Study of phosphodiesterase 5 inhibitors and α-adrenoceptor antagonists used alone or in combination for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia.

INTRODUCTION

This study sought to compare the improvement in lower urinary tract symptoms (LUTS) and complications of phosphodiesterase type 5 inhibitors (PDE5i) and alpha-blockers (Abs) in combination or alone among males with benign prostatic hyperplasia (BPH).

EVIDENCE ACQUISITION

We searched the PubMed, Embase, and Cochrane Library databases to identify all studied variables, including lower urinary tract symptoms (LUTS), BPH, Abs, and PDE5i and performed comparisons between combination treatment and single treatments as primary endpoints. Efficacy analysis including the International Prostate Symptom Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), postvoiding residual volume (PVR), and International Index of Erectile Function erectile function domain (IIEF-EF) score. Complications were also recorded. In addition, the secondary endpoint was a comparison of the efficacy and complications between the two single treatments.

EVIDENCE SYNTHESIS

Nineteen studies involving 2,426 patients met the inclusion criteria. The data synthesized from these studies indicated that the combination treatment is better in efficiency than PDE5i or Abs alone in including IPSS (P<0.00001 in PDE5i; P=0.01 in Abs), QOL (P<0.00001 in PDE5i; P<0.00001 in Abs), Qmax (P<0.00001 in PDE5i; P<0.00001 in Abs), PVR (P=0.04 in PDE5i; P<0.00001 in Abs), and IIEF-EF (P<0.00001 in PDE5i; P<0.00001 in Abs). Regarding complications, only headache (P<0.00001), dyspepsia (P=0.01), and flushing (P=0.04) were more frequent in individuals undergoing the combination treatment.

CONCLUSIONS

Combination treatment is more effective than PDE5i or Abs alone, though the side effects are not significantly different.