Systematic review and meta-analysis of the use of phosphodiesterase type 5 inhibitors for treatment of erectile dysfunction following bilateral nerve-sparing radical prostatectomy
Open accessAbstract
Prostate cancer is relatively common cancer occurring in males. Radical prostatectomy (RP) is the most effective treatment for a localized tumor but erectile dysfunction (ED) is common complication, even when bilateral nerve-sparing RP (BNSRP) is performed. Clinical trials have shown varied effectiveness of phosphodiesterase type-5 inhibitors (PDE5-Is) for treatment of post-BNSRP ED, but there remains controversy over the application of this treatment and no formal systematic review and meta-analysis for the use of PDE5-Is for this condition has been conducted. This review was to systematically assess the efficacy and safety of oral PDE5-Is for post-BNSRP ED. A database search was conducted to identify randomized controlled trials (RCTs). The comparative efficacy of treatments was analyzed by fixed or random effect modeling. Erectile function was measured using the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP) question-2, 3 and the Global Assessment Question (GAQ). The rate and incidence of adverse events (AEs) were determined. The quality of included studies was appraised using the Cochrane Collaboration bias appraisal tool. Eight RCTs were included in the analyses. PDE5-Is were effective for treating post-BNSRP ED compared to placebo when erectile function was determined using the IIEF score [mean difference (MD) 5.63, 95% confidence interval (CI) (4.26-6.99)], SEP-2 [relative risk (RR) 1.63, 95% CI (1.18-2.25) ], SEP-3 [RR 2.00, 95% CI (1.27-3.15) ] and GAQ [RR 3.35, 95% CI (2.68-4.67) ]. The subgroup analysis could find a trend that longer treatment duration, higher dosage, on-demand dosing, sildenafil and mild ED are associated with more responsiveness to PDE5-Is. PDE5-Is were overall well tolerated with headache being the most commonly reported AE. Our data provides compelling evidence for the use of PDE5-Is as a primary treatment for post-BNSRP ED. However, further studies are required to optomize usage parameters (such as dosage and duration of treatment).
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Current guidelines recommend oral medication (PDE5 inhibitors) as front-line treatment for erectile functioning.
“Current guidelines recommend oral medication (ie, PDE5 inhibitors) as front-line treatment.15”
From Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples’ Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach (2021) · cites this paper as [15]
The Introduction says PDE5 inhibitors are often the first line of treatment, and the Methods confirm they are administered orally. But the paper does not say that current guidelines recommend them as front-line treatment; the Introduction instead says there is no consensus or guidelines on their use for erectile dysfunction after bilateral nerve-sparing radical prostatectomy. (LLM, conf=0.86)
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- Authors
- Wang, X., Wang, X., Liu, T., He, Q., Wang, Y., & Zhang, X.
- Affiliations
- Zhongnan Hospital of Wuhan University (CN)
- Corresponding author
- Wang, Xinghuan
- Zhang, Xinhua
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-03-11
- Volume
- 9
- Issue
- 3
- Pages
- e91327
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3949994
- OpenAlex
- W2095279301
- Cited by
- 51
- References
- 42
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 6 · 2020: 2 · 2019: 1 · 2018: 4 · 2017: 9 · 2016: 4 · 2015: 5 · 2014: 3
- FWCI
- 0.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (N.81270843, 81270843)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Diagnosis and Treatment
- Keywords
- erectile dysfunction, phosphodiesterase-5 inhibitors, prostate cancer, sildenafil, erectile function, adverse events, treatment response, on-demand dosing, treatment duration
- MeSH terms
- Humans, Erectile Dysfunction, Male, Prostatectomy, Odds Ratio, Randomized Controlled Trials as Topic, Treatment Outcome, Phosphodiesterase 5 Inhibitors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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