Erectile Dysfunction in End-Stage Liver Disease Men

Abstract

Introduction In men, erectile dysfunction (ED) is an important issue. Data concerning ED in men with end-stage liver disease (ESLD) is limited, and the risk factors for ED in this population are still unknown. Aims To determine the prevalence, timescale, and risk factors for ED in ESLD patients candidates to liver transplantation. Methods Patients candidates for a liver transplantation were asked to participate in a mailed survey about sexual function. Among the 123 eligible men, 98 (84%) agreed to complete the questionnaire. Main Outcome Measures The quality of erection was evaluated using the five-item International Index of Erectile Function (IIEF-5) score, and satisfaction for sexuality, using the patient-baseline Treatment-Satisfaction Scale (TSS) score. Other questions also focused on patient perception of changes over time. Results On the overall population, 28 patients (29%) were nonsexually active. Among the 70 patients who were sexually active, 52 patients (74%) had ED. Regarding the development of ED, 50% of the patients perceived that a deterioration of erectile function occurred within the six previous months. The absence of sexual activity was more frequent in hepatitis B or C patients (P = 0.02). The risk factors for ED were alcohol intake (P = 0.03), tobacco use (P = 0.03), and cardiovascular disease (P = 0.004). The significant risk factors for having a low TSS score were having viral hepatitis (P = 0.01), and cardiovascular disease (P = 0.01). Conclusion Population of men with ESLD who are candidates for a liver transplantation is characterized by a high frequency of lack of sexual activity, and by a high prevalence of ED and should be targeted by interventions to improve sexual functioning. These preliminary data need further validation in prospective trial using more comprehensive questionnaires.

Systemic abnormalities in liver disease

“…Hypogonadism or protein malnutrition found in patients with advanced liver disease may induce ED [199,200] . Removal of causative factors such as iron or ethanol, or administration of testosterone may improve ED in such patients [197,198] .…”

Liver Transplant May Improve Erectile Function in Patients With Benign End-Stage Liver Disease: Single-Center Chinese Experience

“…[2][3][4] For the pre-LT patients, depression and the psychological stress of awaiting an LT combined with a high consumption of drugs, diuretics, beta-blockers (for portal hypertension), and antidepressants appeared to favor sexual dysfunction. 2 A study by Huyghe and associates 6 found that 28.6% of patients (28/98) were sexually inactive, and 74% of the sexually active patients (52/70) had ED. A study by Sorrell and associates 2 found that 32.4% of candidates for an LT with end-stage liver disease reported sexual inactivity, 34.3% of sexually active candidates declared complete ED, and 20.6% declared partial ED.…”

“…6,7 Erectile dysfunction has been reported in nearly 13% of men, and the prevalence increased with age, from 2% in men 18 to 39 years old to 48% in those 70 years old. 8 Patients with end-stage liver disease usually have some hypogonadism, with gynecomastia, testicular atrophy, alteration of hair distribution, reduction of libido, and hormonal disturbances, with reduced basal secretion of gonadotrophins, reduction of free and total testosterone, hyperprolactinemia, and hyperestrogenemia.…”

“…All the above alterations may contribute to the development of ED. 6 Liver transplant (LT) has become a widely accepted treatment for patients with end-stage liver disease. Theoretically, LT may lead to normalization of pathophysiologic abnormalities leading to resolution of ED.…”

Urologische Aspekte bei Patienten mit Leberzirrhose

“…Die erektile Dysfunktion ist mit einer Prä-valenz von >74% ist ein häufiges und multifaktorielles Problem bei LZ-Patienten [18]. Alkoholmissbrauch, chronischer Nikotinabusus, Psychopharmaka, kardiovaskuläre Begleiterkrankungen, Verän-derungen im Glukose-und Hormonmetabolismus (Diabetes mellitus, ↓Testo-steron, ↑ Östrogene), Hypogonadismus, Hodenatrophie, Libidoverlust, Depression, virale Hepatitis (Angst Partner anzustecken) und antivirale Therapien sind die häufigsten Ursachen [19].…”