Men with lower urinary tract symptoms, often a secondary condition of benign prostate hyperplasia (BPH), normally undergo α-adrenergic blockers therapy. Many of these patients also seek medical assistance for erectile dysfunction (ED), and receive therapy known as phosphodiesterase type 5 inhibitors (PDE5Is).
Researchers reviewed published studies — an approach known as a meta-analysis — to address whether combination therapy of α-adrenergic blockers with PDE5Is has a better outcome than just α-blocker monotherapy. They concluded that combined therapy is more effective for LUTS/ED than α-1-adrenergic blocker monotherapy.
The results, “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,” were published in the International Neurology Journal.
PDE5Is act on smooth muscles of voiding-related urological organs such as the bladder, which strongly suggest it may improve or ameliorate symptoms when combined with α-blockers in BPH-lower urinary tract symptoms (LUTS) treatment. However, there is a lack of definite evidence supporting this hypothesis.
Researchers searched published data stored in databases such as MEDLINE, Embase, Cochrane Library, and KoreaMed, between 2000 and 2014. Among the 323 references containing relevant terms for their study, 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.
Analysis revealed the combination therapy was more effective than α-blockers monotherapy to improve symptoms, as shown by a significant improvement in the International Prostrate Symptom Score (IPSS). The authors did not find a significant difference in the time patients were under PDE5Is treatment.
“Our data revealed that the mean differences were minimal between the long- and short-acting PDE5Is,” they wrote.
A similar improvement with combination therapy was observed for the maximum flow rate (Qmax) and residual urine decreased. Moreover, the International Index of Erectile Function value increased by 3.99.
The authors believe this study has limitations due to differences in opinion of the suitability of the studies they selected for review, and the heterogeneity of the data. “… Although our review does not contain long-term data, any combination of the PDE5Is with the α-1-adrenergic blockers, irrespective of the duration of action, can provide more potent options to improving coexisting LUTS/BPH as well as modify sexual function,” the authors wrote.