What are the effects and optimal frequency of administration of phosphodiesterase 5 inhibitors (PDE5Is) for men with postprostatectomy erectile dysfunction?

Abstract

For men with postprostatectomy erectile dysfunction, scheduled PDE5Is seem to have little to no effect on erectile function compared with no treatment or on‐demand PDE5Is. However, most evidence was of very low to low certainty, and the adverse event profile remains unclear.Compared with placebo or no treatment for men with postprostatectomy erectile dysfunction, scheduled PDE5Is appear to have little to no effect on short‐term (up to 11 months) self‐reported potency and erectile function but may result in fewer serious adverse events compared with placebo (23 vs 71 per 1000 men). However, researchers did not describe the nature of the serious adverse events, and the evidence for both these outcomes was low to very low, making it difficult to draw any conclusions. The only longer‐term outcomes (> 12 months) reported by the reviewers were sexual quality of life and treatment discontinuation; both appear to show little to no effect (moderate‐certainty evidence).Compared with on‐demand PDE5Is, reviewers found little to no difference with daily PDE5Is in the International Index of Erectile Function at short term (high‐certainty evidence) nor in sexual quality of life over the longer term (moderate‐certainty evidence). Daily PDE5Is appear to result in little to no difference in both short‐term and long‐term self‐reported potency, erectile function, treatment discontinuation, and serious adverse events, but the evidence for these outcomes was of very low to low certainty.