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American Journal of Men's Health 2020The purpose of this analysis is to assess the efficacy and safety of phosphodiesterase-5 inhibitors (PDE5Is) for the treatment of premature ejaculation (PE). A... (Meta-Analysis)
Meta-Analysis
The purpose of this analysis is to assess the efficacy and safety of phosphodiesterase-5 inhibitors (PDE5Is) for the treatment of premature ejaculation (PE). A comprehensive search was performed to ascertain from trials about PDE5Is for the treatment of PE and compare the results, including intravaginal ejaculatory latency time (IVELT), score of sexual satisfaction scale, and side effects, between the group treated with PDE5Is and that treated with placebo. Seven studies involving a total of 471 patients were included in this meta-analysis. This analysis showed that patients who were treated with PDE5Is had significantly increased IVELT (mean difference [MD] 2.60; 95% CI [1.85, 3.36]; < .00001) and score of sexual satisfaction scale (MD 2.04; 95% CI [0.78, 3.30]; = .002) compared with the group on placebo. More patients had side effects while taking PDE5Is, such as headache, dizziness, flushing, and nasal congestion. PDE5Is were significantly more effective than placebo in the treatment of PE. Side effects were more common among patients who were treated with PDE5Is.
Topics: Humans; Male; Phosphodiesterase 5 Inhibitors; Placebo Effect; Premature Ejaculation
PubMed: 32375542
DOI: 10.1177/1557988320916406 -
Urology Apr 2013To evaluate the efficacy and safety of topical anesthetic agents for patients with premature ejaculation (PE). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the efficacy and safety of topical anesthetic agents for patients with premature ejaculation (PE).
METHODS
Eligible randomized controlled trials (RCTs) were identified from electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) without language restrictions. The database search, quality assessment, and data extraction were performed independently by 2 reviewers. The main outcome for the efficacy of topical anesthetic agents was intravaginal ejaculatory latency time (IELT). Efficacy and safety were explored using Review Manager, version 5.1.0 (Cochrane Collaboration, Oxford, UK).
RESULTS
Eight trials met the inclusion criteria. Our pooled analysis showed that IELT in the topical anesthetic agent group was significantly improved compared to the placebo group (random-effect model; mean difference [MD] 5.82, 95% confidence interval [CI] 3.50-8.14, P <.00001). According to the subgroup analysis, a significant improvement was obtained in the domains of ejaculatory control, sexual satisfaction, and distress in the Index of Premature Ejaculation (IPE) questionnaire (random-effect model, MD 4.53, 95% CI 3.05-6.01, P <.00001). In terms of adverse events (AEs), the pooling outcome showed that the overall incidence of AEs was significantly higher in the topical anesthetic agent group than in the placebo group (random-effect model, relative risk [RR] 4.28, 95% CI 1.63-11.24, P = .003). However, nearly all of the AEs were mild and transient.
CONCLUSION
Topical anesthetic agents have been shown to be effective and well tolerated for patients with primary PE, providing a significant improvement in IELT with a higher incidence of AEs that were not long-lasting or severe. High-quality RCTs are necessary to confirm the efficacy and safety of topical anesthetics for PE.
Topics: Anesthetics, Local; Humans; Male; Premature Ejaculation; Randomized Controlled Trials as Topic
PubMed: 23434101
DOI: 10.1016/j.urology.2012.12.028 -
Urology Sep 2012To present a systematic review to assess efficacy and safety of tramadol for premature ejaculation. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To present a systematic review to assess efficacy and safety of tramadol for premature ejaculation.
METHODS
A literature search was performed using the Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded. Literature reviewed included meta-analyses and randomized and nonrandomized prospective studies. End points included intravaginal ejaculation latency time (in minutes), adverse events, and patient-reported outcome assessments. We used mean difference to measure intravaginal ejaculation latency time and odds ratio to measure adverse events rates. These odds ratios were pooled using a random or fixed effects model and were tested for heterogeneity. We used the Cochrane Collaboration's Review manager (RevMan) 5.1 software for statistical analysis.
RESULTS
We identified 7 publications that strictly met our eligibility criteria. Meta-analysis of extractable data showed that tramadol was associated with a 3-minute intravaginal ejaculation latency time increasing (mean difference 2.77 minutes; 95% CI 1.12-4.47; P = .001) and significantly more patients with adverse events rates compared with placebo (odds ratio 2.89; 95% CI 1.88-4.43; P < .0001). There were no differences between the tramadol and the paroxetine of intravaginal ejaculation latency time (mean difference -0.44; 95% CI -5.07 to 4.18; P = .85). In addition, patients saw significantly greater improvement in patient-reported outcome.
CONCLUSION
In this diverse population, tramadol is an effective and safety pharmacologic therapy for premature ejaculation.
Topics: Ejaculation; Humans; Male; Sexual Dysfunction, Physiological; Tramadol
PubMed: 22840860
DOI: 10.1016/j.urology.2012.05.035 -
Sexual Medicine Feb 2021Clomipramine is effective in treating premature ejaculation, a common form of male sexual dysfunction that affects individual's mental health and quality of life, but... (Review)
Review
INTRODUCTION
Clomipramine is effective in treating premature ejaculation, a common form of male sexual dysfunction that affects individual's mental health and quality of life, but its optimal dosage remains controversial.
AIM
In this systematic review and meta-analysis, we aimed to evaluate the efficacy, safety, and optimal dose of clomipramine for treating premature ejaculation among men.
METHODS
Eligible studies of PubMed, Embase, and Web of Science were identified from the date of inception to June 21, 2020. We conducted the study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data of the study characteristics, intravaginal latency ejaculatory time (IELT), adverse events, success rate, and satisfaction rate of clomipramine vs placebo were extracted and analyzed. The risk ratio and mean difference were used for quantitatively analyzing binary outcomes and continuous outcomes. The standardized mean difference was applied to the outcome of satisfaction rate. The Mantel-Haenszel method was used for meta-analysis under random-effects model. To assess dose effect of clomipramine, a meta-regression analysis was performed.
MAIN OUTCOME MEASURES
The primary outcomes were the IELT and adverse events, and the secondary outcomes were the success rate and satisfaction rate of clomipramine treatment relative to the placebo.
RESULTS
A total 14 randomized controlled trials with 710 patients were included for quantitative analysis. Clomipramine significantly increased the IELT compared with the placebo (mean difference: 1.47, 95% CI: 0.73-2.21). However, clomipramine was associated with higher risks of overall adverse events and adverse events in the nervous and respiratory systems. Significant dosage effects on the IELT (estimate: 0.0637, 95% CI: 0.0074-0.12) and a slightly increasing slope on adverse events were revealed.
CONCLUSION
Clomipramine increased the IELT and yielded greater satisfaction than the placebo, and the higher dose results in a superior IELT without leading to higher risk of adverse events under a dosage of 50-mg clomipramine. Wu P-C, Hung C-S, Kang Y-N, et al. Tolerability and Optimal Therapeutic Dosage of Clomipramine for Premature Ejaculation: A Systematic Review and Meta-Analysis. Sex Med 2021;9:100283.
PubMed: 33291044
DOI: 10.1016/j.esxm.2020.10.011 -
Medicine May 2019Premature ejaculation is a form of male sexual dysfunction. As people's lifestyle changes and the population ages, the incidence of premature ejaculation continues to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Premature ejaculation is a form of male sexual dysfunction. As people's lifestyle changes and the population ages, the incidence of premature ejaculation continues to increase. Many clinical trials have proven that Chinese medicine has a significant effect in the treatment of premature ejaculation. In this systematic review, we aim to evaluate the effectiveness and safety of Traditional Chinese medicine for premature ejaculation.
METHODS
We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to April 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of premature ejaculation.
ETHICS AND DISSEMINATION
This systematic review will evaluate the efficacy and safety of Traditional Chinese medicine for treating premature ejaculation. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.
TRIAL REGISTRATION NUMBER
PROSPERO CRD42017065316.
Topics: China; Drugs, Chinese Herbal; Humans; Male; Medicine, Chinese Traditional; Premature Ejaculation; Randomized Controlled Trials as Topic; Recurrence; Research Design
PubMed: 31045785
DOI: 10.1097/MD.0000000000015379 -
European Urology Focus Feb 2017Phosphodiesterase type 5 inhibitors (PDE5-Is) are prescribed off-label for the treatment of premature ejaculation (PE). (Meta-Analysis)
Meta-Analysis
CONTEXT
Phosphodiesterase type 5 inhibitors (PDE5-Is) are prescribed off-label for the treatment of premature ejaculation (PE).
OBJECTIVE
To systematically review the evidence from randomised controlled trials (RCTs) for PDE5-Is in the management of PE.
EVIDENCE ACQUISITION
Medline and other databases were searched through September 2015. Quality of RCTs was assessed. Intravaginal ejaculatory latency time (IELT) data were pooled in a meta-analysis. Heterogeneity was assessed.
EVIDENCE SYNTHESIS
Fifteen RCTs were included. The majority were of unclear methodological quality. Pooled IELT evidence suggests that PDE5-Is are significantly more effective than placebo (231 participants, p<0.00001), that there is no difference between PDE5-Is and selective serotonin reuptake inhibitors (SSRIs; 405 participants, p=0.50), and that PDE5-Is combined with an SSRI are significantly more effective than SSRIs alone (521 participants, p=0.001); however, high levels of statistical heterogeneity are evident (I ≥ 40%). Single-RCT evidence suggests that sildenafil is significantly more effective than the squeeze technique, but both lidocaine gel and tramadol are significantly more effective than sildenafil. Sildenafil combined with behavioural therapy is significantly more effective than behavioural therapy alone. Sexual satisfaction and ejaculatory control appear to be better with PDE5-Is compared with placebo and with PDE5-Is combined with an SSRI compared with an SSRI alone. Adverse events are reported with both PDE5-Is and other agents.
CONCLUSIONS
PDE5-Is are significantly more effective than placebo and PDE5-Is combined with an SSRI are significantly more effective than SSRIs alone at increasing IELT and improving other effectiveness outcomes; however, heterogeneity is evident across RCTs. The methodological quality of the majority of RCTs is unclear.
PATIENT SUMMARY
We reviewed phosphodiesterase type 5 inhibitors (PDE5-Is) for treating premature ejaculation. We found evidence to suggest that PDE5-Is are effective compared with placebo and that PDE5-Is combined with an SSRI are more effective than an SSRI alone. Adverse events are reported with PDE5-Is and other agents; however, the quality of the evidence is uncertain.
TRIAL REGISTRATION
PROSPERO registration number CRD42013005289.
Topics: Drug Therapy, Combination; Humans; Male; Phosphodiesterase 5 Inhibitors; Premature Ejaculation; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors
PubMed: 28720356
DOI: 10.1016/j.euf.2016.02.001 -
Sexual Health Aug 2019We conducted a systematic review and meta-analysis of published randomised controlled trials of dapoxetine for premature ejaculation. We systematically searched Embase,... (Meta-Analysis)
Meta-Analysis
We conducted a systematic review and meta-analysis of published randomised controlled trials of dapoxetine for premature ejaculation. We systematically searched Embase, PubMed, Cochrane, Web of Knowledge, FDA.gov and Clinical Trials.gov for studies reporting dapoxetine in men with premature ejaculation. Efficacy endpoints included intravaginal ejaculatory latency times (IELT), personal distress related to ejaculation (PDRE) and treatment-emergent adverse events (TEAEs) was used to evaluate safety. Data were analysed using a random-effects model. Electronic search identified 276 papers. The final analysis included eight papers (n = 8422 subjects). Analysis of the pooled results indicated efficacy in both IELT (weighted mean difference (WMD) = 1.67, 95% confidence interval (CI) 1.45-1.89) and PDRE (relative risk = 1.26, 95% CI 1.18-1.35). Subgroup analysis indicated efficacy (i.e. increase in IELT) for 30- and 60-mg on-demand dapoxetine (WMD 1.38 (95% CI 1.01-1.75) and 1.62 (95% CI 1.40-1.84) respectively), as well as daily use of 60 mg dapoxetine (WMD 2.18, 95% CI 1.71-2.64). The safety profile was acceptable. Based on the different effects of magnitude of the three dosing regimens, we recommend a stepwise approach, starting with 30 mg on demand, then 60 mg on demand and finally 60 mg dapoxetine daily.
Topics: Benzylamines; Diarrhea; Dizziness; Headache; Humans; Male; Naphthalenes; Nasopharyngitis; Nausea; Premature Ejaculation; Psychological Distress; Selective Serotonin Reuptake Inhibitors; Time Factors; Treatment Outcome
PubMed: 32172793
DOI: 10.1071/SH18005 -
Sexual Medicine Sep 2015Premature ejaculation (PE) is defined by short ejaculatory latency and inability to delay ejaculation causing distress. Management may involve behavioral and/or... (Review)
Review
INTRODUCTION
Premature ejaculation (PE) is defined by short ejaculatory latency and inability to delay ejaculation causing distress. Management may involve behavioral and/or pharmacological approaches.
AIM
To systematically review the randomized controlled trial (RCT) evidence for behavioral therapies in the management of PE.
METHODS
Nine databases including MEDLINE were searched up to August 2014. Included RCTs compared behavioral therapy against waitlist control or another therapy, or behavioral plus drug therapy against drug treatment alone. [Correction added on 10 September 2015, after first online publication: Search period has been amended from August 2013 to August 2014.].
MAIN OUTCOME MEASURE
Intravaginal ejaculatory latency time (IELT), sexual satisfaction, ejaculatory control, and anxiety and adverse effects.
RESULTS
Ten RCTs (521 participants) were included. Overall risk of bias was unclear. All studies assessed physical techniques, including squeeze and stop-start, sensate focus, stimulation device, and pelvic floor rehabilitation. Only one RCT included a psychotherapeutic approach (combined with stop-start and drug treatment). Four trials compared behavioral therapies against waitlist control, of which two (involving squeeze, stop-start, and sensate focus) reported IELT differences of 7-9 minutes, whereas two (web-based sensate focus, stimulation device) reported no difference in ejaculatory latency posttreatment. For other outcomes (sexual satisfaction, desire, and self-confidence), some waitlist comparisons significantly favored behavioral therapy, whereas others were not significant. Three trials favored combined behavioral and drug treatment over drug treatment alone, with small but significant differences in IELT (0.5-1 minute) and significantly better results on other outcomes (sexual satisfaction, ejaculatory control, and anxiety). Direct comparisons of behavioral therapy vs. drug treatment gave mixed results, mostly either favoring drug treatment or showing no significant difference. No adverse effects were reported, though safety data were limited.
CONCLUSIONS
There is limited evidence that physical behavioral techniques for PE improve IELT and other outcomes over waitlist and that behavioral therapies combined with drug treatments give better outcomes than drug treatments alone. Further RCTs are required to assess psychotherapeutic approaches to PE.
PubMed: 26468381
DOI: 10.1002/sm2.65 -
World Journal of Urology Dec 2017To clarify the efficacy of phosphodiesterase-5 inhibitors (PDE5Is) and selective serotonin reuptake inhibitors (SSRIs) in men with premature ejaculation (PE). (Review)
Review
PURPOSE
To clarify the efficacy of phosphodiesterase-5 inhibitors (PDE5Is) and selective serotonin reuptake inhibitors (SSRIs) in men with premature ejaculation (PE).
METHODS
We searched the PubMed, Embase, and Cochrane Library databases to identify all randomized, controlled trials (RCTs) and compared the results, including intravaginal ejaculation latency time, satisfaction, intercourse per-week and side effects after treatment with PDE5I or SSRIs versus placebo, combined use of PDE5I with SSRIs versus PDE5I or SSRIs alone, and PDE5I versus SSRIs for treating PE.
RESULTS
The study inclusion criteria were met by 23 studies (ten RCTs with five crossover studies) involving 6145 patients. The data synthesized from these studies indicated that the efficacy of PDE5Is and SSRIs was better than that of placebo (p < 0.00001; p < 0.00001); however, more patients had side effects while taking PDE5Is and SSRIs (p < 0.00001; p < 0.00001). The efficacy of the combined treatment was significantly better than that of PDE5Is or SSRIs alone (p < 0.00001; p < 0.00001); however, more patients had side effects from the combined treatment than from SSRIs (p = 0.0002), with no significant difference in PDE5Is (p = 0.5). The efficacy of PDE5Is was better than that of SSRIs (p = 0.006), and no significant difference was observed in the frequency of side effects (p = 0.93).
CONCLUSIONS
PDE5Is were significantly more effective than placebo or SSRIs for treating PE, while SSRIs were better than placebo. The combined treatment had better efficacy than PDE5Is or SSRIs alone.
Topics: Humans; Male; Phosphodiesterase 5 Inhibitors; Premature Ejaculation; Selective Serotonin Reuptake Inhibitors; Treatment Outcome
PubMed: 28913588
DOI: 10.1007/s00345-017-2086-5 -
Asian Journal of Andrology Jul 2013To assess the efficacy and safety of local anaesthetics for premature ejaculation (PE), a systematic review of the literature was performed using the Cochrane Library,... (Meta-Analysis)
Meta-Analysis Review
To assess the efficacy and safety of local anaesthetics for premature ejaculation (PE), a systematic review of the literature was performed using the Cochrane Library, PUBMED and EMBASE. We screened and retrieved the randomized controlled trials on the treatment of PE with local anaesthetics. End points included intravaginal ejaculation latency time (IELT), patient-reported outcome assessments and adverse events. Meta-analyses were conducted with Stata 11.0. In total, seven publications involving 566 patients with local anaesthetics and 388 with placebos strictly met our eligibility criteria. Meta-analyses showed that after the patients were treated with the local anaesthetics, the value of the standardized mean difference of the changes in IELT was 5.02 (95% CI: 3.03-7.00). A higher rate of adverse events occurred compared with placebos (odds ratio: 3.30, 95% CI: 1.71-6.36), but these events were restricted to local side effects. In addition, significantly greater improvement was observed in patient-reported outcomes. In summary, local anaesthetics can prolong IELT and improve ejaculatory control and sexual satisfaction.
Topics: Anesthetics, Local; Humans; Male; Premature Ejaculation; Randomized Controlled Trials as Topic
PubMed: 23708465
DOI: 10.1038/aja.2012.174