Zhang Li Tao, Park Jong Kwan
Li Tao Zhang, Jong Kwan Park, Department of Urology, Chonbuk National University of Medical School, Jeonju-si 561-180, South Korea.
World J Nephrol. 2015 Feb 6;4(1):138-47. doi: 10.5527/wjn.v4.i1.138.
To review the efficacy of phosphodiesterase type 5 inhibitors (PDE5-Is) in lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (LUTS/BPH).
A comprehensive research was conducted to identify all publications relating to benign prostate hyperplasia and treatment with sildenafil, vardenafil and tadalafil. To assess the efficacy, the changes in total international prostate symptom score (IPSS), IPSS subscore including voiding, storage and quality of life (QoL), Benign prostatic hyperplasia Impact Index (BII), maximum urinary flow rate (Qmax) and the International Index of Erectile Function (IIEF) were extracted. A meta-analytical technique was used for the analysis of integrated data from the included studies to evaluate the mean difference in the results.
Total IPSS score, IIEF and BII showed a significant improvement in trials in which LUTS/BPH with or without erectile dysfunction (ED) were compared with the placebo. For LUTS/BPH, the mean differences of total IPSS score, IIEF and BII are -2.17, 4.88 and -0.43, P < 0.00001, respectively. For LUTS/BPH with comorbid ED, the mean difference are -1.97, 4.54 and -0.52, P < 0.00001, respectively. PDE5-Is appear to improve IPSS storage, voiding and QoL subscore (mean difference = -0.71, -1.23 and -0.33, P < 0.00001, respectively). Although four doses of tadalafil (2.5, 5, 10 and 20 mg) failed to reach significance in Qmax (mean difference = 0.22, P = 0.10), the 5 mg dose of tadalafil significantly improved the Qmax (mean difference = 0.33, P = 0.03).
PED5-Is demonstrated efficacy for improving LUTS in BPH patients with or without ED and could be considered to be the first line treatment for LUTS/BPH.
回顾5型磷酸二酯酶抑制剂（PDE5-Is）对提示良性前列腺增生的下尿路症状（LUTS）/良性前列腺增生（BPH）的疗效。
进行全面研究以确定所有与良性前列腺增生及西地那非、伐地那非和他达拉非治疗相关的出版物。为评估疗效，提取总国际前列腺症状评分（IPSS）、包括排尿、储尿和生活质量（QoL）的IPSS子评分、良性前列腺增生影响指数（BII）、最大尿流率（Qmax）和国际勃起功能指数（IIEF）的变化。采用荟萃分析技术对纳入研究的综合数据进行分析，以评估结果的平均差异。
在将伴有或不伴有勃起功能障碍（ED）的LUTS/BPH与安慰剂进行比较的试验中，总IPSS评分、IIEF和BII均有显著改善。对于LUTS/BPH，总IPSS评分、IIEF和BII的平均差异分别为-2.17、4.88和-0.43，P<0.00001。对于合并ED的LUTS/BPH，平均差异分别为-1.97、4.54和-0.52，P<0.00001。PDE5-Is似乎可改善IPSS储尿、排尿和QoL子评分（平均差异分别为-0.71、-1.23和-0.33，P<0.00001）。尽管他达拉非的四个剂量（2.5、5、10和20mg）在Qmax方面未达到显著性（平均差异=0.22，P=0.10），但5mg剂量的他达拉非显著改善了Qmax（平均差异=0.33，P=0.03）。
PED5-Is在改善有或无ED的BPH患者的LUTS方面显示出疗效，可被视为LUTS/BPH的一线治疗药物。
