Abstract
Purpose The purpose of this study was to compare the relative safety and efficacy of different types of phosphodiesterase type 5 inhibitors (PDE5-Is) with tamsulosin for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) (BPH-LUTS) with or without erectile dysfunction (ED). Methods We use the Stata version 13.0 to conduct the network meta-analysis (NMA) with a random effects model of the Bayesian framework. The International Prostate Symptom Score (IPSS), Maximum Urinary Flow Fate (Qmax), International Index of Erectile Function (IIEF), and their credible intervals (CI) were used to compare the efficacy and safety of every medical intervention, including sildenafil plus tamsulosin, tadalafil plus tamsulosin, and vardenafil plus tamsulosin. Results Seven RCTs including 531 participants with seven interventions were analyzed. The results of NMA SUCRA showed that compared with different doses or types of PDE5-Is combined with tamsulosin (0.4 mg qd), the sildenafil (25 mg qd) combined with tamsulosin (0.4 mg qd) group had the greatest probabilities of being the best in the achievement of improving IIEF. The sildenafil (25 mg 4 days per week) combined with tamsulosin (0.4 mg qd) group had the greatest probabilities of being the best in the achievement of improving Qmax, whereas sildenafil (25 mg qd) combined with tamsulosin (0.4 mg qd) ranked the best for the safety outcomes. Conclusions This meta-analysis indicates that sildenafil combined with tamsulosin is the best effective and tolerated treatment option for BPH-LUTS with or without ED. Further RCTs are strongly required to provide more direct evidence.
Highlights
benign prostate hyperplasia (BPH)-lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) had both been found to be highly prevalent conditions in elderly men and are usually becoming evident with the aging growth [1, 2]
Records identified by database search (n = 118) sildenafil and tamsulosin 31 tadalafiland tamsulosin 70 vardenafilandtamsulosin 17
The results indicated that compared with sildenafil with tamsulosin, tadalafil with tamsulosin, and vardenafil with tamsulosin, sildenafil combined with tamsulosin (0.4 mg qd) can greatly improve the efficacy of treatment for BPHLUTS with or without ED
Summary
BPH-LUTS and ED had both been found to be highly prevalent conditions in elderly men and are usually becoming evident with the aging growth [1, 2]. BPH-LUTS has been regarded as an independent risk factor for ED in elderly men and 94% of patients with severe LUTS having coexistent ED [3]. Treatment options for BPH-LUTS included α1-adrenoceptor antagonists (α1-blockers—tamsulosin, alfuzosin, and doxazosin) proposed as the first-line drug. The therapeutic drug for ED including oral PDE5-Is (such as tadalafil, sildenafil, mirodenafil, vardenafil, and udenafil) was found recently to treat BPH-LUTS effectively. An oral drug to treat both conditions (BPH-LUTS and ED) is a major method though the therapeutic strategy is still not clear enough up to now. Further studies should focus on the treatments for BPH-LUTS with or without ED
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