Choi Hoon, Kim Hyun Jung, Bae Jae Hyun, Kim Jae Heon, Moon Du Geon, Cheon Jun, Yeo Jeong-Kyun
Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
Institute for Evidence-Based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
Int Neurourol J. 2015 Dec;19(4):237-45. doi: 10.5213/inj.2015.19.4.237. Epub 2015 Dec 28.
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.
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.
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.
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.
α-1肾上腺素能阻滞剂与5型磷酸二酯酶抑制剂（PDE5Is）联合治疗已显示出能改善下尿路症状（LUTS），且副作用可忽略不计。尽管如此，在症状改善方面的决定性优势并不充分，长效或短效PDE5Is与联合用药之间在临床上并无差异。
回顾关于α-1肾上腺素能阻滞剂单药治疗以及长效与短效PDE5Is联合治疗在LUTS和勃起功能障碍（ED）中应用的研究。使用相关术语组合对2000年至2014年的MEDLINE、Embase、Cochrane图书馆和KoreaMed数据库进行检索。在发现的323篇相关参考文献中，选择10篇进行荟萃分析。数据显示，616名男性接受了联合治疗（PDE5Is与α-1肾上腺素能阻滞剂）或α-1肾上腺素能阻滞剂单药治疗。
联合治疗的荟萃分析表明，在改善症状方面，联合治疗比α受体阻滞剂更有效，国际前列腺症状评分平均变化差异为-1.93，而长效与短效PDE5I的差异分别为-2.12和-1.70。与单药治疗的最大尿流率（Qmax）值相比，联合治疗使Qmax增加得更多（平均差异为0.71），而长效和短效PDE5Is的变化值分别为0.14和1.13。联合治疗使残余尿量比α-1肾上腺素能阻滞剂单药治疗减少得更多，平均差异为-7.09，而长效与短效PDE5Is的平均残余尿量变化值分别为-18.83和-5.93。联合治疗、长效和短效PDE5Is治疗后，国际勃起功能指数值分别增加了3.99、2.85和4.85。
我们的荟萃分析表明，PDE5Is可显著改善良性前列腺增生/ED男性的LUTS。此外，PDE5I与α-1肾上腺素能阻滞剂联合治疗可能比α-1肾上腺素能阻滞剂单药治疗更有效，且长效与短效药物之间的差异极小。
