPH (61). …”