Effect of alpha-adrenoceptor antagonists on sexual function. A systematic review and meta-analysis

Abstract

Background: Alpha-adrenoreceptor antagonists or alpha-blockers are used in the treatment of hypertension, in the therapy of benign prostatic hyperplasia and in medical expulsive treatment of ureteral stones. These agents may affect the sexual function, with differences between drugs within the same class, depending on their selectivity for receptor subtypes. The aim of this review was to analyze the effects of alpha-blockers on sexual function. Materials and methods: We conducted a systematic review and meta-analysis by searching PubMed, EMBASE and other databases for randomized controlled trials (RCTs) reporting sexual adverse effects in patients treated with alpha-blockers. Odds ratios for sexual dysfunction were calculated using random effects Mantel-Haenszel statistics. Results: Out of 608 records retrieved, 75 eligible RCTs were included in the meta-analysis. Compared with placebo, alphablockers were associated with increased odds of ejaculatory disorders both in patients with lower urinary tract symptoms (LUTS) associated to benign prostatic hyperplasia (BPH) (OR: 7.53, 95% CI: 3.77-15.02, Z = 5.73, p < 0.00001, I2 = 55%) and in patients with ureteral stones (OR: 2.88, 95% CI: 1.50-5.44, Z = 3.19, p < 0.001, I2 = 31%). Uroselective alpha-blockers showed higher odds of ejaculatory disorders. Conversely, nonselective alpha-blockers were not associated with higher odds of ejaculatory dysfunction. Silodosin was associated with increased odds of ejaculatory dysfunction compared with tamsulosin (OR: 3.52, 95% CI: 2.18-5.68, 15 series, 1512 participants, Z = 5.15, p < 0.00001, I2 = 0%). Naftopidil and alfuzosin showed lower odds of ejaculatory dysfunction compared to uroselective alpha-blockers.No statistically significant differences in the odds of erectile dysfunction were observed when alpha-blockers were compared to placebo.

Risks and side effects in the medical management of benign prostatic hyperplasia

“…Thankfully, alpha blockers are not associated with an increase in erectile dysfunction compared to placebo on meta-analysis. 27 …”

Erectile Dysfunction: Treatments, Advances and New Therapeutic Strategies

“…However, even when given intracavernously, this drug often produces orthostatic hypotension, tachycardia and, although rarely, also priapism [106,107]. These effects (except priapism) are usually seen with α 1 -adrenergic receptor antagonists given systemically and have been used for a long time as a monotherapy for the control of idiopathic hypertension, benign prostatic hyperplasia and associated bladder neck obstruction, voiding and storage, which also induce alterations in sexual, mainly ejaculatory function [108].…”

“…The blockade of these enzymes by drugs injected intracavernously, such as papaverine, induces penile erection. The intracavernous injection of a combination of prostaglandin E1, phentolamine and papaverine is the most common therapy for the local treatment of ED and is usually used when oral PDe5 inhibitors are found to be inefficacious [105,[107][108][109][110][111][112].…”

The Use of Botulinum Toxin in Medicine: Safety and Efficacy Based on the Latest Research

“…Taka interwencja przynosi znaczącą poprawę w jakości życia pacjentów, co jest kluczowym aspektem w kontekście trudności i dyskomfortu związanego z przewlekłymi schorzeniami takimi jak pęcherz neurogenny. [40] Inne zastosowania w dermatologii W kontekście przeglądu zastosowań toksyny botulinowej w medycynie, nie można pominąć jej istotnej roli w dziedzinie dermatologii. Przegląd literatury pokazuje, że istnieją dobrze udokumentowane dowody na skuteczność toksyny botulinowej w leczeniu takich schorzeń jak: łysienie, ropne zapalenie gruczołów potowych, choroba Dariera, notalgia paresthetica, choroba Raynauda, łuszczyca, ogniskowa idiopatyczna nadpotliwość, tłusta skóra, rumień i zaczerwienienie twarzy, akwageniczna keratoza, wrodzone zgrubienie paznokci, choroba Haileya-Haileya, a także procesów oddzielania skóry w przebiegu pęcherzowym oddzielaniu się naskórka.…”