title: A Meta-Analysis of Long- Versus Short-Acting Phosphodiesterase 5 Inhibitors: Comparing Combination Use With α-Blockers and α-Blocker Monotherapy for Lower Urinary Tract Symptoms and Erectile Dysfunction.
abstract: OBJECTIVE
  Combination therapy with an α-1-adrenergic blocker and phosphodiesterase type 5 inhibitors (PDE5Is) has shown improvements in lower urinary tract symptoms (LUTS) with negligible side effects. Nonetheless, decisive advantages in symptom improvement were insufficient, and there were no clinical differences between long- or short-acting PDE5Is in combination with combination medication.
  
  
  METHODS
  To review the studies on α-1-adrenergic blocker monotherapy and combination therapy with long vs. short-acting PDE5Is in their use in LUTS and erectile dysfunction (ED). A search of the MEDLINE, Embase, Cochrane Library, and KoreaMed databases was conducted from 2000 to 2014 using combinations of the relevant terms. Among the 323 relevant references discovered, 10 were selected for meta-analysis. The data showed that 616 men received combination therapy (PDE5Is with α-1-adrenergic blockers) or α-1-adrenergic blocker monotherapy.
  
  
  RESULTS
  Meta-analysis of the combination therapy showed it was more effective than α-blockers in improving symptoms, with a mean International Prostrate Symptom Score change difference of -1.93 while those of the long- vs. short-acting PDE5I were -2.12 vs. -1.70. Compared to maximum flow rate (Qmax) value with monotherapy, the Qmax increased more with the combination therapy (mean difference of 0.71) while change values were 0.14 and 1.13 for the long- and short-acting PDE5Is, respectively. Residual urine decreased more with the combination therapy than it did with α-1-adrenergic blocker monotherapy with a mean difference of -7.09 while the mean residual urine change values for long- vs. short-acting PDE5Is were -18.83 vs. -5.93. The International Index of Erectile Function value increased by 3.99, 2.85, and 4.85 following combination therapy, and therapy with long- and short-acting PDE5Is.
  
  
  CONCLUSIONS
  Our meta-analysis suggests that PDE5Is can signiﬁcantly improve LUTS in men with benign prostatic hyperplasia/ED. Furthermore, combination PDE5I and α-1-adrenergic blocker could be a more effective treatment than α-1-adrenergic blocker monotherapy, and the differences between long and short-acting agents were minimal.
authors.affiliation: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Hoon
authors.identifier: 0000-0002-8481-8103
authors.initials: H
authors.lastname: Choi
authors.affiliation: Institute for Evidence-Based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Bae
authors.affiliation: Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea.
authors.forename: Jae Heon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Du Geon
authors.initials: du G
authors.lastname: Moon
authors.affiliation: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Cheon
authors.affiliation: Department of Urology, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Jeong-Kyun
authors.identifier: 0000-0001-5027-3451
authors.initials: JK
authors.lastname: Yeo
keywords: Lower Urinary Tract Symptoms; Phosphodiesterase 5 Inhibitors; Prostatic Hyperplasia