Obezite cerrahisinin erkeklerde cinsel yaşam, depresyon ve yaşam kalitesi üzerine olan etkileri

Abstract

Amaç: Obezite, cinsel yaşam kalitesinin yanında genel yaşam kalitesini de düşüren bir bozukluktur. Bariatrik cerrahi, obezite ve eşlik eden komorbiditeler için en etkili tedavi yöntemidir ve medikal tedavilerden de üstündür. Bununla birlikte, bariatrik cerrahinin cinsel yaşam kalitesi üzerine etkilerini inceleyen yeterli sayıda çalışma bulunmamaktadır. Biz bu çalışmamızda bariatrik cerrahinin, özellikle daha sık uygulanan laparoskopik sleeve gastrektomi (LSG) tekniğinin cinsel işlevler, depresyon ve yaşam kalitesi üzerine etkilerini araştırmayı amaçladık. 

Gereç ve Yöntem: Kliniğimizde Nisan 2014 ile Mart 2015 tarihleri arasında LSG yapılan, dışlama kriterleri sonrasında uygun bulunan toplamda 22 erkek hasta çalışmaya dahil edildi. Hastaların yaş, boy, kilo ve beden kitle indeksi (BKİ) verileri ile operasyon öncesi IIEF (Uluslararası Erektil Fonksiyon İndeksi), BECK (Hastalar için Beck depresyon ölçeği), SF-36 (Yaşam kalitesi indeksi) dolduruldu ve sonuçları kaydedildi.Ayrıca, operasyondan sonra hastaların kilo verme miktarları ve BKİ düşüşleri tespit edildi. 

Bulgular: Preoperatif dönem ile karşılaştırıldığında postoperatif dönemde erektil ve orgazmik fonksiyon, cinsel ilişki ve genel yaşam tatminliği, PCS ve MCS skorlarında anlamlı derecede artış saptandı. İki dönem arasında cinsel istek ortalamaları arasında istatistiksel olarak anlamlı bir farklılık gözlenmedi.Postoperatif dönemde BECK depresyon ölçeği puanlarında anlamlı azalmalar saptandı. 

Sonuç: Biz bariatrik cerrahinin kilo kontrolü sağlanmasının yanında erkeklerde cinsel fonksiyon ve yaşam kalitesinin arttırılmasında da faydası olduğunu düşünüyoruz. 

Keywords

• obezite
• cinsel işlev
• bariatrik cerrahi
• sleevegastrektomi
• yaşam ka- litesi

Effects of obesity surgery on sexual function, depression and quality of life of males

Abstract

Background: Obesity decreases the quality of sexual life as well as the overall quality of life. Bariatric surgery is the most effective treatment method for obesity, it is better than the medical treatment options. However, there is not sufficient number of studies about the effects of bariatric surgery on the quality of sexual life yet. 

Aims: So we aimed to research about the effects of bariatric surgery, the laparoscopic sleeve gastrectomy (LSG) method which is being more and more often applied, on the sexual functions, depression and quality of life in our study. 

Materials and Methods: Out of all patients who had LSG surgery due to obesity earlier in our center, 22 applicable male patients were taken under research after a brief exclusion criteria application. Age, height, weight,body mass index (BMI) data of these patients were recorded before the operation. IIEF, Beck depression inventory Short form-36 were filled for the patients. Also, the weight loss amounts and BMI decreases of the patients after the operation were recorded. 

Results: Statistically meaningful increases were observed in the post-operation Erectile, Orgasmic Function, Intercourse Satisfaction, Overall satisfaction, PCS-MCS scores compared to the pre-operation. No statistically meaningful change was observed in the post-operation sexual desire averages when compared to pre-operation. When compared with the pre-operation values; meaningful decreases were detected in the post-operation BECK depression inventory scores. Conclusion: We think that the bariatric surgery not only causes serious amount of weight loss, but also enhances the sexual function and the quality of life among males. 

Keywords

• obesity
• sexual function
• bariat- ric surgery
• sleeve gastrectomy
• quality of life

References

1. 1. Obesity and overweight, Fact sheet N°311: WHO;2011. Available from:http://www.who.int/mediacentre/factsheet/ fs311/en.
2. 2. Çıtak A.G, Özmen M.M, Besler H.T. Obesity the disease of the era. TÜBİTAK Science and Technical Magazine 2007; March :1-9.
3. 3. World Health Organization. WHO global data base on body mass index.
4. 4. Satman I, Yilmaz T, Sengul A, et al. Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes care 2002;25:1551-6.
5. 5. Satman I, Omer B, Tutuncu Y, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabe- tes in Turkish adults. European journal of epidemiology 2013;28:169-80.
6. 6. Sjostrom L, Narbro K, Sjostrom D, et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N. Engl. J. Med 2007;357:741-752.
7. 7. Colquit J.L, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst.Rev 2009; 2:3641.
8. 8. Dixon J.B, le Roux C.W, Rubino F, Zimmet P. Bariatric Sur- gery for Type 2 Diabetes. Lancet 2012; 379:2300- 2311.

9. 9. Buchwald H, Oien D.M. Metabolic/Bariatric Surgery Worldwide 2011. Obes.Surg 2013; 23:427-436.
10. 10. Taylor K. Bariatric surgery fact sheet. American Society for Metabolic and Bariatric Surgery web site. 2011; Available at:http//www.asbs.org/Newsite07/media/asmbs_fs_sur-gery.pdf. Accessed February 23.
11. 11. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric sur-gery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.
12. 12. Esposito K, Ciotola M, Giugliano F, et al. Association of body weight with sexual functioning women. Int. J.Impot. Res 2007;19:353–7.
13. 13. Terranova L, Busetto L, Vestri A, et al. Bariatric surgery:cost-effectiveness and budget impact. Obes. Surg 2012;22:646–653.
14. 14. Salonia A, Munarriz R.M, Nasprop R, et al. Women’s sexual dysfunction: a pathophysiological review. BJU Int 2004;93:1156–1164.
15. 15. Clayton A.H. Epidemiology and neurobiology of female sexual dysfunction. J. Sex. Med 2007;4:260–268.
16. 16. Laumann E.O, Nicolosi A, Glasser D.B, et al. Sexual prob- lems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int. J.Impot. Res 2005; 17:39–57.
17. 17. Palacios S, Castano R, Grazziotin A. Epidemiology of fe- male sexual dysfunction. Maturitas 2009; 63:119– 123.
18. 18. Brethauer S.A, Hammel J.P, Schauer P.R. Systematic review of sleeve gastrectomy as staging and primary bariatric pro- cedure. Surg.Obes.Relat. Dis 2009; 5:469-475.
19. 19. Brethauer S.A. Sleeve Gastrectomy. Surg.Clin. N. Am 2011;42 Aras et al. Erkeklerde obezite cerrahisi ve cinsellik 91:1265-1279.
20. 20. Buchwald H, Oien D.M. Metabolic/bariatric surgery world-wide 2008. Obes. Surg 2009;19:1605-1611.
21. 21. Karamanakos S.N, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and post- prandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann. Surg 2008; 247:401-407.
22. 22. Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gas- trectomy a “food limiting” operation. Obes. Surg 2008; 18:1251-1256.
23. 23. Gill R.S, Birch D.W, Shi X, et al. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg.Obes.Relat 2010;6:707-13.9.
24. 24. Mason E.E, Ito C. Gastric Bypass in Obesity. Surg.Clin. North. Am 1967;47:1345-1351.
25. 25. Müller A, Mulhall J.P. Cardiovascular disease, metabolic syndrome and erectile dysfunction. Curr.Opin. Urol 2006; 16: 435–443.
26. 26. Borges R, Temido P, Sousa L, et al. Metabolic syndrome and sexual (dys)function. J. Sex. Med 2009; 6: 2958–75.
27. 27. Bal K, Oder M, Sahin A.S, et al. Prevalence of metabolic syndrome and its association with erectile dysfunction among urologic patients: metabolic back grounds of erectile dysfunction. Urology 2007; 69:356– 360.
28. 28. Heidler S, Temml C, Broessner C, et al. Is the metabolic syn- drome an independent risk factor for erectile dysfunction? J. Urol 2007; 177: 651–654.
29. 29. Demir T, Demir O, Kefi A, et al. Prevalence of erectile dys- function in patients with metabolic syndrome. Int. J. Urol 2006; 13: 385–358.
30. 30. Katib A. Mechanisms linking obesity to male infertility. Cent. European J. Urol. 2015;68:79-85.
31. 31. Esposito K, Giugliano F, DiPalo C, et al. Effect of life style changes on erectile dysfunction in obese men: a random- ized controlled trial. JAMA 2004; 291: 2978–84.
32. 32. Buchwald H, Oien D.M. Metabolic/bariatric surgery world- wide 2008. Obes. Surg 2008; 19:1605-1611.
33. 33. Dallal R.M, Chernoff A, O’LearyM.P, et al. Sexual dysfunc- tion is common in the morbidly obese male and improves after gastric bypass surgery. J. Am. Coll. Surg 2008; 207: 859–864.
34. 34. Di Frega A.S, Dale B, Di Matteo L, et al. Secondary male factor infertility after Roux-en-Y gastric bypass for morbid obesity: case report. Hum.Reprod 2005; 20: 997–998.
35. 35. Bastounis E.A, Karayiannakis A.J, Syrigos K, et al. Sex hormone changes in morbidly obese patients after vertical banded gastroplasty. Eur. Surg. Res 1998; 30:43-47.
36. 36. Globerman H, Shen-Orr Z, Karnieli E, et al. Inhibin B in men with severy obesity and after weight reduction follow- ing gastroplasty. Endocr. Res 2005; 31:17-26.
37. 37. Omana J, Tamler R, Srohmayer J, et al. Sex hormones in men under going bariatric surgery.J Am. Coll. Surg 2009; 209:22-23.
38. 38. Woodard G.A, Banka G, Morton J.M. Bariatric surgey im- proves male endocrine function. J. Am. Coll 2009; 209:S21. 39. Buggs C, Weinberg F, Kim E, et al. Insulin augments GnRH-stimulated LH beta gene expression by Egr-1. Mol. Cell.En-docrinol 2006; 249:99-106.
39. 40. Sullivan M.E, Thompson C.S, Dashwood M.R, et al. Nitric oxide and penile erection: is erectile dysfunction another manifestation of vasculer disease? Cardiovasc. Res 1999; 43:658-665.
40. 41. Alagna S, Cossu M.L, Gallo P, et al. Bilio pancreatic diver- sion: long term effects on gonadal function in severely obese men. Surg.Obes.Relat. Dis 2006; 2:82-86.
41. 42. Reis L.O, Favaro W.J, Barreiro G.C, et al. Erectile dysfunc- tion and hormonal imbalance in morbidly obese male is re- versed after gastric bypass surgery: a prospective random- ized controlled trial. Int. J.Androl 2010; 33:736-744.
42. 43. Ranasinghe W.K, Wright T, Attia J, et al. Effects of bar- iatric surgery on urinary and sexual function. BJU Int 2011;107:88-94.
43. 44. Kırgız C, Şenel Ö, Sever O, et al. Observing the Quality of Life of the Training Personnel that are Working in Physi- cal Education and Sports Departments. Kafkas Educational Research Magazine 2014; 1.