A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with α-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia

Mauro Gacci, Giovanni Corona, Matteo Salvi, Linda Vignozzi, Kevin T. McVary, Steven A. Kaplan, Claus Roehrborn, Sergio Serni, Vincenzo Mirone, Marco Carini, Mario Maggi

Research output: Contribution to journalArticle

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Abstract

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 α1-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, α-blockers, and α1-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 α1-adrenergic blockers versus α1-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) (-2.8; p < 0.0001) but not the maximum flow rate (Q max) (-0.00; p = not significant) at the end of the study as compared with placebo. The association of PDE5-Is and α1-adrenergic blockers improved the IIEF score (+3.6; p < 0.0001), IPSS score (-1.8; p = 0.05), and Q max (+1.5; p < 0.0001) at the end of the study as compared with α-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.

Original languageEnglish (US)
Pages (from-to)994-1003
Number of pages10
JournalEuropean Urology
Volume61
Issue number5
DOIs
StatePublished - May 2012

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Phosphodiesterase 5 Inhibitors
Lower Urinary Tract Symptoms
Prostatic Hyperplasia
Meta-Analysis
Adrenergic Antagonists
udenafil
Erectile Dysfunction
Prostate
Randomized Controlled Trials
Placebos
Libraries
Observational Studies
Epidemiology
Cross-Sectional Studies
Databases
Guidelines

Keywords

  • Benign prostatic hyperplasia
  • BPH
  • ED
  • Erectile dysfunction
  • IIEF
  • IPSS
  • Lower urinary tract symptoms
  • LUTS
  • PDE5
  • PDE5-I
  • Prostate

ASJC Scopus subject areas

  • Urology

Cite this

A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with α-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. / Gacci, Mauro; Corona, Giovanni; Salvi, Matteo; Vignozzi, Linda; McVary, Kevin T.; Kaplan, Steven A.; Roehrborn, Claus; Serni, Sergio; Mirone, Vincenzo; Carini, Marco; Maggi, Mario.

In: European Urology, Vol. 61, No. 5, 05.2012, p. 994-1003.

Research output: Contribution to journalArticle

Gacci, Mauro ; Corona, Giovanni ; Salvi, Matteo ; Vignozzi, Linda ; McVary, Kevin T. ; Kaplan, Steven A. ; Roehrborn, Claus ; Serni, Sergio ; Mirone, Vincenzo ; Carini, Marco ; Maggi, Mario. / A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with α-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. In: European Urology. 2012 ; Vol. 61, No. 5. pp. 994-1003.
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abstract = "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 α1-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, α-blockers, and α1-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 α1-adrenergic blockers versus α1-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) (-2.8; p < 0.0001) but not the maximum flow rate (Q max) (-0.00; p = not significant) at the end of the study as compared with placebo. The association of PDE5-Is and α1-adrenergic blockers improved the IIEF score (+3.6; p < 0.0001), IPSS score (-1.8; p = 0.05), and Q max (+1.5; p < 0.0001) at the end of the study as compared with α-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.",
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AU - Gacci, Mauro

AU - Corona, Giovanni

AU - Salvi, Matteo

AU - Vignozzi, Linda

AU - McVary, Kevin T.

AU - Kaplan, Steven A.

AU - Roehrborn, Claus

AU - Serni, Sergio

AU - Mirone, Vincenzo

AU - Carini, Marco

AU - Maggi, Mario

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N2 - 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 α1-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, α-blockers, and α1-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 α1-adrenergic blockers versus α1-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) (-2.8; p < 0.0001) but not the maximum flow rate (Q max) (-0.00; p = not significant) at the end of the study as compared with placebo. The association of PDE5-Is and α1-adrenergic blockers improved the IIEF score (+3.6; p < 0.0001), IPSS score (-1.8; p = 0.05), and Q max (+1.5; p < 0.0001) at the end of the study as compared with α-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.

AB - 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 α1-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, α-blockers, and α1-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 α1-adrenergic blockers versus α1-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) (-2.8; p < 0.0001) but not the maximum flow rate (Q max) (-0.00; p = not significant) at the end of the study as compared with placebo. The association of PDE5-Is and α1-adrenergic blockers improved the IIEF score (+3.6; p < 0.0001), IPSS score (-1.8; p = 0.05), and Q max (+1.5; p < 0.0001) at the end of the study as compared with α-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.

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KW - Lower urinary tract symptoms

KW - LUTS

KW - PDE5

KW - PDE5-I

KW - Prostate

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