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

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. Yan H, Zong H, Cui Y, Li N, and Zhang Y. 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. J Sex Med 2014;11:1539–1545.