Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy; Laboratory for Experimental Urology, Gene and Stem Cells Applications, Department of Development and Regeneration, University of Leuven, Leuven, Belgium.
Laboratory for Experimental Urology, Gene and Stem Cells Applications, Department of Development and Regeneration, University of Leuven, Leuven, Belgium.
Eur Urol. 2016 May;69(5):904-16. doi: 10.1016/j.eururo.2015.12.028. Epub 2015 Dec 31.
Premature ejaculation (PE) is the most prevalent male sexual dysfunction. In the last few years, several pharmacologic approaches for oral or topical treatment of PE have been studied.
To systematically review the literature on the outcome of pharmacologic interventions for PE on intravaginal ejaculation latency time (IELT) in comparison to placebo.
A systematic literature search of PubMed and Scopus using the term "premature ejaculation" was performed on 10 April 2015. Full-text articles on prospective randomized controlled trials (RCTs) investigating pharmacotherapy were included. The main outcome measure was IELT.
Out of 266 unique records, a total of 22 were reviewed. The majority of RCTs were of unclear methodological quality because of limited reporting of methods. Pooled evidence suggests that selective serotonin reuptake inhibitors (SSRIs), topical anesthetic creams (TAs), tramadol, and phosphodiesterase type 5 inhibitors (PDE5is) are more effective than placebo at increasing IELT (all p<0.05). However, interpretation of the current meta-analyses may be impaired as a result of frequent heterogeneity in the pooled analyses (all I(2) > 70%). Only pooled analyses for dapoxetine 30mg and 60mg were characterized by homogeneous data (both I(2)<30%) while showing a modest but statistically significant improvement in IELT compared with placebo (mean difference 1.39min, 95% confidence interval 1.23-1.54min; p<0.00001).
Meta-analysis revealed that treatment with dapoxetine significantly improves IELT in patients with PE but with modest efficacy. The efficacy of SSRIs, TAs, tramadol, and PDE5is remains unclear owing to high heterogeneity of the available RCT data. There is a persisting need for drug research and development in the field.
Premature ejaculation is a condition for which the cause is not well understood. Several types of treatment with medium to low efficacy are available. More research is necessary to identify the ideal treatment.
早泄是最常见的男性性功能障碍。近年来，已经研究了几种用于治疗早泄的口服或局部药物治疗方法。
系统回顾关于药物干预早泄对阴道内射精潜伏期时间（IELT）的影响的文献，与安慰剂进行比较。
于 2015 年 4 月 10 日使用术语“早泄”对 PubMed 和 Scopus 进行了系统文献检索。纳入了关于药物治疗的前瞻性随机对照试验（RCT）的全文文章。主要结局指标为 IELT。
在 266 个独特的记录中，共审查了 22 个。由于方法报告有限，大多数 RCT 的方法学质量不明确。综合证据表明，选择性 5-羟色胺再摄取抑制剂（SSRIs）、局部麻醉乳膏（TAs）、曲马多和磷酸二酯酶 5 抑制剂（PDE5is）比安慰剂更能有效增加 IELT（所有 p<0.05）。然而，由于汇总分析中经常存在异质性（所有 I²>70%），当前的荟萃分析的解释可能受到影响。只有达泊西汀 30mg 和 60mg 的汇总分析具有同质数据（两者 I²<30%），同时与安慰剂相比显示出适度但统计学上显著的 IELT 改善（平均差异 1.39min，95%置信区间 1.23-1.54min；p<0.00001）。
荟萃分析显示，达泊西汀治疗可显著改善早泄患者的 IELT，但疗效适度。由于现有 RCT 数据的高度异质性，SSRIs、TAs、曲马多和 PDE5is 的疗效仍不清楚。该领域仍需要药物研究和开发。
早泄是一种病因不明的疾病。有几种疗效中等偏低的治疗方法。需要更多的研究来确定理想的治疗方法。
