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Efficacy of PDE5Is and SSRIs in men with premature ejaculation: a new systematic review and five meta-analyses

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Abstract

Purpose

To clarify the efficacy of phosphodiesterase-5 inhibitors (PDE5Is) and selective serotonin reuptake inhibitors (SSRIs) in men with premature ejaculation (PE).

Methods

We searched the PubMed, Embase, and Cochrane Library databases to identify all randomized, controlled trials (RCTs) and compared the results, including intravaginal ejaculation latency time, satisfaction, intercourse per-week and side effects after treatment with PDE5I or SSRIs versus placebo, combined use of PDE5I with SSRIs versus PDE5I or SSRIs alone, and PDE5I versus SSRIs for treating PE.

Results

The study inclusion criteria were met by 23 studies (ten RCTs with five crossover studies) involving 6145 patients. The data synthesized from these studies indicated that the efficacy of PDE5Is and SSRIs was better than that of placebo (p < 0.00001; p < 0.00001); however, more patients had side effects while taking PDE5Is and SSRIs (p < 0.00001; p < 0.00001). The efficacy of the combined treatment was significantly better than that of PDE5Is or SSRIs alone (p < 0.00001; p < 0.00001); however, more patients had side effects from the combined treatment than from SSRIs (p = 0.0002), with no significant difference in PDE5Is (p = 0.5). The efficacy of PDE5Is was better than that of SSRIs (p = 0.006), and no significant difference was observed in the frequency of side effects (p = 0.93).

Conclusions

PDE5Is were significantly more effective than placebo or SSRIs for treating PE, while SSRIs were better than placebo. The combined treatment had better efficacy than PDE5Is or SSRIs alone.

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Abbreviations

PE:

Premature ejaculation

IVELT:

Intravaginal ejaculation latency time

SSRIs:

Selective serotonin reuptake inhibitors

ED:

Erectile dysfunction

AUA:

American Urological Association

PDE5I:

Phosphodiesterase type 5 inhibitor

IIEF:

International Index of Erectile Function

MD:

Mean difference

CI:

Confidence interval

RR:

Relative risk

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Author information

Author notes

  1. Yi Sun and Lu Yang contributed equally to this work and should share the co-first author.

Authors and Affiliations

  1. Department of Urology, West China Hospital of Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, People’s Republic of China

    Yi Sun, Lu Yang, Yige Bao, Zhenhua Liu, Liangren Liu & Qiang Wei

Authors
  1. Yi Sun
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  2. Lu Yang
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  3. Yige Bao
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  4. Zhenhua Liu
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  5. Liangren Liu
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  6. Qiang Wei
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Contributions

YS: Protocol development; Data collection or management; Data analysis; Manuscript writing. LY: Data collection or management; Data analysis; Manuscript writing. YB: Data collection or management; Data analysis. ZL: Data analysis; Manuscript writing. LL: Data analysis. QW: Protocol development; Manuscript editoring.

Corresponding authors

Correspondence to Lu Yang or Qiang Wei.

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Funding

This study was supported by the National Natural Science Foundation of China (Grant no. 81370855, 81300627 and 81200551), the Prostate Cancer Foundation Young Investigator Award 2013 and Foundation of Science and Technology Department of Sichuan Province (Grant no. 2015SZ0230, 2013SZ0006 and 2013SZ0093), and the Scientific Research Project of Health Department of Sichuan Province (no. 120203).

Conflict of interest

Authors declare that they have no competing interests.

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Sun, Y., Yang, L., Bao, Y. et al. Efficacy of PDE5Is and SSRIs in men with premature ejaculation: a new systematic review and five meta-analyses. World J Urol 35, 1817–1831 (2017). https://doi.org/10.1007/s00345-017-2086-5

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  • DOI: https://doi.org/10.1007/s00345-017-2086-5

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