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Alpha-blockers with or without phosphodiesterase type 5 inhibitor for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis

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Abstract

Purpose

Recently, several randomized controlled trials (RCTs) explored the effects of α-blockers with or without phosphodiesterase type 5 inhibitors (PDE5-Is) for lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). However, the results were inconsistent. We performed this meta-analysis to evaluate the role of combination therapy (α-blockers and PDE5-Is) in patients with LUTS/BPH.

Materials and methods

Databases including PubMed, Cochrane library, Web of Science, and Embase were searched for qualified RCTs. Pooled mean differences (MDs) and odds ratios (ORs) were calculated to measure the effects and adverse events in combination therapy. Moreover, subgroup analyses of ethnicity, dosage of PDE5-Is, treatment duration, and severity of LUTS/BPH were performed. In addition, trial sequential analyses (TSAs) were used to assess whether the evidence for the results was sufficient.

Results

Overall, this study identified 11 eligible RCTs, including 855 LUTS/BPH patients. Patients receiving combination therapy had better improvement in international prostate symptom score (IPSS: MD: 1.66, 95% CI − 3.03 to − 0.29), maximum urinary flow rate (Qmax: MD: 0.94, 95% CI 0.24–1.64), and international index of erectile function (IIEF: MD: 4.73, 95% CI 2.95–6.51), comparing those without PDE5-Is. Besides, subgroup analyses indicated that the effects of combination treatment were associated with ethnicity, treatment duration, and severity of LUTS/BPH. By TSA, the findings in the current study were based on sufficient evidence.

Conclusions

Our results indicated that combination therapy can significantly improve IPSS, Qmax, and IIEF in patients with LUTS/BPH. Combination therapy might be more suitable for these patients.

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Acknowledgements

This work is supported by the grant from the National Natural Science Foundation of China (81671488) and the Beijing Natural Science Foundation (Grant No. 7162152).

Funding

This study was funded by the National Natural Science Foundation of China (81671488) and the Beijing Natural Science Foundation (Grant no. 7162152).

Author information

Author notes

  1. Jianzhong Zhang, Xiao Li and Bin Yang have equally contributed to this work.

Authors and Affiliations

  1. Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Jianzhong Zhang, Bin Yang & Hongjun Li

  2. Department of Urology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China

    Xiao Li

  3. Department of Urology, Dongtai People’s Hospital, Jiangsu, 224200, China

    Cheng Wu

  4. Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Yanghua Fan

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  1. Jianzhong Zhang
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  3. Bin Yang
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  4. Cheng Wu
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Contributions

HJL: project development and manuscript writing. JZZ: data collection and manuscript writing. XL: data collection and data analysis. BY: data collection and data analysis. CW: data collection. YHF.: data analysis.

Corresponding author

Correspondence to Hongjun Li.

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Conflict of interest

Hongjun Li has received research grants from the National Natural Science Foundation of China (81671488) and the Beijing Natural Science Foundation (Grant no. 7162152).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving human participants and/or animals

For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

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345_2018_2370_MOESM1_ESM.tif

Figure S1 Subgroup analyses of effects of combination therapy versus a-blockers alone by assessment of IPSS. A–D Subgroup analyses by ethnicity, treatment period, severity of LUTS, and dosage of PDE5-Is, respectively (TIFF 1091 kb)

345_2018_2370_MOESM2_ESM.tif

Figure S2 Subgroup analyses of effects of combination therapy versus a-blockers alone by assessment of Qmax. A–C Subgroup analyses by treatment period, severity of LUTS, and dosage of PDE5-Is, respectively (TIFF 438 kb)

345_2018_2370_MOESM3_ESM.tif

Figure S3 Subgroup analyses of effects of combination therapy versus a-blockers alone by assessment of PVR. A, B Subgroup analyses by treatment period and dosage of PDE5-Is, respectively (TIFF 476 kb)

345_2018_2370_MOESM4_ESM.tif

Figure S4 Subgroup analyses of effects of combination therapy versus a-blockers alone by assessment of IIEF. A, B Subgroup analyses by treatment period and dosage of PDE5-Is, respectively (TIFF 500 kb)

345_2018_2370_MOESM5_ESM.tif

Figure S5 Sensitivity of each included study in this meta-analysis. A–D indicated sensitivity analyses of IPSS, Qmax, PVR, and IIEF, respectively (TIFF 550 kb)

345_2018_2370_MOESM6_ESM.tif

Figure S6 Funnel plots of the publication bias. A–D indicated funnel plots of IPSS, Qmax, PVR, and IIEF, respectively 6 (TIFF 265 kb)

Table S1 PRISMA checklist (DOC 65 kb)

Table S2 25-item CONSORT checklist (DOCX 19 kb)

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Zhang, J., Li, X., Yang, B. et al. Alpha-blockers with or without phosphodiesterase type 5 inhibitor for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis. World J Urol 37, 143–153 (2019). https://doi.org/10.1007/s00345-018-2370-z

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