Phosphodiesterase inhibitors for the management of lower urinary tract symptoms in men without benign prostatic hyperplasia: a systematic review
Abstract
Background: Lower urinary tract symptoms (LUTS) are common in men and can lead to impaired quality of life. While phosphodiesterase type 5 inhibitors (PDE5-Is) are established in managing LUTS related to benign prostatic hyperplasia (BPH), their role in non-BPH male LUTS remains unclear. This systematic review aimed to evaluate the efficacy and safety of PDE5-Is in men with LUTS unrelated to prostate enlargement.
Methods: A systematic search of four databases (PubMed, Web of Science, ScienceDirect, and EBSCO) identified five eligible clinical trials that enrolled men with LUTS secondary to non-BPH etiologies such as post-prostate brachytherapy, overactive bladder (OAB), and double-J (DJ) ureteral stents. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool for randomized trials and the Risk of Bias in Non-randomized Studies of Intervention (ROBINS-I) tool for non-randomized trials. Data were synthesized descriptively due to heterogeneity and limited number of studies. Our review was registered in advance in PROSPERO (CRD420251072896).
Results: From 341 identified studies, 5 clinical trials met the inclusion criteria. Interventions included tadalafil, sildenafil, and combination regimens with tamsulosin or solifenacin. PDE5-Is consistently improved urinary symptoms, International Prostate Symptom Score (IPSS) reduction, pain, storage and voiding scores, and sexual function. Tadalafil showed the most consistent benefits, particularly in sexual health and…
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