2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland.
Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital in Cracow, Cracow, Poland.
Obes Surg. 2023 Jun;33(6):1652-1658. doi: 10.1007/s11695-023-06572-9. Epub 2023 Apr 22.
Obesity is associated with a higher prevalence of various comorbidities including erectile dysfunction (ED). Bariatric surgery leads to weight loss and remission of weight-related diseases. The exact influence of bariatric treatment on ED is yet to be established; however, the number of papers on the subject is growing.
A systematic review with meta-analysis comparing erectile dysfunction before and after surgery was conducted according to PRISMA guidelines with a literature search performed in June 2022. Inclusion criteria involved (1) ED assessment using the International International Index of Erectile Function (IIEF) and (2) longitudinal study design. Secondary endpoints involved hormonal changes and specific fields of IIEF.
An initial search yielded 878 records. Fourteen studies were included in the meta-analysis involving 508 patients. The quality of analyzed studies was moderate. Analysis showed significant differences in IIEF before and after surgery (Std. MD = 1.19, 95% CI 0.72 to 1.66, p<0.0001). Testosterone after surgery is higher by 156.32 pg/ml (95% CI 84.78 to 227.86, p<0.0001). There were differences in erectile function (MD:4.86, p < 0.0001), desire (MD: 1.21, p < 0.0001), intercourse satisfaction (MD: 2.16, p < 0.0001), and overall satisfaction (MD: 1.21, p = 0.003). There were no differences in terms of orgasms (MD: 0.65, p = 0.06).
There are differences in ED before and after bariatric surgery. Patients achieve 19% more in the IIEF questionnaire showing improvement. Further studies, including multivariate regression models on large cohorts, are required to determine whether the surgery is an independent factor in alleviating ED.
肥胖与多种合并症的患病率较高相关，包括勃起功能障碍（ED）。减重手术可导致体重减轻和与体重相关疾病的缓解。减重治疗对 ED 的确切影响尚待确定；然而，关于这个主题的论文数量正在增加。
根据 PRISMA 指南进行了系统评价和荟萃分析，比较了手术前后的勃起功能障碍，并于 2022 年 6 月进行了文献检索。纳入标准包括：（1）使用国际勃起功能指数（IIEF）评估 ED；（2）纵向研究设计。次要终点包括激素变化和 IIEF 的特定领域。
初步搜索产生了 878 条记录。有 14 项研究被纳入荟萃分析，涉及 508 名患者。分析研究的质量为中等。分析显示手术前后 IIEF 有显著差异（Std. MD = 1.19，95% CI 0.72 至 1.66，p<0.0001）。手术后的睾丸激素高 156.32 pg/ml（95% CI 84.78 至 227.86，p<0.0001）。在勃起功能（MD：4.86，p < 0.0001）、欲望（MD：1.21，p < 0.0001）、性交满意度（MD：2.16，p < 0.0001）和整体满意度（MD：1.21，p = 0.003）方面存在差异。在射精方面没有差异（MD：0.65，p = 0.06）。
减重手术后 ED 存在差异。患者在 IIEF 问卷中获得了 19%的改善。需要进一步的研究，包括对大样本的多元回归模型，以确定手术是否是缓解 ED 的独立因素。
