Phosphodiesterase 5 inhibitors for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review

• Published in: BJU international 2011-04, Vol.107 (7), p.1104-1109
• Main Authors: Laydner, Humberto K., Oliveira, Paulo, Oliveira, Carlos Roberto A., Makarawo, Tafadzwa P., Andrade, Weslley S., Tannus, Matheus, Araújo, José Luciano R.
• Format: Article
• Language: English
• Subjects: Aged; benign prostatic hyperplasia; Biological and medical sciences; Humans; lower urinary tract symptoms; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; phosphodiesterase 5 inhibitors; Phosphodiesterase 5 Inhibitors - therapeutic use; prostate; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - drug therapy; Prostatism - drug therapy; Prostatism - etiology; randomized controlled trials; Randomized Controlled Trials as Topic; Treatment Outcome; Tumors of the urinary system; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09698.x

Study Type – Therapy (systematic review)
Level of Evidence 1a What’s known on the subject? and What does the study add? Phosphodiesterase 5 inhibitors improve lower urinary tract symptoms (LUTS), however the maximum urinary flow rate is not significantly affected. Also, the underlying mechanism of action of these drugs on LUTS is not well understood. This systematic review confirms the findings of the individual studies included; however the high heterogeneity between them precluded meta‐analysis and further recommendations. OBJECTIVE • To review the evidence in support of the effectiveness of phosphodiesterase 5 inhibitors in lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). METHODS • Relevant studies were identified by performing a literature search using MEDLINE® and The Cochrane Library®. The criteria used during the search included randomized, placebo‐controlled trials of treatment for LUTS secondary to BPH using the International Prostate Symptom Score as an outcome measure. RESULTS • Four trials that included a total of 1928 patients met the inclusion criteria. All four studies showed a statistically significant difference in the International Prostate Symptom Score, quality of life and erectile function in favour of phosphodiesterase 5 inhibitors. • No study showed a statistically significant improvement of the maximum urinary flow. • Meta‐analysis of the results was not possible because of heterogeneity across the studies. CONCLUSIONS • Phosphodiesterase 5 inhibitors used in the clinical setting can significantly improve LUTS secondary to BPH, erectile function and quality of life. Maximum urinary flow improvement is not statistically significant. • Future research should focus on pathophysiological principles and cost analysis.