Interventions to treat premature ejaculation: a systematic review short report

摘要: BACKGROUND Premature ejaculation (PE) is commonly defined as with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it. PE can be either lifelong present since first experiences (primary), acquired (secondary), beginning later (Godpodinoff ML. ejaculation: clinical subgroups etiology. J Sex Marital Ther 1989;15:130-4). Treatments include behavioural pharmacological interventions. OBJECTIVE To systematically review evidence for effectiveness of behavioural, topical systemic treatments PE. DATA SOURCES The following databases were searched from inception to 6 August 2013 published unpublished research evidence: MEDLINE; EMBASE; Cumulative Index Nursing Allied Health Literature; Cochrane Library including Systematic Reviews Database, Controlled Trials Register, Database Abstracts Effects Technology Assessment database; ISI Web Science, Science Citation Index, Conference Proceedings Index-Science. US Food Drug Administration website European Medicines Agency (EMA) also searched. METHODS Randomised controlled trials (RCTs) in adult men eligible (or non-RCTs absence RCTs). RCT data extrapolated articles when available. primary outcome was intravaginal ejaculatory latency time (IELT). Data meta-analysed possible. Other outcomes included satisfaction, control over ejaculation, relationship self-esteem, quality life, treatment acceptability adverse events (AEs). RESULTS A total 103 studies (102 RCTs, 65 reviews) included. RCTs available all interventions except yoga. demonstrated significant improvements (p < 0.05) arithmetic mean difference IELT compared placebo: anaesthetics - eutectic mixture local (EMLA(®), AstraZeneca), (Plethora Solutions Ltd) spray; selective serotonin reuptake inhibitors (SSRIs) citalopram (Cipramil(®), Lundbeck), escitalopram (Cipralex(®), fluoxetine, paroxetine, sertraline, dapoxetine (Priligy(®), Menarini), 30 mg 60 mg; serotonin-noradrenaline duloxetine (Cymbalta(®), Eli Lilly & Co Ltd); tricyclic antidepressants inhaled clomipramine 4 mg; phosphodiesterase-5 (PDE5) vardenafil (Levitra(®), Bayer), tadalafil (Cialis(®), opioid analgesics tramadol (Zydol SR(®), Grunenthal). Improvements satisfaction other placebo evident SSRIs, PDE5 tramadol. Outcomes not follows: therapies wait list outcomes, therapy plus pharmacotherapy better than alone; alpha blockers terazosin (Hytrin(®), AMCO) significantly different control; acupuncture sham IELT, conflicting results comparisons SSRIs; Chinese medicine usual; delay device added stop-start technique; yoga improved baseline, fluoxetine Treatment-related AEs most LIMITATIONS Although extraction reviews optimised more one reported same RCT, reliability within these cannot guaranteed by this assessment report. CONCLUSIONS Several IELT. Many outcomes. However, longer-term safety required evaluate whether initial effects are maintained long term, dose escalation required, how soon end cessation stopped resumed at a time. In addition, associated long-term doses have differing AE profiles required. STUDY REGISTRATION This study registered PROSPERO CRD42013005289. FUNDING National Institute Research programme.