Long-Term Phosphodiesterase Type 5 (PDE5) Inhibitor Therapy and Serum Uric Acid Levels in Men With Erectile Dysfunction: A Retrospective Analysis

Background: Serum uric acid (UA) is linked to metabolic dysfunction and endothelial impairment, both of which play a role in erectile dysfunction (ED).Phosphodiesterase type 5 inhibitors (PDE5is) are first-line therapy for ED; however, their effect on UA metabolism remains unclear.This study evaluated changes in serum UA levels in men with ED receiving long-term PDE5i therapy and explored clinical factors associated with UA.Methods: We retrospectively reviewed the medical records of men with ED receiving PDE5i therapy at a tertiary care center.Patients with endocrine disorders, conditions affecting UA metabolism, recent infections, or use of medications influencing sex steroid levels were excluded.Demographic characteristics, body mass index (BMI), comorbidities, and laboratory parameters -including serum UA, lipid profile, fasting glucose, HbA1c, vitamin D, and total testosterone -were collected.Pre-and post-treatment UA measurements were summarized, and associations between baseline UA and clinical variables were assessed using Pearson and Spearman correlation coefficients.Results: Mean age was 59.4 ± 9.4 years, and mean BMI was 30.1 ± 5.0 kg/m².Mean serum UA decreased from 360.8 ± 79.3 µmol/L before treatment to 352.8 ± 77.7 µmol/L after treatment, corresponding to a mean change of -8.1 µmol/L and a median paired change of -1.0 µmol/L.Baseline UA correlated positively with BMI (Pearson r = 0.253; Spearman ρ = 0.293) and age (Pearson r = 0.335; Spearman ρ = 0.346).Conclusions: Long-term PDE5i therapy does not significantly affect serum UA levels in men with ED.BMI emerged as the primary determinant of UA, highlighting the close relationship between obesity, hyperuricemia, and metabolic dysfunction.Serum UA appears to reflect systemic metabolic and vascular health rather than a treatment-responsive marker in men receiving PDE5 inhibitors.These findings do not denote a causal relationship but instead underscore the importance of addressing metabolic risk factors as part of comprehensive ED management.