Efficacy and safety of phosphodieterase-5 inhibitors for treatment of erectile dysfunction secondary to spinal cord injury: a systemic review and meta-analysis

Abstract

Objective: We carried out a systematic review and meta-analysis to assess the efficacy and safety of phosphodieterase-5 (PDE5) inhibitors on erectile dysfunction (ED) secondary to spinal cord injury (SCI). Methods: A literature review was performed to identify all published randomized, double-blind, placebo-controlled trials of PDE5 inhibitors for treatment of ED secondary to SCI. The search included the following database: MEDLINE, EMBASE and the Cochrane Library. The outcomes and complications analyzed involved the Global Efficacy Question (GEQ), sexual encounter profile diary question 2 and 3 (SEP2 and SEP3) and adverse events. All statistical analysis was performed using Stata 12.0 software (Stata Corp., College Station, TX, USA). Results: Six publications were used in analysis, including six randomized controlled trials that compared PDE5 inhibitors with placebo. Compared with placebo, PDE5 inhibitors were associated with significant improvements in GEQ (OR 11.997, 95% CI 8.073-17.830, Po0.0001), SEP2 (RR 1.847, 95% CI 1.561-2.185, Po0.0001) and SEP3 (RR 2.738, 95% CI 2.084-3.598, Po0.0001). Despite significant greater incidences of some adverse events observed (headache: RR 3.717, 95% CI 2.309-5.982, Po0.0001; flushing: RR 9.281, 95% CI 2.858-30.147, Po0.0001; gastrointestinal discomfort: RR 9.064, 95% CI 2.116-38.827, P = 0.003), most adverse events were mild to moderate and transient. Conclusions: This systematic review and meta-analysis indicate that PDE5 inhibitors are effective and well tolerated to treat ED secondary to SCI compared with placebo, as measured by response to GEQ, SEP2, SEP3 and incidence of adverse events. PDE5 inhibitors could be considered as the first choice in the treatment of ED patients with SCI. INTRODUCTIONApproximately 11 000 new cases are estimated to suffer from spinal cord injury (SCI) in America each year and 60% of them are between 16 and 30 years of age. Moreover, men account for 82% of all patients with SCI. 1,2 Erectile dysfunction (ED) is a common condition in individuals with SCI. 3 A high prevalence of ED is reported in about 80% of SCI patients. 4 It is an especially bothersome condition in young men who usually had an active sexual activity before their accident. 5 ED is defined as the persistent inability to achieve or maintain a penile erection for satisfactory sexual performance. 6 Most men with SCI have some type of penile erection, but it is usually not hard enough or does not last long enough for sexual life. 1 ED not only often results in disorder of self-esteem but also deteriorates partner relationship. Hence, ED has a negative effect on the life of men and their sexual partner. 7 Health-care providers deem sex life significant in the process of rehabilitation after SCI and give high priority to improving sexual activity for subjects with SCI. 8,9 Nitric oxide (NO) released by nonadrenergic-noncholinergic nerves in the penis has an important role in initiating and maintaining of the

Effectiveness of Phosphodiesterase 5 Inhibitors in the Treatment of Erectile Dysfunction in Patients with Spinal Cord Trauma: Systematic Review and Meta-Analysis

“…Nevertheless, urologists must realize the variety of tests used to measure the outcome (IIEFrelated tests, GEA and EDITS). This is according to the study of Jia et al [19] who considered PDE5 inhibitors as the main option in SCI patients, mainly using sildenafil as we found. This SR shows the similarities among the different tools while we standardized them to find a more generalizable result.…”

“…In contrast, we lack evidence to support the use of PDE5 inhibitors in patients with multiple sclerosis or any other central nervous system disturbance, since studies are scarce and lack good quality [20,21] . Regarding adverse effects, we found high heterogeneity describing this aspect on different studies; however, it was important to see that the most frequent ones were headache and flushing, according to literature related to the general population and SCI [18,19] .…”

Disability as an Interpersonal Experience: A Systematic Review on Dyadic Challenges and Dyadic Coping When One Partner Has a Chronic Physical or Sensory Impairment

“…Their potential relationship impact is very high due to the interference of physical or sensory impairments with key domains of romantic relationships such as sexual function or couple communication. For example, erectile dysfunction has been reported in up to 80% of males with spinal cord injury (Jia et al, 2016). In couples where one partner has multiple sclerosis, fatigue and fear of pain are often reported as barriers to satisfying sexual relationships (Marck et al, 2016).…”

Sexualidad en hombres y mujeres con lesión medular traumática

“…Los datos son bastante concordantes con los del estudio de Gomes (159), en el que un Los efectos adversos más frecuentes del sildenafilo encontrados en la literatura fueron dolor de cabeza, rubor, dispepsia, congestión nasal, hipotensión, ITU y malestar gastrointestinal (161)(162)(163)(164), la mayoría de ellos de leves a moderados y transitorios (161).…”

“…Esta recomendación choca con lo surgido en los discursos sobre la percepción de desconocimiento de los profesionales, a pesar de ser fármacos que surgieron de forma previa a los orales. El primer inhibidor oral de PDE5, el sildenafil, se lanzó en 1998, mientras que los primeros informes sobre el efecto proeréctil de la administración intracavernosa de fármacos fue en 1982 (60,161).…”