Oral phosphodiesterase-5 inhibitors and hormonal treatments for erectile dysfunction: a systematic review and meta-analysis
Abstract
Erectile dysfunction (ED) is a common male sexual disorder and is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance (1). Advanced age, diabetes, vascular diseases, psychiatric disorders, and possibly hypogonadism are associated with increased prevalence of ED (14). According to data from the Massachusetts Male Aging Study (2), the prevalence of ED in men aged 40 to 70 years is about 50%. Unless contraindicated, oral phosphodiesterase-5 (PDE-5) inhibitors, such as sildenafil, tadalafil, or vardenafil, are currently first-line treatments of ED (5). Alternative treatments include hormones, vacuum constriction devices, intraurethral suppositories, intracavernosal injections, or surgery (for example, penile prosthesis implants) (57). Direct comparisons between treatments have been limited, and the relative long-term efficacy and safety profiles of different therapies have not been adequately explored. Estimates from the National Health and Nutrition Examination Survey suggested that annual U.S. treatment costs of ED could reach $15 billion if all affected men sought care (8). In the past decade, the use of diagnostic tests for underlying causes of ED markedly decreased and use of pharmacologic therapy, especially with oral PDE-5 inhibitors, increased (8). In 2005, sales of sildenafil, tadalafil, and vardenafil were $1.6 billion, $747 million, and $327 million, respectively (911). The value of hormonal blood…
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