Effect of Bariatric Surgery on Male’s Erectile Function: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 RENZheng-ju ¹ , WANGCheng-di ² , LITai-ming ³ , YANGBo ¹ , FANGKun ¹ , RENShang-qing ¹ , LIAOJian ¹ , LIUSheng-zhuo ¹ , LIULiang-ren ¹ ,  DONGQiang ¹

1. Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China;
3. Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

DONGQiang, Email: dqiang666@163.com

Keywords：

Bariatric surgery; Obesity; Erectile function; Sexual function; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20160105

Video：

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Objective To systematically review the effect of bariatric surgery for male’s erectile function. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 5, 2016), CNKI, VIP and WanFang Data from inception to May 30^th 2016, to collect randomized controlled trials and before-after studies about bariatric surgery therapies for erectile function in obese male. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then RevMan 5.3 software was used for meta-analysis. Results A total of 7 before-after studies involving 270 patients were included. The results of meta-analysis showed that: compared with before treatment, bariatric surgery could significantly improve 1-year erectile function score (MD=5.05, 95%CI 3.52 to 6.59, P < 0.000 01), 1-year sexual desire score (MD=0.99, 95%CI 0.47 to 1.51, P=0.000 2), 1-year contact satisfaction score (MD=2.70, 95%CI 0.21 to 5.19, P=0.004) and 1-year total satisfaction score (MD=1.68, 95%CI 0.27 to 3.09, P=0.002), but there was no significant difference in orgasm function score (MD= –0.21, 95%CI –0.74 to 0.33, P=0.45) between before and after treatment. Conclusion Bariatric surgery is effective in improving the erectile function, sexual desire and sexual satisfaction in morbidly obese male. Due to the limited quality and quantity of the included studies, the above conclusion needs to be verified by more large-scale high-quality studies.

Citation： RENZheng-ju, WANGCheng-di, LITai-ming, YANGBo, FANGKun, RENShang-qing, LIAOJian, LIUSheng-zhuo, LIULiang-ren, DONGQiang. Effect of Bariatric Surgery on Male’s Erectile Function: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(6): 676-681. doi: 10.7507/1672-2531.20160105 Copy

1.	Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2014, 384(9945): 766-781.
2.	Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med, 2006, 355(8): 763-778.
3.	Villareal DT, Apovian CM, Kushner RF, et al. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Obes Res, 2005, 13(11): 1849-1863.
4.	Bacon CG, Mittleman MA, Kawachi I, et al. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med, 2003, 139(3): 161-168.
5.	Hadi HA, Carr CS, Al Suwaidi J. Endothelial dysfunction: cardiovascular risk factors, therapy, and outcome. Vasc Health Risk Manag, 2005, 1(3): 183-198.
6.	Kolotkin RL, Zunker C, Ostbye T. Sexual functioning and obesity: a review. Obesity (Silver Spring), 2012, 20(12): 2325-2333.
7.	Hammoud AO, Walker JM, Gibson M, et al. Sleep apnea, reproductive hormones and quality of sexual life in severely obese men. Obesity (Silver Spring), 2011, 19(6): 1118-1123.
8.	Esposito K, Giugliano D. Obesity, the metabolic syndrome, and sexual dysfunction in men. Clin Pharmacol Ther, 2011, 90(1): 169-173.
9.	Kaukua J, Pekkarinen T, Sane T, et al. Sex hormones and sexual function in obese men losing weight. Obes Res, 2003, 11(6): 689-694.
10.	Fernandez-Sanchez A, Madrigal-Santillan E, Bautista M, et al. Inflammation, oxidative stress, and obesity. Int J Mol Sci, 2011, 12(5): 3117-3132.
11.	Reis LO, Favaro WJ, Barreiro GC, et al. Erectile dysfunction and hormonal imbalance in morbidly obese male is reversed after gastric bypass surgery: a prospective randomized controlled trial. Int J Androl, 2010, 33(5): 736-744.
12.	Mora M, Aranda GB, de Hollanda A, et al. Weight loss is a major contributor to improved sexual function after bariatric surgery. Surg Endosc, 2013, 27(9): 3197-3204.
13.	Aguiar IC, Freitas WR Jr, Santos IR, et al. Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial. Multidiscip Respir Med, 2014, 9(1): 43.
14.	Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet, 2015, 386(9997): 964-973.
15.	潘雯, 宫建, 郑刚, 等. 中国内地减肥手术治疗肥胖型2型糖尿病的Meta分析. 中国循证医学杂志, 2013, 13(4): 441-445.
16.	Boido A, Ceriani V, Cetta F, et al. Bariatric surgery and prevention of cardiovascular events and mortality in morbid obesity: mechanisms of action and choice of surgery. Nutr Metab Cardiovasc Dis, 2015, 25(5): 437-443.
17.	Brethauer SA, Aminian A, Romero-Talamas H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg, 2013, 258(4): 628-636.
18.	曾宪涛, 庄丽萍, 杨宗国, 等. Meta分析系列之七: 非随机实验性研究、诊断性试验及动物实验的质量评价工具. 中国循证心血管医学杂志, 2012, 4(6): 496-499.
19.	Kun L, Pin Z, Jianzhong D, et al. Significant improvement of erectile function after Roux-en-Y gastric bypass surgery in obese Chinese men with erectile dysfunction. Obes Surg, 2015, 25(5): 838-844.
20.	Efthymiou V, Hyphantis T, Karaivazoglou K, et al. The effect of bariatric surgery on patient HRQOL and sexual health during a 1-year postoperative period. Obes Surg, 2015, 25(2): 310-318.
21.	Ranasinghe WK, Wright T, Attia J, et al. Effects of bariatric surgery on urinary and sexual function. BJU Int, 2011, 107(1): 88-94.
22.	Araujo AA, Brito AM, Ferreira Mde N, et al. Changes the sexual quality of life of the obeses submitted Fobi-Capella gastroplasty surgery. Rev Col Bras Cir, 2009, 36(1): 42-48.
23.	Dallal RM, Chernoff A, O'Leary MP, et al. Sexual dysfunction is common in the morbidly obese male and improves after gastric bypass surgery. J Am Coll Surg, 2008, 207(6): 859-864.
24.	杜润雨, 韩萍. Roux-en-Y胃转流术对肥胖及其合并疾病疗效的Meta分析. 中国循证医学杂志, 2014, 14(11): 1343-1350.
25.	Botella-Carretero JI, Balsa JA, Gomez-Martin JM, et al. Circulating free testosterone in obese men after bariatric surgery increases in parallel with insulin sensitivity. J Endocrinol Invest, 2013, 36(4): 227-232.
26.	Higdon JV, Frei B. Obesity and oxidative stress: a direct link to CVD? Arterioscler Thromb Vasc Biol, 2003, 23(3): 365-367.
27.	Esposito K, Ciotola M, Giugliano F, et al. Effects of intensive lifestyle changes on erectile dysfunction in men. J Sex Med, 2009, 6(1): 243-250.
28.	Kirby M, Jackson G, Simonsen U. Endothelial dysfunction links erectile dysfunction to heart disease. Int J Clin Pract, 2005, 59(2): 225-229.
29.	Aversa A, Isidori AM, De Martino MU, et al. Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction. Clin Endocrinol (Oxf), 2000, 53(4): 517-522.
30.	Traish AM, Park K, Dhir V, et al. Effects of castration and androgen replacement on erectile function in a rabbit model. Endocrinology, 1999, 140(4): 1861-1868.
31.	Flores L, Vidal J, Nunez I, et al. Effect of bariatric surgery on the mechanisms involved in obesity-related hypertension: the renin-angiotensin-aldosterone and sympathetic nervous systems and endothelial dysfunction. Diabetologia, 2011, 54: S448-S449.

1. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2014, 384(9945): 766-781.
2. Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med, 2006, 355(8): 763-778.
3. Villareal DT, Apovian CM, Kushner RF, et al. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Obes Res, 2005, 13(11): 1849-1863.
4. Bacon CG, Mittleman MA, Kawachi I, et al. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med, 2003, 139(3): 161-168.
5. Hadi HA, Carr CS, Al Suwaidi J. Endothelial dysfunction: cardiovascular risk factors, therapy, and outcome. Vasc Health Risk Manag, 2005, 1(3): 183-198.
6. Kolotkin RL, Zunker C, Ostbye T. Sexual functioning and obesity: a review. Obesity (Silver Spring), 2012, 20(12): 2325-2333.
7. Hammoud AO, Walker JM, Gibson M, et al. Sleep apnea, reproductive hormones and quality of sexual life in severely obese men. Obesity (Silver Spring), 2011, 19(6): 1118-1123.
8. Esposito K, Giugliano D. Obesity, the metabolic syndrome, and sexual dysfunction in men. Clin Pharmacol Ther, 2011, 90(1): 169-173.
9. Kaukua J, Pekkarinen T, Sane T, et al. Sex hormones and sexual function in obese men losing weight. Obes Res, 2003, 11(6): 689-694.
10. Fernandez-Sanchez A, Madrigal-Santillan E, Bautista M, et al. Inflammation, oxidative stress, and obesity. Int J Mol Sci, 2011, 12(5): 3117-3132.
11. Reis LO, Favaro WJ, Barreiro GC, et al. Erectile dysfunction and hormonal imbalance in morbidly obese male is reversed after gastric bypass surgery: a prospective randomized controlled trial. Int J Androl, 2010, 33(5): 736-744.
12. Mora M, Aranda GB, de Hollanda A, et al. Weight loss is a major contributor to improved sexual function after bariatric surgery. Surg Endosc, 2013, 27(9): 3197-3204.
13. Aguiar IC, Freitas WR Jr, Santos IR, et al. Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial. Multidiscip Respir Med, 2014, 9(1): 43.
14. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet, 2015, 386(9997): 964-973.
15. 潘雯, 宫建, 郑刚, 等. 中国内地减肥手术治疗肥胖型2型糖尿病的Meta分析. 中国循证医学杂志, 2013, 13(4): 441-445.
16. Boido A, Ceriani V, Cetta F, et al. Bariatric surgery and prevention of cardiovascular events and mortality in morbid obesity: mechanisms of action and choice of surgery. Nutr Metab Cardiovasc Dis, 2015, 25(5): 437-443.
17. Brethauer SA, Aminian A, Romero-Talamas H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg, 2013, 258(4): 628-636.
18. 曾宪涛, 庄丽萍, 杨宗国, 等. Meta分析系列之七: 非随机实验性研究、诊断性试验及动物实验的质量评价工具. 中国循证心血管医学杂志, 2012, 4(6): 496-499.
19. Kun L, Pin Z, Jianzhong D, et al. Significant improvement of erectile function after Roux-en-Y gastric bypass surgery in obese Chinese men with erectile dysfunction. Obes Surg, 2015, 25(5): 838-844.
20. Efthymiou V, Hyphantis T, Karaivazoglou K, et al. The effect of bariatric surgery on patient HRQOL and sexual health during a 1-year postoperative period. Obes Surg, 2015, 25(2): 310-318.
21. Ranasinghe WK, Wright T, Attia J, et al. Effects of bariatric surgery on urinary and sexual function. BJU Int, 2011, 107(1): 88-94.
22. Araujo AA, Brito AM, Ferreira Mde N, et al. Changes the sexual quality of life of the obeses submitted Fobi-Capella gastroplasty surgery. Rev Col Bras Cir, 2009, 36(1): 42-48.
23. Dallal RM, Chernoff A, O'Leary MP, et al. Sexual dysfunction is common in the morbidly obese male and improves after gastric bypass surgery. J Am Coll Surg, 2008, 207(6): 859-864.
24. 杜润雨, 韩萍. Roux-en-Y胃转流术对肥胖及其合并疾病疗效的Meta分析. 中国循证医学杂志, 2014, 14(11): 1343-1350.
25. Botella-Carretero JI, Balsa JA, Gomez-Martin JM, et al. Circulating free testosterone in obese men after bariatric surgery increases in parallel with insulin sensitivity. J Endocrinol Invest, 2013, 36(4): 227-232.
26. Higdon JV, Frei B. Obesity and oxidative stress: a direct link to CVD? Arterioscler Thromb Vasc Biol, 2003, 23(3): 365-367.
27. Esposito K, Ciotola M, Giugliano F, et al. Effects of intensive lifestyle changes on erectile dysfunction in men. J Sex Med, 2009, 6(1): 243-250.
28. Kirby M, Jackson G, Simonsen U. Endothelial dysfunction links erectile dysfunction to heart disease. Int J Clin Pract, 2005, 59(2): 225-229.
29. Aversa A, Isidori AM, De Martino MU, et al. Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction. Clin Endocrinol (Oxf), 2000, 53(4): 517-522.
30. Traish AM, Park K, Dhir V, et al. Effects of castration and androgen replacement on erectile function in a rabbit model. Endocrinology, 1999, 140(4): 1861-1868.
31. Flores L, Vidal J, Nunez I, et al. Effect of bariatric surgery on the mechanisms involved in obesity-related hypertension: the renin-angiotensin-aldosterone and sympathetic nervous systems and endothelial dysfunction. Diabetologia, 2011, 54: S448-S449.

Chinese Journal of Evidence-Based Medicine

Effect of Bariatric Surgery on Male’s Erectile Function: A Meta-analysis

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