Promising selective alpha-1 blocker silodosin as a new therapeutic strategy for premature ejaculation and its drug adverse effect: A systematic review and meta-analysis of randomized controlled trials

Introduction and Objectives: Premature ejaculation (PE) occurs in 31% of productive men aged 18-59 years, leading to disappointment and avoidance of sexual relations. The current guideline of treatment for PE is Dapoxetine, which possesses several adverse effects causing the limitation of long-term use. Silodosin, an alpha-1 blocker, has been proposed as a new option for treating PE due to its minimal side effects. Therefore, our study aims to assess the efficacy of silodosin in treating PE.
Materials and Methods: This systematic review and meta-analysis was in accordance with Cochrane Handbook guidelines. Comprehensive literature search was conducted in several databases including PubMed, ScienceDirect, and Cochrane Central Register of Controlled Trials. The studies were included if they met the following criteria: (1) Involving premature ejaculation patients; (2) Intervention using silodosin; (3) Comparing placebo or other therapies for PE (4) Outcome includes the Intravaginal Ejaculation Latency Time (IELT) and reported adverse events related to the therapy. Study quality was assessed using Cochrane risk-of-bias criteria. Statistical analysis in this study was performed using Review Manager 5.4  
Results: A total of four studies were included in this meta-analysis. Our study showed that patients who received silodosin had a significantly longer IELT compared to control (MD: 132.54, 95% CI 51.51-213.57, p<0.001). However, patient treated with silodosin also possessed significantly higher risk of adverse event for developing reduced semen ejaculation (OR 10.79, 95% CI 3.46 – 33.67, p<0.0001).
Conclusion: Silodosin significantly increased IELT. However, it also reduced semen ejaculation as its drug adverse effect. This result supports the clinical use of silodosin as an alternative treatment for premature ejaculation.