Objective: To determine the effectiveness of the Phosphodiesterase 5 (PDE5) Inhibitors for the treatment of erectile dysfunction in patients with spinal trauma. Methods: A systematic review and meta-analysis comparing PDE5 inhibitors versus placebo were carried out for clinical trials conducted between 1980 and 2014 that evaluated male patients older than 18 years, diagnosed with spinal cord trauma and erectile dysfunction. We designed a search strategy for Medline, CENTRAL, EMBASE and other electronic sources. Two investigators independently and blindly screened the studies for inclusion. A random effect meta-analysis was performed. Results: Six studies involving 963 patients were included. Male patients over 18 years with ED attributable or subsequent to traumatic spinal cord injury (SCI) were included from these studies. In 4 of these studies, patients were randomized to the treatment group receiving sildenafil and the comparison group was placebo. Out of the remaining 2 trials, one compared tadalafil against the placebo and the other vardenafil versus placebo. The improvement on SCIs with PDE5 inhibitors was found to be large (standardized mean difference 0.71; 95% CI 0.39-1.03), with a high heterogeneity (I2 = 74.4%). Conclusions: PDE5 inhibitors are effective for the treatment of erectile dysfunction secondary to SCI.

Journal Section:
Editor's choice
Keywords:
Spinal cord injuries, Phosphodiesterase 5 inhibitors, Erectile dysfunction, Systematic review, Meta-analysis
1.
Acevedo GJ, Varón LF, Berbeo CM, Feo LO, Días OR: Avances fisiopatológicos para el entendimiento de la lesión medular traumática. Revisión bibliográfica. Rev Col Or Tra 2008;22:272-281.
2.
Rizio N, Tran C, Sorenson M: Efficacy and satisfaction rates of oral PDE5is in the treatment of erectile dysfunction secondary to spinal cord injury: a review of literature. J Spinal Cord Med 2012;35:219-228.
3.
Ludwig W, Phillips M: Organic causes of erectile dysfunction in men under 40. Urol Int 2014;92:1-6.
4.
Schmid DM, Hauri D, Schurch B: Nocturnal penile tumescence and rigidity (NPTR) findings in spinal cord injured men with erectile dysfunction. Int J Impot Res 2004;16:433-440.
5.
Lombardi G, Macchiarella A, Cecconi F, Del Popolo G: Ten years of phosphodiesterase type 5 inhibitors in spinal cord injured patients. J Sex Med 2009;6:1248-1258.
6.
Deforge D, Blackmer J, Garritty C, Yazdi F, Cronin V, Barrowman N, Fang M, Mamaladze V, Zhang L, Sampson M, Moher D: Male erectile dysfunction following spinal cord injury: a systematic review. Spinal Cord 2006;44:465-473.
7.
O'Connor D, Green S, Higgins JPT (eds): Chapter 5: defining the review question and developing criteria for including studies; in Higgins JPT, Green S (eds): Cochrane Handbook for Systematic Reviews of Interventions. Version 5. The Cochrane Collaboration, 2011.
8.
Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, Guyatt GH: Chapter 12: interpreting results and drawing conclusions; in Higgins JPT, Green J (eds): Cochrane Handbook for Systematic Reviews of Interventions. Version 5. The Cochrane Collaboration, 2011.
9.
Higgins JPT, Deeks JJ, Altman DG (eds): Chapter 16: special topics in statistics; in Higgins JPT, Green S (eds): Cochrane Handbook for Systematic Reviews of Interventions. Version 5. The Cochrane Collaboration, 2011.
10.
Cochran W: The combination of estimates from different experiments. Biometrics 1954;10:110-129.
11.
Higgins JP, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. BMJ 2003;327:557-560.
12.
Giuliano F, Hultling C, El Masry WS, Smith MD, Osterloh IH, Orr M, Maytom M: Randomized trial of sildenafil for the treatment of erectile dysfunction in spinal cord injury. Sildenafil study group. Ann Neurol 1999;46:15-21.
13.
Maytom MC, Derry FA, Dinsmore WW, Glass CA, Smith MD, Orr M, Osterloh IH: A two-part pilot study of sildenafil (VIAGRA) in men with erectile dysfunction caused by spinal cord injury. Spinal Cord 1999;37:110-116.
14.
Ergin S, Gunduz B, Ugurlu H, Sivrioglu K, Oncel S, Gok H, Erhan B, Levendoglu F, Senocak O: A placebo-controlled, multicenter, randomized, double-blind, flexible-dose, two-way crossover study to evaluate the efficacy and safety of sildenafil in men with traumatic spinal cord injury and erectile dysfunction. J Spinal Cord Med 2008;31:522-531.
15.
Khorrami MH, Javid A, Moshtaghi D, Nourimahdavi K, Mortazavi A, Zia HR: Sildenafil efficacy in erectile dysfunction secondary to spinal cord injury depends on the level of cord injuries. Int J Androl 2010;33:861-864.
16.
Giuliano F, Sanchez-Ramos A, Löchner-Ernst D, Del Popolo G, Cruz N, Leriche A, Lombardi G, Reichert S, Dahl P, Elion-Mboussa A, Casariego J: Efficacy and safety of tadalafil in men with erectile dysfunction following spinal cord injury. Arch Neurol 2007;64:1584-1592.
17.
Giuliano F, Rubio-Aurioles E, Kennelly M, Montorsi F, Kim ED, Finkbeiner AE, Pommerville PJ, Colopy MW, Wilkins HJ, Wachs BH: Efficacy and safety of vardenafil in men with erectile dysfunction caused by spinal cord injury. Neurology 2006;66:210-216.
18.
Chen L, Staubli SE, Schneider MP, Kessels AG, Ivic S, Bachmann LM, Kessler TM: Phosphodiesterase 5 inhibitors for the treatment of erectile dysfunction: a trade-off network meta-analysis. Eur Urol 2015;68:674-680.
19.
Jia DD, Shuang WB, Cheng T, Jia XM, Zhang M: Efficacy and safety of phosphodieterase-5 inhibitors for treatment of erectile dysfunction secondary to spinal cord injury: a systemic review and meta-analysis. Spinal Cord 2016;54:494-501.
20.
Lombardi G, Musco S, Kessler TM, Li Marzi V, Lanciotti M, Del Popolo G: Management of sexual dysfunction due to central nervous system disorders: a systematic review. BJU Int 2015;115(suppl 6):47-56.
21.
Xiao Y, Wang J, Luo H: Sildenafil citrate for erectile dysfunction in patients with multiple sclerosis. Cochrane Database Syst Rev 2012;4:CD009427.
22.
Lombardi G, Musco S, Wyndaele JJ, Del Popolo G: Treatments for erectile dysfunction in spinal cord patients: alternatives to phosphodiesterase type 5 inhibitors? A review study. Spinal Cord 2015;53:849-854.
© 2016 S. Karger AG, Basel
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