Is Multidisciplinary Approach Necessary to Erectile Dysfunction Patients?

Öz

Aim: To investigate the effects of hormonal, metabolic and demographic variables on male sexual health and to discuss these relationships in a multidisciplinary context. Material and Methods: Erectile function, mean age, body mass index (BMI), comorbidities, medications, smoking and alcohol use of 286 male patients and 49 healthy participants who were admitted to the andrology clinics of Zonguldak Bulent Ecevit University and Samsun Gazi State Hospital were recorded. The erectile functions of a total of 335 participants were classified into 5 categories as; Category-1 (Normal), Category-2 (Mild), Category-3 (Mild-moderate), Category-4 (Moderate), Category-5 (Severe) erectile function using the International Index of Erectile Function (IIEF 1-5,15). Participants were grouped as; non-ED group, group A (n=49) and ED group as, group B (n=286). Patients in Group B with mild and moderate ED were grouped as Group BI (n=140), and those with moderate and severe ED were grouped as Group BII (n=146). The demographic, hormonal and metabolic characteristics of the cases in each category were statistically calculated and the groups were compared categorically. Results: The mean age of the patients in group A and group B were 50.2±8.6 and 52.3±10.1 years, respectively (p=0.185). In group A and group B, mean BMI values were 26.7 and 28.4 kg/m2, belly circumference 100cm and 103.3cm (Table 1). The prevalence of diabetes mellitus in Group A and B was 6.1% and 20.6% (p=0.001). Mean age and BMI values of group BI were 51.5±10.9 years and 28.2 ± 4.2 kg/m2, while it was calculated as 53.1±9.3 years and 29.0±3.9 kg/m2, respectively, in group BII. The mean umbilical circumference of the patients in groups BI and BII was calculated as 101.1±10.9 cm and 105.5±11.0 cm, respectively (p=0.001). Conclusion: Patients who apply to the andrology outpatient clinic with erectile dysfunction should be evaluated especially in terms of comorbidities such as diabetes, hypertension and obesity, and cases with coexistence should be treated with a multidisciplinary approach.

Anahtar Kelimeler

• Diabetes, Erectile dysfunction, Comorbidity, Multidisciplinary treatment, Obesity

Erektil Disfonksiyon Hastalarına Multidisipliner Yaklaşım Gerekir mi?

Öz

Amaç: Hormonal, metabolik ve demografik değişkenlerin erkek cinsel sağlığı üzerine etkilerini araştırmak ve varsa bu ilişkileri multidisipliner çerçevede tartışmaktır. Gereç ve Yöntemler: Zonguldak Bülent Ecevit Üniversitesi ve Samsun Gazi Devlet Hastanesi Üroloji kliniklerine cinsel işlev bozuklukları nedeniyle başvuran 286 erkek hastanın ve sağlıklı 49 katılımcının erektil fonksiyonları ile ortalama yaş, vücut kütle indeksi (VKİ), ek hastalıkları, kullandıkları ilaçlar, sigara içme süresi, alkol alışkanlıkları kaydedildi. Toplam 335 katılımcının erektil fonksiyonları Uluslararası Erektil Fonksiyon İndeksi (IIEF 1-5,15) kullanılarak Kategori-1 (Normal), Kategori-2 (Hafif erektil disfonksiyon (ED)), Kategori-3 (Hafif-orta ED), Kategori-4 (Orta ED), Kategori-5 (Şiddetli (ED)) olarak 5 kategoride sınıflandırıldı. Katılımcılar; ED olmayanlar grup A (n=49) ve olanlar grup B (n=286) olarak gruplandırıldı. Grup B’de yer alan hastalardan hafif ve hafif-orta şiddette ED’u olanlar Grup BI (n=140), orta ve şiddetli derecede ED’u olan hastalar ise Grup BII (n=146) olarak gruplandırıldı. Her bir kategorideki olguların demografik, hormonal ve metabolik özellikleri istatistiksel olarak hesaplandı ve gruplar kategorik olarak karşılaştırıldı. Bulgular: Grup A ve grup B’de yer alan hastaların yaş ortalamaları sırasıyla 50,2±8,6 ve 52,3±10,1 yıldı (p=0,185). Grup A ve grup B’de ortalama VKİ değerleri sırasıyla 26,7 ve 28,4 kg/m2, göbek çevresi 100 cm ve 103 cm (p=0,020) (Tablo 1). Grup A ve B’de diyabetes mellitus prevalansı %6,1 ve %20,6 bulundu (p=0,001). Grup BI’in yaş ortalaması ve VKİ değerleri sırasıyla 51,5±10,9 yıl ve 28,2±4,2 kg/m2, grup BII’nin 53,1±9,3 yıl ve 29,0±3,9 kg/m2 olarak hesaplandı (p>0,05). Grup BI ve BII’de yer alan hastaların ortalama göbek çevreleri sırasıyla 101,1±10,9 cm ve 105,5±11,0 cm olarak hesaplandı (p=0,001). Sonuç: Androloji polikliniğine erektil disfonksiyon nedeniyle başvuran hastalar, özellikle diyabet, hipertansiyon, obezite gibi komorbiditeleri bakımından multidisipliner yaklaşımla değerlendirilmeli, bu olgular eşgüdümle takip ve tedavi edilmelidir.

Anahtar Kelimeler

• Diyabet
• Erektil Disfonksiyon
• Komorbidite
• Multidisipilner Yaklaşım
• Obezite

Kaynakça

1. 1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993 Jul 7;270(1):83-90. PMID: 8510302.
2. 2. Virag R, Zwang G, Dermange H, Legman M. Vasculogenic impotence: a review of 92 cases with 54 surgical operations. Vasc Surg. 1981;15:9–17.
3. 3. Saigal CS, Wessells H, Pace J, Schonlau M, Wilt TJ; Urologic Diseases in America Project. Predictors and prevalence of erectile dysfunction in a racially diverse population. Arch Intern Med. 2006 Jan 23;166(2):207-12. doi: 10.1001/archinte.166.2.207. PMID: 16432090.
4. 4. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. A prospective study of risk factors for erectile dysfunction. J Urol. 2006 Jul;176(1):217-21. doi: 10.1016/S0022-5347(06)00589-1. PMID: 16753404.
5. 5. Sai Ravi Shanker A, Phanikrishna B, Bhaktha Vatsala Reddy C. Association between erectile dysfunction and coronary artery disease and its severity. Indian Heart J. 2013 Mar-Apr;65(2):180-6. doi: 10.1016/j.ihj.2013.02.013. Epub 2013 Feb 24. PMID: 23647898; PMCID: PMC3861235.
6. 6. Montorsi P, Ravagnani PM, Galli S, Rotatori F, Veglia F, Briganti A, Salonia A, Dehò F, Rigatti P, Montorsi F, Fiorentini C. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J. 2006 Nov;27(22):2632-9. doi: 10.1093/eurheartj/ehl142. Epub 2006 Jul 19. PMID: 16854949.
7. 7. Baumhäkel M, Schlimmer N, Kratz M, Hackett G, Jackson G, Böhm M. Cardiovascular risk, drugs and erectile function--a systematic analysis. Int J Clin Pract. 2011 Mar;65(3):289-98. doi: 10.1111/j.1742-1241.2010.02563.x. Erratum in: Int J Clin Pract. 2011 Apr;65(4):516. Hacket, G [corrected to Hackett, G]. PMID: 21314866.
8. 8. Guo W, Liao C, Zou Y, Li F, Li T, Zhou Q, Cao Y, Mao X. Erectile dysfunction and risk of clinical cardiovascular events: a meta-analysis of seven cohort studies. J Sex Med. 2010 Aug;7(8):2805-16. doi: 10.1111/j.1743-6109.2010.01792.x. Epub 2010 Mar 30. PMID: 20367771.

9. 9. Jackson G, Boon N, Eardley I, Kirby M, Dean J, Hackett G, Montorsi P, Montorsi F, Vlachopoulos C, Kloner R, Sharlip I, Miner M. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract. 2010 Jun;64(7):848-57. doi: 10.1111/j.1742-1241.2010.02410.x. PMID: 20584218.
10. 10. Gandaglia G, Briganti A, Jackson G, Kloner RA, Montorsi F, Montorsi P, Vlachopoulos C. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2014 May;65(5):968-78. doi: 10.1016/j.eururo.2013.08.023. Epub 2013 Aug 23. PMID: 24011423.
11. 11. Glina S, Sharlip ID, Hellstrom WJ. Modifying risk factors to prevent and treat erectile dysfunction. J Sex Med. 2013 Jan;10(1):115-9. doi: 10.1111/j.1743-6109.2012.02816.x. Epub 2012 Sep 12. PMID: 22971247.
12. 12. Vlachopoulos C, Jackson G, Stefanadis C, Montorsi P. Erectile dysfunction in the cardiovascular patient. Eur Heart J. 2013 Jul;34(27):2034-46. doi: 10.1093/eurheartj/eht112. Epub 2013 Apr 24. PMID: 23616415.
13. 13. Turunç T, Deveci S, Güvel S, Peşkircioğlu L. The assessment of Turkish validation with 5 question version of International Index of Erectile Function (IIEF-5). Turk J Urol. 2007;33:45–49.
14. 14. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994 Jan;151(1):54-61. doi: 10.1016/s0022-5347(17)34871-1. PMID: 8254833.
15. 15. Goldstein I, McCullough AR, Jones LA, Hellstrom WJ, Bowden CH, Didonato K, Trask B, Day WW. A randomized, double-blind, placebo-controlled evaluation of the safety and efficacy of avanafil in subjects with erectile dysfunction. J Sex Med. 2012 Apr;9(4):1122-33. doi: 10.1111/j.1743-6109.2011.02629.x. Epub 2012 Jan 16. PMID: 22248153.
16. 16. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol. 2000 Feb;163(2):460-3. PMID: 10647654.
17. 17. Selvin, E., Burnett, A. L., & Platz, E. A. (2007). Prevalence and risk factors for erectile dysfunction in the US. The American Journal of. Medicine, 120(2), 151–157.
18. 18. Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005 Dec 21;294(23):2996-3002. doi: 10.1001/jama.294.23.2996. PMID: 16414947.
19. 19. Pegge NC, Twomey AM, Vaughton K, Gravenor MB, Ramsey MW, Price DE. The role of endothelial dysfunction in the pathophysiology of erectile dysfunction in diabetes and in determining response to treatment. Diabet Med. 2006 Aug;23(8):873-8. doi: 10.1111/j.1464-5491.2006.01911.x. PMID: 16911625.
20. 20. Kouidrat Y, Pizzol D, Cosco T, Thompson T, Carnaghi M, Bertoldo A, Solmi M, Stubbs B, Veronese N. High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabet Med. 2017 Sep;34(9):1185-1192. doi: 10.1111/dme.13403. Epub 2017 Jul 18. PMID: 28722225.
21. 21. Bolat MS, Cinar O, Akdeniz E, Aşcı R. Low dose daily versus on-demand high dose tadalafil in diabetic patients with erectile and ejaculatory dysfunction. Int J Impot Res. 2018 Jun;30(3):102-107. doi: 10.1038/s41443-018-0019-5. Epub 2018 May 25. PMID: 29795527.
22. 22. Gratzke, C., Angulo, J., Chitaley, K., Dai, Y.‐t., Kim, N.N., Paick, J.‐S., Simonsen, U., Ückert, S., Wespes, E., Andersson, K.E., Lue, T.F. and Stief, C.G. (2010), Anatomy, Physiology, and Pathophysiology of Erectile Dysfunction. The Journal of Sexual Medicine, 7: 445-475. https://doi.org/10.1111/j.1743-6109.2009.01624.x.
23. 23. El-Sakka AI, Morsy AM. Screening for ischemic heart disease in patients with erectile dysfunction: role of penile Doppler ultrasonography. Urology. 2004 Aug;64(2):346-50. doi: 10.1016/j.urology.2004.03.016. PMID: 15302492.
24. 24. Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013 Jan 12;381(9861):153-65. doi: 10.1016/S0140-6736(12)60520-0. Epub 2012 Oct 5. PMID: 23040455.
25. 25. Hannan JL, Maio MT, Komolova M, Adams MA. Beneficial impact of exercise and obesity interventions on erectile function and its risk factors. J Sex Med. 2009 Mar;6 Suppl 3:254-61. doi: 10.1111/j.1743-6109.2008.01143.x. PMID: 19170860.
26. 26. Meller SM, Stilp E, Walker CN, Mena-Hurtado C.The link between vasculogenic erectile dysfunction, coronary artery disease, and peripheral artery disease: role of metabolic factors and endovascular therapy. J Invasive Cardiol. 2013;25(6):313-319.
27. 27. Andersson DP, Trolle Lagerros Y, Grotta A, Bellocco R, Lehtihet M, Holzmann MJ. Association between treatment for erectile dysfunction and death or cardiovascular outcomes after myocardial infarction. Heart. 2017 Aug;103(16):1264-1270. doi: 10.1136/heartjnl-2016-310746. Epub 2017 Mar 9. PMID: 28280146; PMCID: PMC5537549.
28. 28. Giannetta E, Feola T, Gianfrilli D, Pofi R, Dall'Armi V, Badagliacca R, Barbagallo F, Lenzi A, Isidori AM. Is chronic inhibition of phosphodiesterase type 5 cardioprotective and safe? A meta-analysis of randomized controlled trials. BMC Med. 2014 Oct 20;12:185. doi: 10.1186/s12916-014-0185-3. PMID: 25330139; PMCID: PMC4201993.