Pilot Study of Sexual Dysfunction Following Abdominal Aortic Aneurysm Surgery

Abstract

Introduction The complication of sexual dysfunction as a quality of life (QoL) component after abdominal aortic aneurysm (AAA) surgery in men is poorly studied. Aims To investigate the prevalence of sexual dysfunction and to highlight the importance of discussing this issue with patients undergoing AAA repair. Main Outcome Measures The self-reported sexual dysfunction prevalence pre- and postoperatively, the effects on sexual QoL, and the postoperative Sexual Health Inventory for Men (SHIM) scores. Methods Between April 1999 and July 2002, a questionnaire-based study, including the SHIM, was conducted on male patients 1–2 years after their elective open (EO) and rupture open (RO) or endovascular repair (EVAR) AAA repair. Demographics, risk factors for sexual dysfunction, sexual history, and postoperative sexual QoL data were obtained. Results Out of 142 alive male patients surveyed, 56 (40%) patients responded (26 EO, 21 EVAR, and 9 RO repair). The mean age was 69, 73, and 70 years, respectively, and 65%, 66%, and 66%, respectively, admitted to be sexually active postoperatively. The self-reported sexual dysfunction prevalence preoperatively was 27% (EO), 63% (EVAR), and 45% (RO); and postoperatively was 58%, 76%, and 67%, respectively. Detection using SHIM was higher at 70%, 95%, and 78%, respectively. There was a significantly greater increase in the postoperative prevalence of sexual dysfunction in the EO group than in the EVAR group (P <0.05, χ2). The sexual QoL was worsened postoperatively in all groups: 53% (EO), 75% (EVAR), and 50% (RO); but only one-third of EO and EVAR patients, and none in RO patients, would seek treatment for their sexual dysfunction. Conclusion There was a negative impact on the sexual QoL in all groups after surgery, and a significantly higher proportion of patients experienced deterioration in sexual QoL following EO surgical repair. Our results demonstrate the need for a prospective study.

Prospective follow-up of sexual function after elective repair of abdominal aortic aneurysms using open and endovascular techniques

“…These findings were based on retrospective studies and can therefore only provide knowledge, which may be subject to question. 2,3,[4][5][6] The results of these studies may be challenged since they had a follow-up percentage of less than 50% of the included and participant patients.A prospective study from Netherlands showed that both EVAR and open elective AAA repair have an impact on sexual function in the early postoperative period but the recovery to the preoperative level was faster with EVAR than after OR. 7 Assessment of health related quality of life (HQOL) following AAA surgery has been examined for patients with AAA in several studies with different instruments such as SF-36 and Nottingham Health Profile (NHP).…”

“…These findings were based on retrospective studies and can therefore only provide knowledge, which may be subject to question. 2,3,[4][5][6] The results of these studies may be challenged since they had a follow-up percentage of less than 50% of the included and participant patients.…”

“…It is, however, a theoretical possibility present with both open and endovascular procedures. Jimenez et al 4 found in a review of articles from MEDLINE that the incidence of sexual dysfunction is lower overall in patients operated upon with EVAR. These findings were based on retrospective studies and can therefore only provide knowledge, which may be subject to question.…”

Use of Internal Endoconduits as an Adjunct to Endovascular Aneurysm Repair in the Setting of Challenging Aortoiliac Anatomy

“…While the significance of acutely covering the hypogastric arteries for pelvic ischemia has not been clearly elucidated in the literature, complications of this have been reported to be as high as 40% or 50% in some series 8,9. Sexual complications as a result of aneurysm repair, characterized by erectile dysfunction or ejaculatory failure, have been described in both open repair and EVAR, with a significantly greater incidence among patients who have open repair 10,11. With regard to EVAR, sexual dysfunction has been attributed to poor pelvic perfusion as a result of hypogastric artery occlusion, primarily in cases where an associated iliac aneurysm necessitates coverage of a patent hypogatric artery 10,11.…”

“…Sexual complications as a result of aneurysm repair, characterized by erectile dysfunction or ejaculatory failure, have been described in both open repair and EVAR, with a significantly greater incidence among patients who have open repair 10,11. With regard to EVAR, sexual dysfunction has been attributed to poor pelvic perfusion as a result of hypogastric artery occlusion, primarily in cases where an associated iliac aneurysm necessitates coverage of a patent hypogatric artery 10,11. Given this, however, some studies have concluded that acute coverage of one or both hypogastric arteries in the course of EVAR results in a negligible number of complications related to pelvic ischemia 12.…”