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Gao X, Li P, Wang G, Li W, Song Z, Zhu S, Zhu L. Effect of laparoscopic sleeve gastrectomy on male reproductive function in Chinese men with obesity: a prospective cohort study. Int J Surg 2024; 110:3373-3381. [PMID: 38477110 PMCID: PMC11175819 DOI: 10.1097/js9.0000000000001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/03/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Obesity is a widely recognized global public health issue, and bariatric surgery has emerged as an effective intervention for alleviating obesity associated health complications. However, the impact of bariatric surgery on male reproductive function remains inconclusive in the literature. The current understanding of the impact of laparoscopic sleeve gastrectomy (LSG) on male reproductive function remains ambiguous, despite its status as the most commonly performed bariatric surgery. This prospective cohort study aimed to investigate the impact of LSG on erectile function and semen quality. PATIENTS AND METHODS A total of 34 obese patients were enrolled in this study and underwent LSG. Prior to the operation and at 3, 6, and 12 months postoperation, all participants were required to complete the International Index of Erectile Function-5 (IIEF-5) questionnaire and undergo a nocturnal erectile function test and semen quality analysis. RESULTS Within 12 months postoperation, BMI, blood lipids, and insulin resistance showed significant improvement. The IIEF-5 score increased significantly (18.88±5.97 vs. 23.78±3.19, P <0.05), and the frequency and duration of erections significantly improved compared to baseline. Sperm concentration, total motility, survival rate, and sperm morphology parameters exhibited a significant decline at 3 months but demonstrated a significant improvement at 6 and 12 months postoperation. At 12 months, sperm concentration was shown to be correlated with changes in zinc (r=0.25, P =0.033) as well as changes in testosterone (r=0.43, P =0.013). CONCLUSIONS LSG has beneficial effects on erectile function, despite a transient decline in semen quality at 3 months postoperatively, followed by a significant improvement at 12 months.
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Affiliation(s)
| | | | | | | | | | - Shaihong Zhu
- Department of Metabolic and Bariatric Surgery, The Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Liyong Zhu
- Department of Metabolic and Bariatric Surgery, The Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
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Hu Z, Chen K, Dai H, Lv Z, Li J, Yu P, Feng J, Abdulkarem AM, Wu H, He R, Li G. ROUX-en-Y gastric bypass surgery improves metabolic syndrome-related erectile dysfunction in mice via the IRS-1/PI3K/AKT/eNOS pathway. Sex Med 2024; 12:qfae029. [PMID: 38817951 PMCID: PMC11134102 DOI: 10.1093/sexmed/qfae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 04/10/2024] [Accepted: 05/05/2024] [Indexed: 06/01/2024] Open
Abstract
Objective Although many clinical studies have shown that ROUX-en-Y gastric bypass (RYGB) surgery significantly improves metabolic syndrome-related erectile dysfunction (MED), the role and mechanism are unclear. Aim In this study we used a mouse model to explore how RYGB improves MED induced by a high-fat diet (HFD). Methods We established a mouse model of metabolic syndrome by feeding an HFD for 16 weeks. The mice were randomly assigned to the standard chow diet (SCD), HFD, or RYGB groups. Body weight, fasting blood glucose, plasma insulin, and total plasma cholesterol were analyzed. Erectile responses were evaluated by determining the mean systolic blood pressure and the intracavernosal pressure (ICP). Penile histologic examination (Masson's trichrome and immunohistochemical stain) and Western blot were performed. Result Compared with the SCD group, the ICP in the sham group was significantly lower, and the ICP of the RYGB was significantly increased. Masson's trichrome and immunohistochemical staining showed that the content of endothelium and smooth muscle in the corpus cavernosum of mice with MED was significantly reduced. Western blot analysis showed a significant decrease in α-smooth muscle actin and a significant increase in osteopontin in penile tissue in the sham group, which was improved by RYGB surgery. Furthermore, RYGB significantly increased IRS-1/PI3K/Akt/eNOS phosphorylation. Clinical Translation In this study we explored the mechanism of bariatric surgery to improve erectile dysfunction associated with metabolic syndrome and provided a theoretical basis for clinical research. Strengths and Limitations First, we did not investigate the mechanism by which RYGB affects the IRS-1/PI3K/Akt/eNOS signaling pathway. Second, the effect of the IRS-1/PI3K/Akt/eNOS signaling pathway on the function of corpus cavernosum endothelial cells and smooth muscle cells remains to be investigated in cellular studies. Conclusion This study demonstrated that RYGB may not only improve metabolic parameters but also restore erectile function in MED patients. The mechanism of the therapeutic effect of RYGB may be reactivation of the IRS-1/PI3K/Akt/eNOS pathway.
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Affiliation(s)
- Zhenxing Hu
- Department of Urology, General Hospital of Ningxia Medical University, Ningxia Medical University, Xingqing District, Yinchuan 750000, People’s Republic of China
- Department of Urology, The First Affiliated Hospital of Yangtze University, Jingzhuo 434000, People’s Republic of China
| | - Keming Chen
- Department of Urology, General Hospital of Ningxia Medical University, Ningxia Medical University, Xingqing District, Yinchuan 750000, People’s Republic of China
| | - Haitao Dai
- Department of Urology, The First Affiliated Hospital of Yangtze University, Jingzhuo 434000, People’s Republic of China
| | - Zhiyong Lv
- Department of Urology, General Hospital of Ningxia Medical University, Ningxia Medical University, Xingqing District, Yinchuan 750000, People’s Republic of China
| | - Jian Li
- Department of Urology, General Hospital of Ningxia Medical University, Ningxia Medical University, Xingqing District, Yinchuan 750000, People’s Republic of China
| | - Puguang Yu
- Department of Urology, General Hospital of Ningxia Medical University, Ningxia Medical University, Xingqing District, Yinchuan 750000, People’s Republic of China
| | - Jiajing Feng
- Department of Urology, General Hospital of Ningxia Medical University, Ningxia Medical University, Xingqing District, Yinchuan 750000, People’s Republic of China
| | - Alqaisi Mohammed Abdulkarem
- Department of Urology, General Hospital of Ningxia Medical University, Ningxia Medical University, Xingqing District, Yinchuan 750000, People’s Republic of China
| | - Haifeng Wu
- Department of Urology, General Hospital of Ningxia Medical University, Ningxia Medical University, Xingqing District, Yinchuan 750000, People’s Republic of China
| | - Rui He
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, School of Basic Medical Sciences, Ningxia Medical University, Yinchuan 750000, People’s Republic of China
| | - Guangyong Li
- Department of Urology, General Hospital of Ningxia Medical University, Ningxia Medical University, Xingqing District, Yinchuan 750000, People’s Republic of China
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Viken AF, Siiak SP, Schlünssen V, Thorarinsdottir EH, Skulstad SM, Gyawali S, Bertelsen RJ, Real FG. Muscle Strength and Male Sexual Function. J Clin Med 2024; 13:426. [PMID: 38256560 PMCID: PMC10816204 DOI: 10.3390/jcm13020426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Sexual dysfunction, in particular erectile dysfunction, is a common complaint among aging men. Obesity, diabetes, hypertension, and smoking are shown to be independent risk factors for erectile dysfunction, while cardiorespiratory fitness is shown to be protective. Less is known about the role of muscle strength in male sexual function. Our objective was to study the association between male sexual function and typical cardiovascular risk factors, together with exercise and muscle strength. We included data from the fourth wave of the RHINE study. Data on anthropometrics, exercise habits, diseases, muscle strength, and sexual function were collected using questionnaires, including the Aging Males' Symptoms (AMS) scale. We used multivariable logistic regression analysis to measure the association between sexual function and body mass index (BMI), age, smoking, diabetes, hypertension, exercise and muscle strength status. We included 2116 men aged 48-75 from four Nordic-Baltic countries. BMI, age, smoking, diabetes, and hypertension were found to be associated with higher odds of reporting decreased sexual function, while reporting intact muscle strength was associated with lower odds. In a large Nordic-Baltic male study population, we show that known cardiovascular risk factors are associated with decreased sexual function, while reporting intact muscle strength is associated with lower odds of reporting decreased sexual function.
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Affiliation(s)
- Anders Flataker Viken
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (R.J.B.); (F.G.R.)
| | | | - Vivi Schlünssen
- Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark;
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | | | - Svein Magne Skulstad
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway (S.G.)
| | - Sanjay Gyawali
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway (S.G.)
| | | | - Francisco Gómez Real
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (R.J.B.); (F.G.R.)
- Department of Gynecology and Obstetrics, Haukeland University Hospital, 5021 Bergen, Norway
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Esparham A, Roohi S, Ahmadyar S, Dalili A, Nelson PR, Khorgami Z. Impact of bariatric surgery on carotid intima-media thickness, flow-mediated dilation, and nitrite-mediated dilation: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:1188-1199. [PMID: 37429755 DOI: 10.1016/j.soard.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/03/2023] [Accepted: 05/14/2023] [Indexed: 07/12/2023]
Abstract
Obesity is considered one of the independent risk factors for atherosclerosis and is strongly correlated with cardiovascular morbidity and mortality. Previous studies showed carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), and nitrite-mediated dilatation (NMD) are reliable non-invasive markers of arterial damage and dysfunction. The aim of this study was to evaluate the effect of bariatric surgery on CIMT, FMD, and NMD markers in patients with obesity. A systematic search was performed in the PubMed, Embase, Scopus, and Web of Science databases until May 2022. All the English-published studies on the effect of bariatric surgery on CIMT, FMD, and NMD were included. A quantitative meta-analysis was performed, as well as subgroup analyses for the type of procedure and duration of follow-up. Meta-analysis of 41 studies with 1639 patients showed CIMT was significantly reduced by .11 mm after bariatric surgery (95% CI, -.14 to -.08; P < .001; mean follow-up = 10.8 mo). The pooled analysis of 23 studies with 1106 patients showed an increase of FMD by 4.57% after bariatric surgery (95% CI, 2.69-6.44; P < .001; mean follow-up = 11.5 mo). The results of a pooled analysis of 12 studies with 346 patients showed a significant increase of NMD by 2.46% after bariatric surgery (95% CI, .99-3.94; P < .001; mean follow-up = 11.4 mo). The random effect meta-regression demonstrated that baseline CIMT and FMD significantly affect the changes in CIMT and FMD. This meta-analysis showed bariatric surgery can improve CIMT, FMD, and NMD markers in patients with obesity. These improvements show the known effect of metabolic surgery in decreasing cardiovascular risk.
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Affiliation(s)
- Ali Esparham
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Roohi
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Ahmadyar
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Dalili
- Department of General Surgery, School of Medicine, Surgical Oncology Research Center, Imam, Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Peter R Nelson
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma, Tulsa, Oklahoma
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Małczak P, Wysocki M, Pisarska-Adamczyk M, Strojek J, Rodak H, Lastovetskyi I, Pędziwiatr M, Major P. Influence of Bariatric Surgery on Erectile Dysfunction-a Systematic Review and Meta-Analysis. Obes Surg 2023:10.1007/s11695-023-06572-9. [PMID: 37086370 DOI: 10.1007/s11695-023-06572-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Obesity is associated with a higher prevalence of various comorbidities including erectile dysfunction (ED). Bariatric surgery leads to weight loss and remission of weight-related diseases. The exact influence of bariatric treatment on ED is yet to be established; however, the number of papers on the subject is growing. METHODOLOGY A systematic review with meta-analysis comparing erectile dysfunction before and after surgery was conducted according to PRISMA guidelines with a literature search performed in June 2022. Inclusion criteria involved (1) ED assessment using the International International Index of Erectile Function (IIEF) and (2) longitudinal study design. Secondary endpoints involved hormonal changes and specific fields of IIEF. RESULTS An initial search yielded 878 records. Fourteen studies were included in the meta-analysis involving 508 patients. The quality of analyzed studies was moderate. Analysis showed significant differences in IIEF before and after surgery (Std. MD = 1.19, 95% CI 0.72 to 1.66, p<0.0001). Testosterone after surgery is higher by 156.32 pg/ml (95% CI 84.78 to 227.86, p<0.0001). There were differences in erectile function (MD:4.86, p < 0.0001), desire (MD: 1.21, p < 0.0001), intercourse satisfaction (MD: 2.16, p < 0.0001), and overall satisfaction (MD: 1.21, p = 0.003). There were no differences in terms of orgasms (MD: 0.65, p = 0.06). CONCLUSION There are differences in ED before and after bariatric surgery. Patients achieve 19% more in the IIEF questionnaire showing improvement. Further studies, including multivariate regression models on large cohorts, are required to determine whether the surgery is an independent factor in alleviating ED.
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Affiliation(s)
- Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital in Cracow, Cracow, Poland
| | | | - Jakub Strojek
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Hanna Rodak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Ilie Lastovetskyi
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
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Adipose Tissue Dysfunction and Obesity-Related Male Hypogonadism. Int J Mol Sci 2022; 23:ijms23158194. [PMID: 35897769 PMCID: PMC9330735 DOI: 10.3390/ijms23158194] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/12/2022] Open
Abstract
Obesity is a chronic illness associated with several metabolic derangements and comorbidities (i.e., insulin resistance, leptin resistance, diabetes, etc.) and often leads to impaired testicular function and male subfertility. Several mechanisms may indeed negatively affect the hypothalamic–pituitary–gonadal health, such as higher testosterone conversion to estradiol by aromatase activity in the adipose tissue, increased ROS production, and the release of several endocrine molecules affecting the hypothalamus–pituitary–testis axis by both direct and indirect mechanisms. In addition, androgen deficiency could further accelerate adipose tissue expansion and therefore exacerbate obesity, which in turn enhances hypogonadism, thus inducing a vicious cycle. Based on these considerations, we propose an overview on the relationship of adipose tissue dysfunction and male hypogonadism, highlighting the main biological pathways involved and the current therapeutic options to counteract this condition.
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Chen G, Sun L, Jiang S, Chen X, Zhu J, Zhao X, Yu S, Dong Z, Chen Y, Zhang W, Yang W, Wang C. Effects of bariatric surgery on testosterone level and sexual function in men with obesity: A retrospective study. Front Endocrinol (Lausanne) 2022; 13:1036243. [PMID: 36760810 PMCID: PMC9902700 DOI: 10.3389/fendo.2022.1036243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/28/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Bariatric surgeries induce well-documented weight loss and resolve obesity comorbidities. Sexual function is one of the aspects of life quality and may benefit from surgery. Few studies have revealed the impact of bariatric surgeries on sexual function in Chinese men with obesity. METHODS This is a retrospective cohort study of patients undergoing bariatric surgery [laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB)]. Data were collected between September 2017 and February 2022. The International Index of Erectile Function (IIEF) questionnaire was used to evaluate erectile function, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction. Sex hormones and other blood tests were evaluated before and at least 1 year after the surgery. RESULTS Fifty-nine Chinese male patients completed the IIEF questionnaire. The multivariate logistic regression analysis revealed that body mass index (BMI) was the single independent risk factor of the severity of erectile dysfunction (ED). Preoperative testosterone levels had negative correlations with BMI and waist circumference. Thirty-seven patients completed the postoperative questionnaire with a mean follow-up of 23.2 months. CONCLUSION BMI and waist circumference were negatively correlated with testosterone levels. BMI was an independent risk factor for the severity of ED. LSG and LRYGB led to positive and sustained improvement in sexual function of men with obesity. The two procedures had a comparable effect, more subjects being needed. Sex hormone levels also could be reversible. However, more weight loss did not predict a positive change in sexual function. A greater BMI loss might predict a greater increase in testosterone.
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Affiliation(s)
- Guoji Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
- Department of Gastrointestinal Surgery, The First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Luping Sun
- Department of urinary Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shuwen Jiang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Xiaomei Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
| | - Jie Zhu
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Xin Zhao
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Shuqing Yu
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Yuan Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Wen Zhang
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
- Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
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Li H, Xu W, Wang T, Wang S, Liu J, Jiang H. Effect of weight loss on erectile function in men with overweight or obesity: A meta-analysis of randomised controlled trials. Andrologia 2021; 54:e14250. [PMID: 34644814 DOI: 10.1111/and.14250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/04/2021] [Accepted: 09/03/2021] [Indexed: 01/20/2023] Open
Abstract
Obesity and overweight are independent risk factors of erectile dysfunction (ED). It is controversial whether weight loss can improve erectile function. We thereby performed this meta-analysis to clarify the therapeutic effect of weight loss on erectile function in overweight or obese men. Literature search was conducted on databases including Cochrane Library, Embase, Web of Science and PubMed to obtain all relevant English articles published before March 1, 2021. The primary outcome was final International Index of Erectile Function (IIEF) score or change in IIEF score. The secondary outcome was final body weight and body mass index (BMI) or change in body weight and BMI. After screening, 5 studies with 619 participants were enrolled in our meta-analysis. Our result showed that the mean difference in body weight between weight loss group and control group was -18.07 kg with p < .01, and the mean difference in BMI was -9.6 kg/m2 with p < .01. The mean difference of IIEF between weight loss group and control group was 1.99 with p < .01. This meta-analysis showed that weight loss could improve erectile function in overweight or obese men. Losing weight could serve as an adjuvant therapy for ED.
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Affiliation(s)
- Hao Li
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wenchao Xu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jihhong Liu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyang Jiang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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9
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Tu Y, Bao Y, Zhang P. Metabolic surgery in China: present and future. J Mol Cell Biol 2021; 13:mjab039. [PMID: 34240190 PMCID: PMC8697345 DOI: 10.1093/jmcb/mjab039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Obesity and its related complications comprise a serious public health problem worldwide, and obesity is increasing in China. Metabolic surgery is a new type of treatment with unique advantages in weight loss and obesity-related metabolic complications. The pathogenesis of obesity is complex and not yet fully understood. Here, we review the current efficacy and safety of metabolic surgery, as well as recent progress in mechanistic studies and surgical procedures in China. The exciting and rapid advances in this field provide new opportunities for patients with obesity and strike a balance between long-term effectiveness and safety.
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Affiliation(s)
- Yinfang Tu
- Department of Endocrinology and Metabolism, Shanghai
Jiao Tong University Affiliated Sixth People’s HospitalShanghai Diabetes
Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of
Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic
Disease, Shanghai 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai
Jiao Tong University Affiliated Sixth People’s HospitalShanghai Diabetes
Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of
Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic
Disease, Shanghai 200233, China
- Department of Endocrinology and Metabolism, Jinshan
District Central Hospital of Shanghai Sixth People's
Hospital, Shanghai 201599, China
| | - Pin Zhang
- Department of Bariatric and Metabolic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People’s
Hospital, Shanghai 200233, China
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10
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Sarhan MD, Khattab M, Sarhan MD, Maurice KK, Hassan H. Impact of Bariatric Surgery on Male Sexual Health: a Prospective Study. Obes Surg 2021; 31:4064-4069. [PMID: 34169483 DOI: 10.1007/s11695-021-05522-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Obesity is a worldwide prevalent problem which negatively affects most of the human body systems. Male sexual dysfunction is a frequent problem in obese individuals. Nowadays, bariatric surgery is the most successful way for the management of morbid obesity. Recent research has concluded that it has a significant improving effect on sexual function. AIM OF THE STUDY This study aimed to assess the long-term effect of bariatric surgery on male sexual function. PATIENTS AND METHODS Sixty-six male patients indicated for bariatric surgery were enrolled in this prospective study. Only forty-eight of them completed the study. Patients were invited to fill the International Index of Erectile Function (IIEF) questionnaire twice, preoperatively (T1) and 12 months postoperatively (T2). Simultaneously, patients' serum testosterone levels were assayed. RESULTS At T2, the patients showed highly significant increase in the IIEF scores and the serum testosterone levels (p<0.001). Only weight and BMI were significant predictors of the IIEF scores. The same factors as well as the patients' age were predictors of the serum testosterone levels. CONCLUSION Bariatric surgery improves male sexual health. It is associated with significant increase in IIEF score and serum testosterone levels.
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Affiliation(s)
- Mohamed D Sarhan
- Department of General Surgery, Kasr Alainy Hospital, Cairo University, Elmanial, Cairo, Egypt
| | - Mohammed Khattab
- Department of General Surgery, Kasr Alainy Hospital, Cairo University, Elmanial, Cairo, Egypt
| | - Mai D Sarhan
- Department of Family Medicine, Kasr Alainy Hospital, Cairo University, Elmanial, Cairo, Egypt
| | - Karim K Maurice
- Department of General Surgery, Kasr Alainy Hospital, Cairo University, Elmanial, Cairo, Egypt.
| | - Haitham Hassan
- Department of General Surgery, Kasr Alainy Hospital, Cairo University, Elmanial, Cairo, Egypt
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Yannas D, Frizza F, Vignozzi L, Corona G, Maggi M, Rastrelli G. Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Men's Health? J Clin Med 2021; 10:jcm10102221. [PMID: 34065601 PMCID: PMC8161068 DOI: 10.3390/jcm10102221] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 12/14/2022] Open
Abstract
Erectile dysfunction (ED) is an early manifestation of cardiovascular (CV) disease. For this reason, men with ED should be carefully assessed for CV risk factors in order to prevent future major adverse CV events (MACE). Traditional risk factors are not found in all subjects at high CV risk. In fact, a relevant proportion of MACE occurs in men who are apparently risk factor free. In men with ED, it is important to take into account not only traditional risk factors but also unconventional ones. Several parameters that derive from good clinical assessment of subjects with ED have proven to be valuable predictors of MACE. These include family history of cardiometabolic events, alcohol abuse, fatherhood, decreased partner’s sexual interest, severe impairment in erection during intercourse or during masturbation, impaired fasting glucose, increased triglycerides, obesity even without metabolic complications, decreased penile blood flows or impaired response to an intra-cavernosal injection test. Recognizing these risk factors may help in identifying, among subjects with ED, those who merit stricter lifestyle or pharmacological interventions to minimize their CV risk. Effective correction of risk factors in ED men considered as high risk, besides reducing CV risk, is also able to improve erectile function.
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Affiliation(s)
- Dimitri Yannas
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50121-50145 Florence, Italy; (D.Y.); (L.V.); (M.M.)
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi Teaching Hospital, 50121-50145 Florence, Italy
| | - Francesca Frizza
- Endocrinology Unit, Medical Department, Azienda Usl Maggiore-Bellaria Hospital, 40121-40141 Bologna, Italy; (F.F.); (G.C.)
| | - Linda Vignozzi
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50121-50145 Florence, Italy; (D.Y.); (L.V.); (M.M.)
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi Teaching Hospital, 50121-50145 Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl Maggiore-Bellaria Hospital, 40121-40141 Bologna, Italy; (F.F.); (G.C.)
| | - Mario Maggi
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50121-50145 Florence, Italy; (D.Y.); (L.V.); (M.M.)
- Endocrinology Unit, Careggi Teaching Hospital, 50121-50145 Florence, Italy
| | - Giulia Rastrelli
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50121-50145 Florence, Italy; (D.Y.); (L.V.); (M.M.)
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi Teaching Hospital, 50121-50145 Florence, Italy
- Correspondence:
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Liu S, Cao D, Ren Z, Li J, Peng L, Zhang Q, Cheng B, Cheng Z, Ai J, Zheng X, Liu L, Wei Q. The relationships between bariatric surgery and sexual function: current evidence based medicine. BMC Urol 2020; 20:150. [PMID: 33008406 PMCID: PMC7532646 DOI: 10.1186/s12894-020-00707-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/26/2020] [Indexed: 02/08/2023] Open
Abstract
Background Controversy remains despite several studies have discussed the role of bariatric surgery in improving male’s sexual function. This study aims to evaluate the efficacy of bariatric surgery in promoting male’s erectile function. Methods PubMed, EMbase, The Cochrane Library, CNKI and Clinical Trails.gov were searched from database inception to May 2019. The language of publication was limited in English. The International Index of Erectile Function (IIEF) score and Brief Male Sexual Function Inventory (BSFI) score were set as the primary outcome. Results Eleven studies with a total of 370 patients were enrolled in this meta-analysis. The results showed significant improvement in the IIEF score (erectile function: MD = 5.33, 95% CI 4.12–6.54; intercourse satisfaction: MD = 2.57, 95% CI 1.19–3.94; orgasmic function: MD = 0.50, 95%CI 0.60–0.94; overall satisfaction: MD = 1.67, 95% CI 0.78–2.56; sexual desire: MD = 1.27, 95% CI 0.61–1.93; total erectile function: MD = 7.21, 95% CI 4.33–10.10) and the BSFI score (erection: MD =2.53, 95% CI 2.39–2.67; ejaculation: MD = 1.40, 95% CI 1.28–1.51; desire: MD =1.40, 95% CI 1.32–1.49; problem assessment: MD = 2.20, 95% CI 2.06–2.34; sexual satisfaction: MD = 0.70, 95% CI 0.60–0.76) in obese individuals after bariatric surgery. Conclusions This systematic review and meta-analysis indicated that bariatric surgery could be effective in promoting males’s sexual function for obese individuals.
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Affiliation(s)
- Shengzhuo Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhengju Ren
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jinze Li
- DepartmentofUrology, Nanchong CentralHospital, The Second ClinicalMedical College, NorthSichuanMedicalCollege (University), Nanchong, Sichuan, China
| | - Lei Peng
- DepartmentofUrology, Nanchong CentralHospital, The Second ClinicalMedical College, NorthSichuanMedicalCollege (University), Nanchong, Sichuan, China
| | - Qin Zhang
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Bo Cheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheyu Cheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaonan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liangren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Sultan S, Patel AG, El-Hassani S, Whitelaw B, Leca BM, Vincent RP, le Roux CW, Rubino F, Aywlin SJB, Dimitriadis GK. Male Obesity Associated Gonadal Dysfunction and the Role of Bariatric Surgery. Front Endocrinol (Lausanne) 2020; 11:408. [PMID: 32636807 PMCID: PMC7318874 DOI: 10.3389/fendo.2020.00408] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/20/2020] [Indexed: 01/01/2023] Open
Abstract
Obesity is an ever growing pandemic and a prevalent problem among men of reproductive age that can both cause and exacerbate male-factor infertility by means of endocrine abnormalities, associated comorbidities, and direct effects on the precision and throughput of spermatogenesis. Robust epidemiologic, clinical, genetic, epigenetic, and preclinical data support these findings. Clinical studies on the impact of medically induced weight loss on serum testosterone concentrations and spermatogenesis is promising but may show differential and unsustainable results. In contrast, literature has demonstrated that weight loss after bariatric surgery is correlated with an increase in serum testosterone concentrations that is superior than that obtained with only lifestyle modifications, supporting a further metabolic benefit from surgery that may be specific to the male reproductive system. The data on sperm and semen parameters is controversial to date. Emerging evidence in the burgeoning field of genetics and epigenetics has demonstrated that paternal obesity can affect offspring metabolic and reproductive phenotypes by means of epigenetic reprogramming of spermatogonial stem cells. Understanding the impact of this reprogramming is critical to a comprehensive view of the impact of obesity on subsequent generations. Furthermore, conveying the potential impact of these lifestyle changes on future progeny can serve as a powerful tool for obese men to modify their behavior. Healthcare professionals treating male infertility and obesity need to adapt their practice to assimilate these new findings to better counsel men about the importance of paternal preconception health and the impact of novel non-medical therapeutic interventions. Herein, we summarize the pathophysiology of obesity on the male reproductive system and emerging evidence regarding the potential role of bariatric surgery as treatment of male obesity-associated gonadal dysfunction.
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Affiliation(s)
- Sana Sultan
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ameet G. Patel
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Shamsi El-Hassani
- Minimal Access and Bariatric Unit, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Orpington, United Kingdom
| | - Benjamin Whitelaw
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Bianca M. Leca
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Royce P. Vincent
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Carel W. le Roux
- Diabetes Complication Research Centre, School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Belfield, Ireland
| | - Francesco Rubino
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Simon J. B. Aywlin
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Georgios K. Dimitriadis
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
- *Correspondence: Georgios K. Dimitriadis
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Xu T, Wang C, Zhang H, Han X, Liu W, Han J, Yu H, Chen J, Zhang P, Di J. Timing of Maximal Weight Reduction Following Bariatric Surgery: A Study in Chinese Patients. Front Endocrinol (Lausanne) 2020; 11:615. [PMID: 33042006 PMCID: PMC7522214 DOI: 10.3389/fendo.2020.00615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Bariatric surgery is a well-received treatment for obesity with maximal weight loss at 12-36 months postoperatively. We investigated the effect of early bariatric surgery on weight reduction of Chinese patients in accordance with their preoperation characteristics. Materials and Methods: Altogether, 409 patients with obesity from a prospective cohort in a single bariatric center were enrolled retrospectively and evaluated for up to 4 years. Measurements obtained included surgery type, duration of diabetic condition, besides the usual body mass index data tuple. Weight reduction was expressed as percent total weight loss (%TWL) and percent excess weight loss (%EWL). Results: RYGB or SG were performed laparoscopically without mortality or complications. BMI generally plateaued at 12 months, having decreased at a mean of 8.78 kg/m2. Successful weight loss of >25% TWL was achieved by 35.16, 49.03, 39.22, 27.74, 20.83% of patients at 6, 12, 24, 36, and 48 months after surgery. Overall, 52.91% of our patients had lost 100% of their excess weight at 12 months, although there was a rather wide range among individuals. Similar variability was revealed in women of child-bearing age. Conclusion: Chinese patients undergoing bariatric surgery tend to achieve maximal weight loss and stabilization between 12 and 24 months postoperatively, instead of at >2 years. The finding of the shorter stabilization interval has importance to earlier intervention of weight loss related conditions and women's conception planning.
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Affiliation(s)
- Ting Xu
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chen Wang
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongwei Zhang
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaodong Han
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weijie Liu
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junfeng Han
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jin Chen
- Department of Computer Science, Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, United States
| | - Pin Zhang
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianzhong Di
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Mahutte N, Kamga-Ngande C, Sharma A, Sylvestre C. Obesity and Reproduction. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:950-966. [PMID: 29921431 DOI: 10.1016/j.jogc.2018.04.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide a comprehensive review and evidence-based recommendations for the delivery of fertility care to women with obesity. OUTCOMES The impact of obesity on fertility, fertility treatments, and both short and long-term maternal fetal outcomes was carefully considered. EVIDENCE Published literature was reviewed through searches of MEDLINE and CINAHL using appropriate vocabulary and key words. Results included systematic reviews, clinical trials, observational studies, clinical practice guidelines, and expert opinions. VALUES The Canadian Fertility & Andrology Society (CFAS) is a multidisciplinary, national non-profit society that serves as the voice of reproductive specialists, scientists, and allied health professionals working in the field of assisted reproduction in Canada. The evidence obtained for this guideline was reviewed and evaluated by the Clinical Practice Guideline (CPG) Committee of the CFAS under the leadership of the principal authors. BENEFITS, HARMS, AND COSTS The implementation of these recommendations should assist clinicians and other health care providers in counselling and providing reproductive care to women with obesity. VALIDATION This guideline and its recommendations have been reviewed and approved by the membership, the CPG Committee and the Board of Directors of the CFAS. SPONSORS Canadian Fertility & Andrology Society. RECOMMENDATIONS Twenty-one evidence based recommendations are provided. These recommendations specifically evaluate the impact of obesity on natural fertility, fertility treatments, and maternal-fetal outcomes. Strategies to lose weight and BMI cut-offs are also addressed.
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Affiliation(s)
| | - Carole Kamga-Ngande
- Department of Obstetrics and Gynecology, University of Montréal, Montréal, QC
| | | | - Camille Sylvestre
- Department of Obstetrics and Gynecology, University of Montréal, Montréal, QC
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Xu J, Wu Q, Zhang Y, Pei C. Effect of Bariatric Surgery on Male Sexual Function: A Meta-Analysis and Systematic Review. Sex Med 2019; 7:270-281. [PMID: 31302076 PMCID: PMC6728768 DOI: 10.1016/j.esxm.2019.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/28/2019] [Accepted: 06/09/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Obesity is a worldwide public health issue with serious psychological and social impacts. Erectile dysfunction is also a common clinical condition, and obesity is one of its main risk factors. OBJECTIVE The objective of this study was to systematically evaluate the effect of bariatric surgery on male sexual function. METHODS A systematical research was carried out in Medline via PubMed, EMBASE, Cochrane Library, and Web of Science up to March 16, 2019, to identify published articles related to bariatric surgery and male sexual function in men. Two reviewers screened literature, extracted data, and assessed the quality of included studies. I2 index was applied to estimate the heterogeneity. All analyses were done using RevMan5.3 and Stata14. RESULTS A total of 12 studies involving 420 participants were included. Analysis showed that bariatric surgery significantly reduced body mass index in morbidly obese patients (mean difference [MD] = -13.73; 95% CI -17.23 to -10.22; P < .00001). From 10 studies that reported the International Index of Erectile Function (IIEF) score, bariatric surgery led to a significant increase in IIEF-total score (MD = 8.2; 95% CI = 5.52-10.88; P < .00001), and erectile function score (MD = 3.76; 95% CI = 2.34-5.19; P < .00001), sexual desire (MD = 0.93; 95% CI = 0.55-1.32; P < .00001), sexual intercourse satisfaction (MD = 1.73; 95% CI = 0.43-3.03; P < .01), and total satisfaction (MD = 1.28; 95% CI = 0.56-2.00; P = .0005) were also significantly improved. However, bariatric surgery did not affect orgasm function (MD = 0.26; 95% CI = -0.15 to 0.68; P = .21). Three studies that reported the IIEF-5 score also showed a significant improvement of erectile function (MD = 5.45; 95% CI = 3.38-7.52; P < .00001). CONCLUSIONS Bariatric surgery could improve the erectile function, sexual desire, sexual intercourse satisfaction, and total satisfaction in morbidly obese men. Due to limited data on body mass index and hormone levels, our meta-analysis had some limitations. More clinical studies are needed to further explore the relationship between bariatric surgery and male sexual function. Xu J, Wu Q, Zhang Y, et al. Effect of Bariatric Surgery on Male Sexual Function: A Meta-Analysis and Systematic Review. Sex Med 2019;7:270-281.
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Affiliation(s)
- Jiangnan Xu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China; Soochow University, Suzhou, China
| | - Qian Wu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China; Soochow University, Suzhou, China
| | | | - Changsong Pei
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Liu W, Zhang H, Han X, Zhang P, Mao Z. Uric acid level changes after bariatric surgery in obese subjects with type 2 diabetes mellitus. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:332. [PMID: 31475202 DOI: 10.21037/atm.2019.06.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The purpose of the study was to investigate the incidence of hyperuricemia (HU) in obese subjects with type 2 diabetes mellitus (T2DM) before and after Roux-en-Y gastric bypass (RYGB), to describe the impact of this therapy in reducing uric acid levels, and its possible mechanism. This study was performed by cooperation with the First affiliated hospital of Soochow University and the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, department of general surgery. Methods A retrospective study was performed. From February 2015 to December 2017, we evaluated 147 obese patients with T2DM. Blood samples and other clinical data were drawn before and postoperative (1, 3, 6, 12 months after RYGB). All obese patients with T2DM underwent laparoscopic Roux-en-Y gastric bypass surgery (LRYGB). Different gender with HU were compared before and after surgery. Results A total of 147 patients received LRYGB (75 were female, 72 were male), and 48 patients with HU (22 were female, 26 were male). Four women and 2 men were lost to follow-up, they were excepted from this study. No patients with HU lost to follow-up. There's an intuitive downward trend about uric acid levels both in men and women, with men from 497.9 µmol/L before surgery to 371.5 µmol/L 1 year after surgery, P=0.000; women from 432.3 to 354.1 µmol/L, P=0.002. The proportion of HU changed with men from 37.1% (26/70) before surgery to 12.9% (9/70) one year after surgery, women from 31.0% (22/71) to 14.1% (10/71). The results of binary logistic regression analysis confirmed that triglycerides were clinical predictors for HU remission (P=0.004). No major late surgical complications were reported. Conclusions Our data showed that, bariatric surgery was effective to decrease the levels of serum uric acid (SUA) in obese patients with T2DM. Compared with traditional drug treatment, this shows a possible treatment of HU by RYGB. The remission of HU was associated with the decreased triglyceride levels in obese patients with T2DM, independent of BMI. The potential role of triglycerides in the remission of HU merits further study.
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Affiliation(s)
- Weijie Liu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Hongwei Zhang
- Department of Metabolic & Bariatric Surgery, the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China
| | - Xiaodong Han
- Department of Metabolic & Bariatric Surgery, the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China
| | - Pin Zhang
- Department of Metabolic & Bariatric Surgery, the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China
| | - Zhongqi Mao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Di Vincenzo A, Busetto L, Vettor R, Rossato M. Obesity, Male Reproductive Function and Bariatric Surgery. Front Endocrinol (Lausanne) 2018; 9:769. [PMID: 30619096 PMCID: PMC6305362 DOI: 10.3389/fendo.2018.00769] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 12/06/2018] [Indexed: 12/21/2022] Open
Abstract
Overweight and obesity are associated with several chronic complications, such as type 2 diabetes, arterial hypertension and atherosclerotic cardiovascular diseases, with relevant consequences for patients and public health systems. Reproductive function abnormalities, such as obesity-related secondary hypogonadism, erectile dysfunction and infertility, represent other abnormalities negatively affecting the quality of life of men suffering from obesity but, despite their high prevalence, these are often understated because of a general lack of awareness in clinical practice. Obesity and gonadal function are closely related, with obesity being associated with hypogonadism that is reversed by body weight reduction thus ameliorating reproductive and sexual health. Clinical studies specifically evaluating the impact of non-surgical weight loss on testosterone levels sometimes showed conflicting results, whereas extensive literature has demonstrated that weight loss after bariatric surgery is correlated with an increase in testosterone levels greater than that obtained with only lifestyle interventions, suggesting the role of surgery also for the treatment of hypogonadism in obese male. However, studies concerning the consequences of bariatric surgery on overall reproductive function in the male, including also sexual activity and fertility, are limited and data regarding long-term effects are lacking. Here we present a brief review summarizing the evidence regarding the interplay between obesity and reproductive abnormalities in the obese male, together with the role of bariatric surgery for the treatment of these complications, describing both the positive effects and the limitations of this procedure.
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Affiliation(s)
- Angelo Di Vincenzo
- Department of Medicine—DIMED, Center for the Study and Integrated Management of Obesity, Clinica Medica 3, University-Hospital of Padova, Padova, Italy
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Impact of Bariatric Surgery on Male Sex Hormones and Sperm Quality: a Systematic Review and Meta-Analysis. Obes Surg 2018; 29:334-346. [DOI: 10.1007/s11695-018-3557-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Moon KH, Park SY, Kim YW. Obesity and Erectile Dysfunction: From Bench to Clinical Implication. World J Mens Health 2018; 37:138-147. [PMID: 30079640 PMCID: PMC6479091 DOI: 10.5534/wjmh.180026] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/17/2018] [Accepted: 05/23/2018] [Indexed: 12/25/2022] Open
Abstract
Obesity is a major public health issue worldwide and is frequently associated with erectile dysfunction (ED). Both conditions may share an internal pathologic environment, also known as common soil. Their main pathophysiologic processes are oxidative stress, inflammation, and resultant insulin and leptin resistance. Moreover, the severity of ED is correlated with comorbid medical conditions, including obesity. Therefore, amelioration of these comorbidities may increase the efficacy of ED treatment with phosphodiesterase 5 inhibitors, the first-line medication for patients with ED. Although metformin was originally developed as an insulin sensitizer six decades ago, it has also been shown to improve leptin resistance. In addition, metformin has been reported to reduce oxidative stress, inflammatory response, and body weight, as well as improve ED, in animal and human studies. Moreover, administration of a combination of metformin and phosphodiesterase 5 inhibitors improves erectile function in patients with ED who have a poor response to sildenafil and are insulin resistant. Thus, concomitant treatment of metabolic derangements associated with obesity in patients with ED who are obese would improve the efficacy and reduce the refractory response to penile vasodilators. In this review, we discuss the connecting factors between obesity and ED and the possible combined treatment modalities.
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Affiliation(s)
- Ki Hak Moon
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - So Young Park
- Department of Physiology, Yeungnam University College of Medicine, Daegu, Korea
| | - Yong Woon Kim
- Department of Physiology, Yeungnam University College of Medicine, Daegu, Korea.
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Liu F, Tu Y, Zhang P, Bao Y, Han J, Jia W. Decreased visceral fat area correlates with improved total testosterone levels after Roux-en-Y gastric bypass in obese Chinese males with type 2 diabetes: a 12-month follow-up. Surg Obes Relat Dis 2018; 14:462-468. [DOI: 10.1016/j.soard.2017.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/15/2017] [Accepted: 11/03/2017] [Indexed: 01/21/2023]
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Wen JP, Wen LY, Zhao YJ, Li Q, Lin W, Huang HB, Liang JX, Li LT, Lin LX, Chen G. Effect of Bariatric Surgery on Sexual Function and Sex Hormone Levels in Obese Patients: A Meta-Analysis. J Endocr Soc 2017. [DOI: 10.1210/js.2017-00233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jun-Ping Wen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Ling-Ying Wen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Ya-Jun Zhao
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Qian Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Wei Lin
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Hui-Bin Huang
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Ji-Xing Liang
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Lian-Tao Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Li-Xiang Lin
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Gang Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
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24
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Glina FPA, de Freitas Barboza JW, Nunes VM, Glina S, Bernardo WM. What Is the Impact of Bariatric Surgery on Erectile Function? A Systematic Review and Meta-Analysis. Sex Med Rev 2017; 5:393-402. [PMID: 28526630 DOI: 10.1016/j.sxmr.2017.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Obesity is a worldwide public health issue that has severe psychological and social implications. Erectile dysfunction also is a prevalent clinical situation, and obesity is one of the primary risk factors for its development. AIM To determine whether bariatric surgery can lessen erectile dysfunction in obese men because of evidence showing that weight loss in obese men contributes to decreasing erectile dysfunction and bariatric surgery contributes to significant weight loss. METHODS A search was conducted using Medline, LILACS, Cochrane, Scopus, CINAHL, Embase, Web of Science, Eric, and EBM up to April 13, 2016. The authors selected by title, abstract, and full text. Scottish Intercollegiate Guidelines Network checklists were used for comparative studies to show the limitations and biases of each article. RevMan 5.3 software from the Cochrane Library was used for meta-analyses. Results were demonstrated with forest plots. MAIN OUTCOME MEASURES The outcome selected was resolution of erectile dysfunction, which was analyzed by improvement in the International Index of Erectile Function (IIEF) score. RESULTS Of 185 articles analyzed, 7 were selected for systematic review. Meta-analysis of two articles that evaluated erectile function showed a 5.66-point increase in the five-item IIEF score of patients who underwent bariatric surgery (95% CI = 7.88-3.45, I2 = 35%, P < .00001), demonstrating statistical significance. Meta-analysis of three articles showed a 4.10-point increase in the IIEF erectile function score of patients who underwent bariatric surgery (95% CI = 6.10-2.10, I2 = 0%, P < .0001), demonstrating statistical significance. CONCLUSION Bariatric surgery leads to an improvement of erectile function. Glina FPI, de Freitas Barboza JW, Nunes VM, et al. What Is the Impact of Bariatric Surgery on Erectile Function? A Systematic Review and Meta-Analysis. Sex Med Rev 2017;5:393-402.
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Affiliation(s)
| | | | - Victor Moises Nunes
- Faculdade de Ciências Médicas de Santos, Centro Universitário Lusíada, São Paulo, Brazil
| | - Sidney Glina
- Department of Urology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
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25
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Zhang H, Di J, Yu H, Han X, Li K, Zhang P. The Short-Term Remission of Diabetic Nephropathy After Roux-en-Y Gastric Bypass in Chinese Patients of T2DM with Obesity. Obes Surg 2015; 25:1263-70. [PMID: 25925612 PMCID: PMC4460269 DOI: 10.1007/s11695-015-1666-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The study aimed to examine the effect of gastric bypass on diabetic nephropathy (DN) in Chinese patients. A retrospective study of 101 samples with DN stages I to IV underwent Roux-en-Y gastric bypass. Anthropometric and biochemical parameters were assessed during a 1-year follow-up. Binary logistic regression analysis was used for predictors and ROC for cutoff points. There was significant reduction of medication for diabetes and hypertension. Overall remission of T2DM was 80.2 %. Preoperative albumin/creatinine ratio (ACR) and serum creatinine (SCr) levels could be predictors for DN remission, and the cutoff points were 126 mg/g cr and 57 μmol/L, respectively. Gastric bypass showed improvement of T2DM and DN. Gastric bypass may be more beneficial for those with lower preoperative ACR and SCr.
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Affiliation(s)
- Hongwei Zhang
- />Department of General Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Jianzhong Di
- />Department of General Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Haoyong Yu
- />Department of Endocrinology and Metabolism, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Xiaodong Han
- />Department of General Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Kun Li
- />Department of General Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Pin Zhang
- />Department of General Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
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