Sexual dysfunction in subjects treated with inhibitors of 5α‐reductase for benign prostatic hyperplasia: a comprehensive review and meta‐analysis

G. Corona; G. Tirabassi; D. Santi; E. Maseroli; M. Gacci; M. Dicuio; A. Sforza; E. Mannucci; M. Maggi

doi:10.1111/andr.12353

journal article Apr 28, 2017

Sexual dysfunction in subjects treated with inhibitors of 5α‐reductase for benign prostatic hyperplasia: a comprehensive review and meta‐analysis

G. Corona

G. Tirabassi

D. Santi E. Maseroli M. Gacci M. Dicuio A. Sforza E. Mannucci M. Maggi

Andrology Vol. 5 No. 4 pp. 671-678 · Wiley

View at Publisher Save 10.1111/andr.12353

Abstract

SummaryDespite their efficacy in the treatment of benign prostatic hyperplasia, the popularity of inhibitors of 5α‐reductase (5ARIs) is limited by their association with adverse sexual side effects. The aim of this study was to review and meta‐analyze currently available randomized clinical trials evaluating the rate of sexual side effects in men treated with 5ARIs. An extensive Medline Embase and Cochrane search was performed including the following words: ‘finasteride’, ‘dutasteride’, ‘benign prostatic hyperplasia’. Only placebo‐controlled randomized clinical trials evaluating the effect of 5ARIin subjects with benign prostatic hyperplasia were considered. Of 383 retrieved articles, 17 were included in this study. Randomized clinical trials enrolled 24,463 in the active and 22,270 patients in the placebo arms, respectively, with a mean follow‐up of 99 weeks and mean age of 64.0 years. No difference was observed between trials using finasteride or dutasteride as the active arm considering age, trial duration, prostate volume or International Prostatic Symptoms Score at enrollment. Overall, 5ARIs determined an increased risk of hypoactive sexual desire [OR = 1.54 (1.29; 1.82);p < 0.0001] and erectile dysfunction [OR = 1.47 (1.29; 1.68);p < 0.0001]. No difference between finasteride and dutasteride regarding the risk of hypoactive sexual desire and erectile dysfunction was observed. Meta‐regression analysis showed that the risk of hypoactive sexual desire and erectile dysfunction was higher in subjects with lowerQmaxat enrollment and decreased as a function of trial follow‐up. Conversely, no effect of age, low urinary tract symptom or prostate volume at enrollment as well asQmaxat end‐point was observed. In conclusion, present data show that the use of 5ARIsignificantly increases the risk of erectile dysfunction and hypoactive sexual desire in subjects with benign prostatic hyperplasia. Patients should be adequately informed before 5ARIs are prescribed.

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Details

Published: Apr 28, 2017
Vol/Issue: 5(4)
Pages: 671-678
License: View

Authors

G

G. Corona

Endocrinology Unit Maggiore‐Bellaria Hospital Medical Department Azienda‐Usl Bologna Bologna Italy

G

G. Tirabassi

Division of Endocrinology Department of Clinical and Molecular Sciences Umberto I Hospital Polytechnic University of Marche Ancona Italy

D

D. Santi

Unit of Endocrinology & Metabolism Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy

E

E. Maseroli

Sexual Medicine and Andrology Unit Department of Experimental, Clinical and Biomedical Sciences University of Florence Florence Italy

M

M. Gacci

Department of Urology University of Florence Florence Italy

M

M. Dicuio

Urology Unit Maggiore‐Bellaria Hospital Surgical Department Azienda‐Usl Bologna Bologna Italy; Department of Urology Sahlgrenska University Hospital Göteborg Sweden

A

A. Sforza

Endocrinology Unit Maggiore‐Bellaria Hospital Medical Department Azienda‐Usl Bologna Bologna Italy

E

E. Mannucci

Diabetology Careggi Teaching Hospital Florence Italy

M

M. Maggi

Sexual Medicine and Andrology Unit Department of Experimental, Clinical and Biomedical Sciences University of Florence Florence Italy

Cite This Article

G. Corona, G. Tirabassi, D. Santi, et al. (2017). Sexual dysfunction in subjects treated with inhibitors of 5α‐reductase for benign prostatic hyperplasia: a comprehensive review and meta‐analysis. Andrology, 5(4), 671-678. https://doi.org/10.1111/andr.12353

Sexual dysfunction in subjects treated with inhibitors of 5α‐reductase for benign prostatic hyperplasia: a comprehensive review and meta‐analysis

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