Efficacy and safety of phosphodiesterase type 5 ( PDE 5) inhibitors in treating erectile dysfunction after bilateral nerve‐sparing radical prostatectomy

Summary We carried out a systematic review and meta‐analysis to assess the efficacy and safety of phosphodiesterase type 5 ( PDE 5) inhibitors for treating erectile dysfunction ( ED ) after bilateral nerve‐sparing radical prostatectomy ( BNSRP ). A literature review was performed to identify all published randomised double‐blind, placebo‐controlled trials of PDE 5 inhibitors for the treatment of ED after BNSRP . The search included the following databases: MEDLINE , EMBASE and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. Six publications involving a total of 1678 patients were used in the analysis, including six RCT s that compared PDE 5 inhibitors (tadalafil, sildenafil, avanafil and vardenafil) with placebo. Co‐primary efficacy end points: International Index of Erectile Function‐Erectile Function ( IIEF ‐ EF ) domain score [the standardised mean difference ( SMD ) = 4.04, 95% confidence interval ( CI ) = 2.87–5.22, P  < 0.00001]; successful vaginal penetration ( SEP 2) [the odds ratio ( OR ) = 14.87, 95% CI  = 4.57–48.37, P  < 0.00001]; and successful intercourse ( SEP 3) ( OR  = 47, 95% CI  = 3–13.98, P  < 0.00001) indicated that PDE 5 inhibitors was more effective than the placebo. Specific adverse events with PDE 5 inhibitors included headache (12.08%), dyspepsia (6.76%) and flushing (6.52%), which were significantly less likely to occur with placebo. This meta‐analysis indicates that PDE 5 inhibitors to be an effective and well‐tolerated treatment for ED after BNSRP .