title: 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.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Urology, University of Florence, Florence, Italy. maurogacci@yahoo.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.forename: Matteo
authors.initials: M
authors.lastname: Salvi
authors.forename: Linda
authors.initials: L
authors.lastname: Vignozzi
authors.forename: Kevin T
authors.initials: KT
authors.lastname: McVary
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kaplan
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D002243:Carbolines / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D007172:Erectile Dysfunction / Q000188:drug therapy; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy*; D008297:Male; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D011687:Purines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000627:therapeutic use; D013450:Sulfones / Q000627:therapeutic use; D000068581:Tadalafil; D016896:Treatment Outcome; D014227:Triazines / Q000627:therapeutic use; D000069058:Vardenafil Dihydrochloride; D000096926:Benzenesulfonamides
chemical_list: D000317:Adrenergic alpha-Antagonists; D002243:Carbolines; D007093:Imidazoles; D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011687:Purines; D011743:Pyrimidines; D000068677:Sildenafil Citrate; D013449:Sulfonamides; D013450:Sulfones; D000068581:Tadalafil; D014227:Triazines; D000069058:Vardenafil Dihydrochloride; C419664:udenafil; D000096926:Benzenesulfonamides