Erectile Dysfunction: An Umbrella Review of Meta-Analyses of Risk-Factors, Treatment, and Prevalence Outcomes

Abstract

Introduction Erectile dysfunction (ED) is a major health care problem that has implications for quality of life. Aim This umbrella review sought to synthesize all meta-analytic research on risk factors, treatment, and prevalence of ED. Methods 8 electronic databases were searched for relevant meta-analyses in June 2018. The evidence was graded with 2 measures that use quantitative criteria to establish the quality of report writing and confidence in the effect size reported. Main Outcome Measures Lifestyle factors, genetic markers, medical conditions, treatments. Results In total, 98 meta-analyses were identified that included 421 meta-analytic effects, 4,188 primary-effects, and 3,971,122 participants. Pooled estimates showed that an unhealthy lifestyle, genetic markers, and medical conditions were associated with an increased risk of ED. Testosterone therapy and phosphodiesterase type 5 inhibitors showed the greatest treatment efficacy, with mild adverse events observed across treatments. Psychological and behavior change interventions produced effect sizes that were comparable to medication but had greater imprecision in effect sizes. There was little evidence that combined treatments were more efficacious than single treatments. Meta-analyses of prevalence estimates showed consistent age trends but were limited to particular regions or clinical samples, meaning that global estimates of ED are difficult to determine. Clinical Implications The umbrella review synthesized findings for many treatment options that might aid evidence-based clinical decision-making. Based on prevalence estimates, we recommend that primary care physicians take a proactive approach and enquire about erectile problems in all men over age 40 displaying any health-related issue (eg, overweight, cigarette smoking). Strengths & Limitations Strengths include the calculation and comparison of summary estimates across multiple meta-analyses. Limitations include heterogeneity in research quality across research themes limiting effect size comparisons. Conclusion The review provides summary estimates for 37 risk factors and 28 treatments. Meta-analyses of risk factors often did not control for important confounders, and meta-analyses of randomized trials were not exclusive to double-blinded trials, active placebo controls, or tests of long-term effects. We recommend further meta-analyses that eliminate lower quality studies and further primary research on behavioral and combined treatments.

SHBG levels in primary infertile men: a critical interpretation in clinical practice

“…Testosterone plays a pivotal role in overall men’s health ( 1 ), therefore the identification and management of hypogonadal individuals is crucial in clinical practice. This is particularly relevant in patients at higher risk of hypogonadism and when the restoration of physiological testosterone levels might have important clinical and prognostic rebounds, such as in infertile men and in those with sexual dysfunction ( 30 , 31 ).…”

Peyronie’s disease: Contemporary evaluation and management

“…hypertension, hyperlipidemia, diabetes, tobacco use etc. ), or in those with severe ventral curvature as a result of the significant risk for postoperative ED posed by ventral grafting, as previously noted 26,110,128 …”

“…If symptoms of hypogonadism are present, an early morning total testosterone is recommended 25 . Fasting serum glucose, hemoglobin A1c, complete blood count and lipid panel might be considered to identify underlying ED risk factors 26 . In those endorsing penile sensitivity or risk factors for neuropathy (e.g.…”

“…Penile prosthesis placement with straightening maneuvers allows for satisfactory penile straightening along with reliable penile rigidity 26,109 . Prosthesis placement might also be considered in men with more severe penile curvature (>60–70°, significant indentation deformity resulting in hinge effect) who would otherwise be candidates for grafting procedures, but have significant baseline medical comorbidities known to increase their risk for developing ED over time (i.e.…”

Practical Approaches to Treat ED in PDE5i Nonresponders

“…Erectile dysfunction (ED) is a common sexual disorder in adult males and has significant biological, psychological and social effects on the quality of life (QOL) of men with ED and their sexual partners or spouses [1][2]. Indeed, the high prevalence of ED has become a global health concern [3].…”