The authors1 present a meta-analysis concerning the efficacy and safety of phosphodiesterase-5 inhibitors for the treatment of erectile dysfunction secondary to spinal cord injury. From a methodological standpoint, the authors are congratulated for their brilliant work. The search strategy, the data extraction and the statistical analysis were performed exactly according to the current guidelines for this type of publication. As a reader, having to counsel my patients with spinal cord injury, however, this review is not of essential value to me. Questions my patients ask me are: what is the chance that I will get an erection if I take the drug? If my answer is: the odds ratio is 11.997, with a 95% confidence interval 8.073–17.830, those of my patients who happened not to be statisticians (the majority, to be frank) will not be able to deal with the answer. They will like a percentage, for example, 2/3 of the patients taking the drug have a satisfying erection. Next, they will ask me for the appropriate dosing and if it matters if they take the one or the other drug; the review does not mention any of these questions.

Please do not get me wrong: the authors did a good job and presented a solid meta-analysis. l congratulate them for their tedious and time-consuming work. The question to me is rather: are meta-analysis in the way we perform them now suitable to counsel our patients appropriately? Is evidence-based medicine, entirely based on thorough analysis of the existing data, the best method to deliver best patient care?

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