Effectiveness and Safety of PDE5 Inhibitors for Men with Erectile Dysfunction Caused by Spinal Cord Injury

Aims: The objective of this review was to assess the effectiveness of phosphodiesterase type 5 (PDE5) inhibitors in men with erectile dysfunction (ED) and spinal cord injury (SCI).

Methodology: The following databases were sought up to May 2015: PubMed, Google scholar, EMBASE and Cochrane Library. We performed a meta-analysis of all available randomised controlled trials. We used odds ratios (ORs) to assess the strength of the association, and 95% confidence intervals (CIs) gave a sense of the precision of the estimate. Statistical analyses were performed by Review Manager, version 5.0.

Results: After searching and screening the relevant articles, ten studies were included and assessed the effectiveness of PDE5 inhibitors in men with erectile dysfunction and spinal cord injury. The pooled results showed that sildenafil significantly improved erection compared with placebo in ED patients with SCI (OR = 5.96, 95% CI [3.36–10.55], P ＜ 0.00001) and there was no statistical difference compared incomplete injury group with complete injury group (OR = 0.73, 95% CI [0.38–1.43], P=0.36). It is evident that compared upper motor neuron with lower motor neuron, there were better responsive rates in sildenafil(OR = 11.56, 95% CI [2.88–46.36], P=0.0006). Because of lacking studies and data, we could not perform meta-analysis for other PDE5 inhibitors. The commonly reported adverse effects (AEs) were headache, flushing, dizziness and urinary tract infection in these studies. No severe adverse events were found.

Conclusion: Current evidence suggests that sildenafil is effective treatment for ED patients with SCI. In future, we need more high quality randomized controlled trials (RCTs) to confirm these findings and evaluate the effectiveness of other PDE5 inhibitors.