title: PDE-5 inhibitors in monotherapy versus combination therapy in a sample of 1200 patients with erectile dysfunction.
abstract: OBJECTIVE
  To compare the effectiveness in the treatment of erectile dysfunction when using PDE-5 inhibitors (PDE5i), alprostadil (PG-E1) and testosterone (TES) in monotherapy or combination therapy.
  
  
  METHODS
  Observational multicentre retrospective study of men diagnosed and treated for ED between January 2008 and January 2014. Age, social and employment situation, pathological medical history, risk factors, usual treatments, IIEF-5 at the first consultation and at first and each 6 months follow-ups, physical examination, calculated total and free testosterone and received treatment were analysed. Descriptive statistics, one-way ANOVA analysis, Chi2 for qualitative data, t-test, Fisher's exact test and Pearson's correlation coefficient were used; p &lt; 0.05 is considered significant.
  
  
  RESULTS
  Average age was 58.61 years, SD5.02, average follow- up time 48.21 months, SD 6.21, range 6-174 months. Out of the patients 76.12% were married, 9.81% divorced/separated, 10.04% single, 4.03% widowed; 85.14% of the total in stable partnership but 66.16% were not accompanied by their partners. In total 844 patients received monotherapy (597 PDE5i; 62 PG-E1; 36 TES; 27 penile prosthesis; 121 psychotherapy/alternative therapies) and 357 combination therapy (167 PDE5i+TES; 124 PDE5i+PGE1; 66 PG-E1+TES). There was a homogeneous distribution between risk factors and medical history groups. Satisfactory response according to IIEF-5 was achieved for 72.33% of patients on PDE5i monotherapy, 46.65% of patients on PDE5i+PG-E1 combination therapy and 83.41% of patients on PDE5i+TES.
  
  
  CONCLUSIONS
  The best therapeutic success for ED in this series was achieved through a combination of testosterone+PDE-5 inhibitors without increasing morbidity and maintaining the response over time. Larger studies with longer follow-up will corroborate these findings.
authors.affiliation: Department of Urology, University Hospital of Donostia. luislabairu@hotmail.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Labairu-Huerta
authors.forename: Bárbara
authors.initials: B
authors.lastname: Padilla-Fernández
authors.forename: José Luis
authors.initials: JL
authors.lastname: Arrondo-Arrondo
authors.forename: Lauro Sebastián
authors.initials: LS
authors.lastname: Valverde-Martínez
authors.forename: Agustín
authors.initials: A
authors.lastname: Martín-Rodríguez
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Silva-Abuín
authors.forename: María Begoña
authors.initials: MB
authors.lastname: García-Cenador
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Mirón-Canelo
authors.forename: María Fernanda
authors.initials: MF
authors.lastname: Lorenzo-Gómez
mesh_terms: D000328:Adult; D000527:Alprostadil / Q000627:therapeutic use*; D000728:Androgens / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000379:methods; D007172:Erectile Dysfunction / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013030:Spain; D013739:Testosterone / Q000627:therapeutic use*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000728:Androgens; D058986:Phosphodiesterase 5 Inhibitors; D014665:Vasodilator Agents; D013739:Testosterone; D000527:Alprostadil