The effects of combination therapy consisted of an α-blocker and a phosphodiesterase-5 inhibitor (PDE5I) for the treatment of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). The objective is to systematically investigate the efficacy and safety of the combination therapy in comparison to monotherapy.
The study complied with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) the recommendations of the European Association of Urology Guidelines office. The primary endpoint was the quality of life related to LUTS and ED. Secondary endpoints included the adverse events rate. In the subgroup analysis of the influence of adding a PDE5I to the treatment of LUTS, the use of different PDE5Is were considered.
After the screening of 6687 publications, 26 RCTs were considered eligible to be included in the meta-analysis. In the combination group, IPSS and PVR was lower and Qmax was higher than in the α-blocker group. The mean change of the values was bigger in the combination group. IIEF and the mean change of IIEF had no difference between the combination group and the PDE5I group. Regarding the adverse events, the meta-analysis was in favor of the monotherapy. None of the studies referred any serious or severe adverse event.
Treatment with the combination therapy is more effective for the improvement of IPSS. Less significant improvement was shown in Qmax and PVR. The beneficial effect of combination therapy regarding ED was similar to the effect of PDE5I monotherapy. The combination therapy seemed to be safe and well tolerated.
