Impact of combination therapy 5-alpha reductase inhibitors (5-ARI) plus alpha-blockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/BPH: a systematic review with meta-analysis

Figures & data

Figure 1. Flowchart of included studies.

Table 1. Characteristics of RCTs included in this meta-analysis.

Paper	Design	Age	Treatments	Subjects	Sample size	Treatment duration (months)
Lepor et al. 1996	RCT	Finasteride: 65 ± 7 Terazosin: 65 ± 6 Combination: 65 ± 7	Terazosin 10 mg plus Finasteride 5 mg	IPSS of at least 8, a mean peak urinary flow rate ≤15 ml/s and no less than 4 ml/s, with a minimal voided volume of 125 ml, and a mean residual volume after voiding of less than 300 ml	1229	12
McConnell et al. 2003	RCT	62.6 ± 7.3	Doxazosin 4 mg plus Finasteride 5 mg	Men ≥50 years of age, an IPSS≥8 points, and Qmax >5 ml/s and ≥15 ml/s with a minimum voided volume≥125 ml	3042	12
Roerhborn et al. 2010	RCT	66.0 ± 7.05	Tamsulosin 0.4 mg plus Dutasteride 0.5 mg	Men ≥50 years of age with a BPH clinical diagnosis by medical history and physical examination, an IPSS ≥12 points, prostate volume ≥30 cm^3 by TRUS, total serum PSA ≥1.5 ng/ml, and Qmax > 5 ml/s and≥15 ml/s with a minimum voided volume≥125 ml	3221	48
Joo et al. 2012	RCT	Tamsulosin: 65.79 ± 8.87 Dutasteride + Tamsulosin: 65.85 ± 7.77	Tamsulosin 0.4 mg plus Dutasteride 0.5 mg	Age≥40 years; diagnosis of BPH; IPSS ≥13 points; maximal urinary flow rate (Qmax) of 4–15 ml/s in a total voided volume≥150 ml	193	12
Kirby et al. 2003	RCT	Doxazosin: 63 ± 7 Finasteride: 63 ± 7 Doxazosin + Finasteride: 64 ± 7	Doxazosin 4 mg plus Finasteride 5 mg	Aged 50–80 years with BPH and a total IPSS ≥12, Qmax ≥5 ml/s but ≤15 ml/s in a total voided volume of 150 ml or greater, and an enlarged prostate as determined by DRE.	1095	12

Figure 2. Forest plot comparing the risk of erectile dysfunction (a) and libido alterations (b) in RCT evaluating alpha-blockers versus combination therapy.

Figure 3. Forest plot comparing the risk of erectile dysfunction (a) and libido alterations (b) in RCT evaluating 5-ARI versus combination therapy.

Figure 4. Forest plot comparing the risk of erectile dysfunction (a) and libido alterations (b) in RCT evaluating alpha-blockers versus 5-ARI.