The Quality of Systematic Reviews and Meta-Analyses in Erectile Dysfunction Treatment and Management Published in the Sexual Medicine Literature

Daniel R Greenberg; Michael T Richardson; Jonathan D Tijerina; Michelle B Bass; Michael L Eisenberg

doi:10.1016/j.jsxm.2019.01.009

The Quality of Systematic Reviews and Meta-Analyses in Erectile Dysfunction Treatment and Management Published in the Sexual Medicine Literature

J Sex Med. 2019 Mar;16(3):394-401. doi: 10.1016/j.jsxm.2019.01.009. Epub 2019 Feb 14.

Authors

Daniel R Greenberg¹, Michael T Richardson², Jonathan D Tijerina², Michelle B Bass³, Michael L Eisenberg²

Affiliations

¹ Department of Urology, Stanford Hospital and Clinics, Stanford, CA, USA. Electronic address: dgreenberg@stanford.edu.
² Department of Urology, Stanford Hospital and Clinics, Stanford, CA, USA.
³ Lane Medical Library, Stanford University School of Medicine, Stanford, CA, USA.

PMID: 30773501
DOI: 10.1016/j.jsxm.2019.01.009

Abstract

Introduction: Erectile dysfunction (ED) is a common medical condition that requires high-quality evidence to guide clinical practice; however, systematic reviews (SRs) and meta-analyses (MAs) often vary in quality, raising concerns regarding the validity of their results.

Aim: To perform an objective analysis of SRs and MAs in ED treatment and management and to report on the quality of published literature.

Methods: A comprehensive search in PubMed/MEDLINE and EMBASE of 12 high-impact urology journals was used to identify relevant publications. 2 authors independently performed searches, screened citations for eligibility, extracted data for analysis, and graded methodologic quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) criteria.

Main outcome measures: The main outcome was AMSTAR score, which is a validated tool to evaluate the quality of SRs and MAs.

Results: 31 publications met inclusion criteria and were included in the analysis. The mean AMSTAR score (± SD) among all publications was 6.5 (±2.2) of 11, reflecting "fair to good" quality. 74.2% of systematic reviews and meta-analyses focused on pharmaceutical therapy for ED, with 51.6% studying the effect of phosphodiesterase-5 inhibitors. Only 1 SR/MA studied intracavernosal injection therapy and vacuum erection devices. No publications studied intraurethral injection therapy or implantable penile prostheses. Although not statistically significant, there has been a trend of increasing quality of SRs/MAs over time (P = .072).

Clinical implication: The methodologic quality of SRs/MAs should be assessed to ensure high-quality evidence for clinical practice guidelines in ED treatment and management.

Strength & limitation: The data showed that methodologic quality of SRs/MAs in the treatment and management of ED is increasing over time. 12 high-impact urology journals were included in our search, which may introduce selection bias in our results.

Conclusions: This review highlights a need for increased effort to study second- and third-line treatments for patients who fail oral therapy. Greenberg DR, Richardson MT, Tijerina JD, et al. The Quality of Systematic Reviews and Meta-Analyses in Erectile Dysfunction Treatment and Management Published in the Sexual Medicine Literature. J Sex Med 2019;16:394-401.

Keywords: AMSTAR; Erectile Dysfunction; Impotence; Quality; Systematic Reviews.

MeSH terms

Erectile Dysfunction / therapy*
Humans
Male
Meta-Analysis as Topic*
Penile Prosthesis
Systematic Reviews as Topic*
Urology