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首页> 外文期刊>The journal of sexual medicine >Does Current Scientific and Clinical Evidence Support the Use of Phosphodiesterase Type 5 Inhibitors for the Treatment of Premature Ejaculation? A Systematic Review and Meta-analysis
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Does Current Scientific and Clinical Evidence Support the Use of Phosphodiesterase Type 5 Inhibitors for the Treatment of Premature Ejaculation? A Systematic Review and Meta-analysis

机译：当前的科学和临床证据是否支持使用磷酸二酯酶5型抑制剂来治疗早泄？系统评价和荟萃分析

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Introduction. Premature ejaculation (PE) is a highly prevalent and complex syndrome that remains poorly defined and inadequately characterized. Pharmacotherapy represents the current basis of lifelong PE treatment. Aim. The goal of this study was to assess the role of phosphodiesterase type 5 inhibitors (PDE5-Is) in the treatment of patients with PE without associated erectile dysfunction (ED). Main Outcome Measure. The posttreatment intravaginal ejaculatory latency time was used as the primary end point of efficacy. Methods. A systematic review of the literature was performed by electronically searching the MedLine database for peer-reviewed articles regarding the mechanism of action and the clinical trials of PDE5 in the management of PE. A meta-analysis of these clinical studies was performed to pool the efficacy. Results. Twenty-nine articles that examined the supposed mechanisms of action and 14 articles that reported data from clinical studies were reviewed. The PDE5 may exert their influence by increasing the levels of nitric oxide both centrally (reducing sympathetic drive) and peripherally (leading to smooth-muscle dilatation of the seminal tract). These drugs may also induce peripheral analgesia to prolong the duration of the erection, increase confidence, improve the perception of ejaculatory control and overall sexual satisfaction, and decrease the postorgasmic refractory time for achieving a second erection after ejaculation. Concerning the efficacy, the meta-analysis shows an overall positive effect for the use of PDE5 as monotherapy or as components of a combination regimen in the treatment of PE. The major limitations of the published literature included poor study design, the absence of solid methodology, which was characterized by the lack of a unique PE definition, and the lack of appropriate endpoints for outcome evaluation of a placebo control arm and of Institutional Review Board approval. Conclusion. There is inadequate, partial basic, and clinical evidence to support the use of PDE5 for the treatment of PE.
机译：介绍。早泄（PE）是一种高度流行和复杂的综合症，仍然定义不清且特征不充分。药物疗法代表了终身PE治疗的当前基础。目标。这项研究的目的是评估5型磷酸二酯酶抑制剂（PDE5-Is）在治疗无相关勃起功能障碍（ED）的PE患者中的作用。主要结果指标。治疗后阴道内射精潜伏时间被用作疗效的主要终点。方法。通过电子检索MedLine数据库中有关PDE5在PE管理中的作用机理和临床试验的同行评审文章，对文献进行了系统的综述。对这些临床研究进行了荟萃分析，以汇总疗效。结果。审查了29篇文章，研究了假定的作用机制，并审查了14篇报道临床研究数据的文章。 PDE5可能通过在中央（减少交感神经驱动力）和周围（导致精液平滑肌扩张）增加一氧化氮的水平发挥作用。这些药物还可以诱导外周镇痛，以延长勃起的持续时间，增加自信心，改善射精控制的感觉和总体性满足感，并减少性高潮后的难治时间，以实现射精后的第二次勃起。关于功效，荟萃分析显示将PDE5用作PE的单一疗法或作为联合治疗方案的组成部分具有总体积极作用。已发表文献的主要限制包括不良的研究设计，缺乏可靠的方法学（其特点是缺乏独特的PE定义，缺乏适当的终点用于安慰剂对照组的评估和机构审查委员会的批准） 。结论。没有足够的，部分的基础和临床证据支持PDE5用于治疗PE。

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