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12.06.2018 | Original Article | Ausgabe 1/2019

World Journal of Urology 1/2019

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

Zeitschrift:
World Journal of Urology > Ausgabe 1/2019
Autoren:
Jianzhong Zhang, Xiao Li, Bin Yang, Cheng Wu, Yanghua Fan, Hongjun Li
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00345-018-2370-z) contains supplementary material, which is available to authorized users.
Jianzhong Zhang, Xiao Li and Bin Yang have equally contributed to this work.

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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Zusatzmaterial
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_MOESM1_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_MOESM2_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_MOESM3_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_MOESM4_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_MOESM5_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)
345_2018_2370_MOESM6_ESM.tif
Table S1 PRISMA checklist (DOC 65 kb)
345_2018_2370_MOESM7_ESM.doc
Table S2 25-item CONSORT checklist (DOCX 19 kb)
345_2018_2370_MOESM8_ESM.docx
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