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Among many potential explanations, the vasodilatory effect of PDE5i may have contributed to a lower surgical rate. This is the first study to explore this novel association. Future prospective studies are necessary to better define the utility of PDE5i in LSS. Prevalence of LDS for LSS was significantly lower in patients in the treatment group on PDE5i therapy compared to the control group. Among many potential explanations, the vasodilatory effect of PDE5i may have contributed to a lower surgical rate. This is the first study to explore