Ejaculatory Dysfunction Caused by Alpha Blockers for the Treatment of Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Systematic Review and Network Meta-analysis

To provide a systematic review and network meta-analysis of randomized clinical trials focus on ejaculatory dysfunction (ED) rate of alpha blockers (ABs) for treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH), a systematic literature search was performed to identify all available published randomized controlled trial (RCTs) as regards ABs for the treatment in BPH patients. A systematic review and network meta-analysis was performed using ADDIS 1.16.5. 15. RCTs involving 22593 participants were included, comparing 2 selective ABs (silodosin and tamsulosin) and 2 unselective ABs (terazosin and doxazosin) with placebo. For the ejaculatory dysfunction rate, silodosin was higher than placebo (OR=70.31, 95% CI: 17.70 to 538.38), doxazosin (OR=52.82, 95% CI: 5.44 to 833.41) and terazosin (OR=40.14, 95% CI: 2.74 to 1362.98). And so was tamsulosin compared with placebo (OR=8.70, 95% CI: 2.36 to 59.61), doxazosin (OR=6.45, 95% CI: 0.81 to 83.43) and terazosin (OR=4.95, 95% CI: 0.35 to 164.75). No statistical differences were observed among doxazosin, terazosin and placebo (OR≈1). As such, the ranks of ejaculatory dysfunction rate were silodosin > tamsulosin > terazosin ≈ doxazosin ≈ placebo. The selective ABs were associated with higher risk of ejaculatory dysfunction while the unselective ABs have the same risk as placebo. When focusing on better sexual life, the unselective ABs like doxazosin and terazosin are better.