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

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.

Effect of tadalafil 5mg daily treatment on the ejaculatory times, lower urinary tract symptoms and erectile function in patients with erectile dysfunction

“…Some studies have determined the role of phosphodiesterase type 5 inhibitors in the treatment of men with LUTS associated with benign prostatic enlargement. Yan et al (29) conducted a meta-analysis on the use of PDE5 inhibitors in the treatment of LUTS and reported that these inhibitors reduced IPSS by 4.21 points. Similarly, in this study, we found a significant decrease of 4.3 points in IPSS and an increase in the IIEF-5 score after using tadalafil 5mg daily treatment.…”

PDE-5 inhibitors in monotherapy versus combination therapy in a sample of 1200 patients with erectile dysfunction

“…Other studies have reported the same with smaller series of patients (43), even in patients who had undergone radical prostatectomy who had not responded to monotherapy and in both studies with no increase of adverse effects after combination therapy (44). A metaanalysis with 515 men with ED and LUTS concluded that combination therapy is more effective than PDE5i, with better scores on the IIEF questionnaires, IPSS, and peak flow (45).…”

Drug-related problems in patients with erectile dysfunctions and multiple comorbidities

“…One such interaction was between sildenafil and doxazosin, which could be explained by the significant association between BPH/LUTS and ED 30. Despite coadministration of alpha-blockers and PDE-5 inhibitors that possess the risk of hypotension, a recent systematic review had found that a combination of both agents in treating BPH/LUTS and ED was beneficial 53. Nevertheless, PDE-5 inhibitors still need to be used with caution in combination with alpha-blockers.…”

“…The concurrent use of PDE-5 inhibitors for ED and alpha-blockers for BPH/LUTS had contributed to this. Despite recent studies and clinical trials that had found the efficacy of the combined use of alpha-blockers and PDE-5 inhibitors for both ED and BPH/LUTS, the potential interaction between them should also be considered 53,60. LUTS alone were also significantly associated with higher incidence of “Other” problems, which represent patients’ dissatisfaction with therapy.…”