Prevalence and risk factors of erectile dysfunction in patients with liver cirrhosis: a systematic review and meta-analysis

Abstract

Background and aims Liver cirrhosis is associated with an increased risk of developing erectile dysfunction (ED). The aim of this systematic review and meta-analysis was to evaluate the prevalence of ED and its risk factors in male patients with liver cirrhosis. Methods A systematic search of PubMed (Medline), EMBASE, OVID Medline, the Cochrane Library, and other databases was performed for this review. Two investigators reviewed the abstracts obtained from the search and selected manuscripts for full-text review. The event rates were calculated with random-effects model and quality effects model. Results Fourteen studies evaluating ED with the International Index of Erectile Function (IIEF) scores were selected. A total of 770 patients with liver cirrhosis were analyzed. The prevalence of ED in cirrhotic patients was 79% [decompensated: 88.4%, CI 35.95-70.84%, I 2 heterogeneity 85%; compensated: 53.6%, CI 77.64-32%, I 2 heterogeneity 80%]. Through a metaregression analysis, we discovered that the presence of decompensation, use of beta-blocker and diuretics were related with ED. In addition, risk factors for ED included high body mass index [odds ratio (

Erectile dysfunction in patients with liver cirrhosis; upper Egypt experience

“…This result was agreed with Maimone et al who concluded that Patients with ED were signi cantly older than those without ED (p.value = 0.006) 13 The explanation for this result is morphologic and physiologic mechanisms that are involved in the aging process play a key role in the development of sexual dysfunction in the absence of any other clinical or medical condition. Also, a meta-analysis done by Yoo et al concluded that Patients with ED were 5.8 years older (p < 0.001) 14 .…”

The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

“…However, we want to emphasize that frequently sexual function and ED, in particular, are often poorly investigated, if not ignored, in the vast majority of cases. Some evidence indicates that an improvement of sexual function can ameliorate couple intimacy quality, and quality of life, as well as diseases-related distress [ 22 , 23 , 28 , 30 ].…”

“…Systemic diseases characterized by organ failure (such as end-stage renal diseases [22] and liver cirrhosis [23], as well as those conditions related to systemic inflammation such as HIV infection [24,25] or to some rheumatic and/or autoimmune diseases [26][27][28][29]) are frequently associated with ED, couple impairment and reduced quality of life. Similarly, considerations can be drawn for some malignancies with long life expectancy such as lymphomas and testis cancers [30].…”

Chronic liver diseases and erectile dysfunction

“…At present, some scholars consider that there is a correlation between cirrhosis and ED, which can be explained by haemodynamic alteration, hypogonadism, hypotestosteronemia, unhealthy lifestyle, and a lower quality of life. Through meta-analysis, Yoo et al (17) found that the prevalence of ED in cirrhotic patients was 79.08%, and in decompensated cirrhotic patients was 88.4%. After controlling for other conditions such as diabetes, alcoholism, severe cardiac conditions, etc., Paternostro et al (18) discovered that among male cirrhotic patients, 55% were categorized as mild-to-moderate ED and 8.3% as moderate-to-severe ED, and that with the decline of liver function, the severity of ED increased and the IIEF-5 score decreased significantly.…”

“…Bioavailable testosterone includes albumin-bound testosterone and free testosterone. According to a meta-analysis, free testosterone levels were significantly lower in ED patients than in the non-ED group (17). Patients with hepatic insufficiency frequently have higher levels of estrogen and lower levels of testosterone, which can result in an increase in the production of sex hormone-binding globulin through a negative feedback loop.…”