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Darmadi D, Pakpahan C, Ruslie RH, Amanda B, Ibrahim R. The sex life of male patients with cirrhosis and its organic factors: What we have got so far? PLoS One 2023; 18:e0280915. [PMID: 36730272 PMCID: PMC9894452 DOI: 10.1371/journal.pone.0280915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/11/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the sex lives of male cirrhotic patients organic factors affect them. METHOD We did an observational study of 220 cirrhotic men's satisfaction with their sexual lives. Assessment of sex satisfaction was carried out using the New Sexual Satisfaction Scale. The frequency of intercourse and masturbation was estimated. Then, the levels of albumin, total bilirubin, vitamin D, and sex steroids were examined. Ascites and sarcopenia subgroups of our patients were stratified. RESULTS Along with sex steroids, albumin, total bilirubin, and vitamin D all had an impact on how satisfying sex was (r = 0.22), (r = 0.24), and (r = -0.17) affected sex satisfaction. There were strong positive correlations between vitamin D (r = 0.33), albumin (r = 0.59), and free testosterone, along with a negative correlation between total bilirubin (r = -0.63) and free testosterone. An imbalance in sex steroid levels was observed, leading to decreased frequency of intercourse(p < 0.0001), weakened erections(p < 0.0001), and reduced quality of orgasm (p < 0.0001). Significant new sex behavior changes were found, such as an increase in masturbation. Physical limitations such as ascites and sarcopenia also impacted the decreasing sex life. CONCLUSION The sex life of cirrhotic men is affected. The decrease in the frequency of intercourse and sexual satisfaction is noticeable in male patients and leads to increased masturbation. Free Testosterone, vitamin D, albumin, and bilirubin play role in their sex life. In addition, ascites and sarcopenia not only affect their sex life but also hamper the quality of their well-being.
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Affiliation(s)
- Darmadi Darmadi
- Faculty of Medicine, Department of Internal Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Cennikon Pakpahan
- Faculty of Medicine, Andrology Study Program, Universitas Airlangga, Surabaya, Indonesia
- Faculty of Medicine, Department of Biomedical Sciences, Universitas Airlangga, Surabaya, Indonesia
| | - Riska Habriel Ruslie
- Faculty of Medicine, Department of Child Health, Universitas Prima Indonesia, Medan, Indonesia
| | - Bella Amanda
- Faculty of Medicine, Andrology Study Program, Universitas Airlangga, Surabaya, Indonesia
- Faculty of Medicine, Department of Biomedical Sciences, Universitas Airlangga, Surabaya, Indonesia
| | - Raditya Ibrahim
- Faculty of Medicine, Andrology Study Program, Universitas Airlangga, Surabaya, Indonesia
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Ramani N, Kawli K, Karad A, Kale A, Kahalekar V, Sundaram S, Bhatia S, Shah R, Bandgar T, Deshmukh H, Patwardhan S, Shukla A. Gonadal dysfunction in male patients with Budd Chiari syndrome and its reversibility with treatment. Hepatol Int 2022; 16:640-648. [PMID: 35301679 DOI: 10.1007/s12072-022-10316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIMS Budd Chiari syndrome (BCS) commonly affects adolescents and adults. With improved survival, important quality-of-life parameters such as sexual life and fertility become more relevant. This study was aimed to assess the gonadal function in male patients with BCS and the effect of treatment on gonadal function. METHODS Thirty male patients with newly diagnosed BCS were prospectively assessed for the presence of gonadal dysfunction. Erectile function was assessed using standardized International Index of Erectile Function questionnaire (IIEF). Follicular stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), estradiol, total testosterone (TT), calculated free testosterone (cFT), calculated bioavailable testosterone (cBT), sperm count, and sperm motility were compared at baseline and at 6 months of treatment for the assessment of gonadal function. RESULTS Sixteen (53.3%) out of 30 patients were sexually active at the time of study and 5/16 (31%) had erectile dysfunction. Hypogonadotropic hypogonadism (HH) was the most common pattern seen in 50% cases followed by hypergonadotropic hypogonadism (HyH) in 23% cases. 27% patients had eugonadism. At 6 months of treatment, 60% of patients in HH group became eugonadal as compared to only 14% in HyH group. Proportion of patients with erectile dysfunction reduced (5/16 vs 1/16) after 6 months of therapy. The improvement in sperm count and sperm motility was not significant. CONCLUSION Gonadal dysfunction is common in male patients with BCS. HH remains the most common type of hypogonadism BCS and the type which improves significantly after treatment.
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Affiliation(s)
- Nitin Ramani
- Department of Gastroenterology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, 400012, India
| | - Kashmira Kawli
- Department of Gastroenterology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, 400012, India
| | - Abhijeet Karad
- Department of Gastroenterology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, 400012, India
| | - Aditya Kale
- Department of Gastroenterology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, 400012, India
| | - Vinit Kahalekar
- Department of Gastroenterology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, 400012, India
| | - Sridhar Sundaram
- Department of Gastroenterology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, 400012, India
| | - Shobna Bhatia
- Department of Gastroenterology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, 400012, India
| | - Ravikumar Shah
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Hemant Deshmukh
- Department of Radiology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Sujata Patwardhan
- Department of Urology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Akash Shukla
- Department of Gastroenterology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, 400012, India.
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Prevalence and risk factors of erectile dysfunction in patients with liver cirrhosis: a systematic review and meta-analysis. Hepatol Int 2021; 17:452-462. [PMID: 34799837 DOI: 10.1007/s12072-021-10270-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Liver cirrhosis is associated with an increased risk of developing erectile dysfunction (ED). The aim of this systematic review and meta-analysis was to evaluate the prevalence of ED and its risk factors in male patients with liver cirrhosis. METHODS A systematic search of PubMed (Medline), EMBASE, OVID Medline, the Cochrane Library, and other databases was performed for this review. Two investigators reviewed the abstracts obtained from the search and selected manuscripts for full-text review. The event rates were calculated with random-effects model and quality effects model. RESULTS Fourteen studies evaluating ED with the International Index of Erectile Function (IIEF) scores were selected. A total of 770 patients with liver cirrhosis were analyzed. The prevalence of ED in cirrhotic patients was 79% [decompensated: 88.4%, CI 35.95-70.84%, I2 heterogeneity 85%; compensated: 53.6%, CI 77.64-32%, I2 heterogeneity 80%]. Through a meta-regression analysis, we discovered that the presence of decompensation, use of beta-blocker and diuretics were related with ED. In addition, risk factors for ED included high body mass index [odds ratio (OR) 1.13, 95% CI 1.01-1.26], advanced Child-Pugh class (OR 2.29, 95% CI 1.12-4.72), MELD score (OR 1.19, 95% CI 1.05-1.35), diabetes (OR 3.44, 95% CI 1.38-8.57), and hypertension (OR 8.24, 95% CI 1.62-41.99). CONCLUSION ED is relatively common in male patients with cirrhosis, and presence of risk factors increases the prevalence of ED. CLINICAL TRIAL NUMBER PROSPERO (International Prospective Register of Systematic Reviews), CRD42020220411.
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Romano L, Granata L, Fusco F, Napolitano L, Cerbone R, Priadko K, Sciorio C, Mirone V, Romano M. Sexual Dysfunction in Patients With Chronic Gastrointestinal and Liver Diseases: A neglected Issue. Sex Med Rev 2021; 10:620-631. [PMID: PMID: 37051954 DOI: 10.1016/j.sxmr.2021.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Normal sexual activity is an important determinant of quality of life. Unfortunately, several chronic health disorders are associated with an impaired sexual function. OBJECTIVE To provide coverage of the current literature on prevalence and pathophysiology of sexual dysfunction in patients with gastrointestinal and liver disorders METHODS: A Comprehensive review of the literature on the prevalence of sexual dysfunction in chronic gastrointestinal and liver disorders, assessing the underlying mechanism (s) was performed. RESULTS Many gastrointestinal disorders, either functional or organic, are associated with some degree of sexual dysfunction. The main pathogenic mechanisms are: (i) the disease itself causing fatigue, anxiety or depression with a potential alteration of self-esteem; (ii) worry of transmitting a potential infectious agent through sexual activity; (iii) alteration of the endocrine mechanisms which are necessary for normal sexual functioning; (iv) chronic pro- inflammatory conditions which may cause endothelial dysfunction and abnormal vascular responses; (v) iatrogenic. CONCLUSION Based on this review, a thorough evaluation of sexual function through validated questionnaires and/or psychological interviews with patients with chronic gastrointestinal disorders should be part of the clinical assessment in order to timely diagnose and possibly treat sexual dysfunction in this clinical setting. L Romano, L Granata, F Fusco, et al. Sexual Dysfunction in Patients With Chronic Gastrointestinal and Liver Diseases: A neglected Issue. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Lorenzo Romano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Lucia Granata
- Dipartimento di Medicina di Precisione, Hepato-Gastroenterology Unit, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Ferdinando Fusco
- Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Rosa Cerbone
- Dipartimento di Medicina di Precisione, Hepato-Gastroenterology Unit, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Kateryna Priadko
- Dipartimento di Medicina di Precisione, Hepato-Gastroenterology Unit, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | | | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Marco Romano
- Dipartimento di Medicina di Precisione, Hepato-Gastroenterology Unit, Università della Campania Luigi Vanvitelli, Napoli, Italy
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Alhefnawy M, Mohey A, Fathi A, Mansour A, Abd-Elsalam S, Eissa A, Hagras A, Puliatti S, Almekaty K. Effect of Direct-Acting Antiviral Drugs on Erectile Functions among Hepatitis C Patients: A Prospective Interventional Study. Endocr Metab Immune Disord Drug Targets 2021; 22:310-317. [PMID: 33583390 DOI: 10.2174/1871530321666210212143932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND & OBJECTIVE Erectile dysfunction (ED) is one of the extrahepatic manifestations of hepatitis C virus infection that greatly affects patients' quality of life. Unfortunately, some of the drugs used for HCV treatment may have a negative impact on the patient's erectile function such as the pegylated interferon. Currently, with the introduction of directacting antiviral drugs, there are scarce data in the literature about its potential impact on erectile function. In these settings, we aimed to assess the impact of sofosbuvir-based therapy on male erectile function. METHODS This prospective interventional study was carried out in Benha University hospitals between January 2019 and May 2020. The study included all consecutive HCV patients with simultaneous ED coming to the hepatology outpatient clinic. Patients were divided into a study group who received sofosbuvir-based therapy (group A) or a control group who received silymarin therapy (group B). The International Index of Erectile Function-5 (IIEF-5) was used for assessment of erectile function at different time points (pretreatment, 6 months, and 12 months after treatment). Different variables in both groups have been statistically analyzed. RESULTS Overall, 75 patients who received sofosbuvir-based therapy and a control group (n = 35) matched for age and pretreatment variables (Child-Turcotte-Pugh score and Fibrosis- 4 score). There was no significant difference between both groups in the pretreatment data. On the other hand, the posttreatment IIEF-5 was significantly higher in the sofosbuvir arm compared to the silymarin arm both at six months (p<0.001) and at 12 months (p<0.001). Furthermore, the age and the stage of liver fibrosis were negatively correlated with IIEF-5 at all-time points. CONCLUSION The age and the stage of liver fibrosis are significantly correlated with the degree of ED. Furthermore, sofosbuvir-based therapy may be associated with significant improvement in the patients' erectile function.
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Affiliation(s)
- Mohamed Alhefnawy
- Urology Department, Faculty of Medicine, Benha University, Benha. Egypt
| | - Ahmed Mohey
- Urology Department, Faculty of Medicine, Benha University, Benha. Egypt
| | - Ahmed Fathi
- Urology Department, Faculty of Medicine, Benha University, Benha. Egypt
| | - Ahmed Mansour
- Internal Medicine Department, Faculty of Medicine, Benha University, Benha. Egypt
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta. Egypt
| | - Ahmed Eissa
- Urology Department; Faculty of Medicine; Tanta University; Tanta. Egypt
| | - Ayman Hagras
- Urology Department; Faculty of Medicine; Tanta University; Tanta. Egypt
| | - Stefano Puliatti
- Urology Department, University of Modena and Reggio Emilia, Modena. Italy
| | - Khaled Almekaty
- Urology Department; Faculty of Medicine; Tanta University; Tanta. Egypt
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Sarkar M, Brady CW, Fleckenstein J, Forde KA, Khungar V, Molleston JP, Afshar Y, Terrault NA. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 73:318-365. [PMID: 32946672 DOI: 10.1002/hep.31559] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Monika Sarkar
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Jean P Molleston
- Indiana University and Riley Hospital for Children, Indianapolis, IN
| | - Yalda Afshar
- University of California, Los Angeles, Los Angeles, CA
| | - Norah A Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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Payne K, Popat S, Lipshultz LI, Thirumavalavan N. The Prevalence and Treatment of Erectile Dysfunction in Male Solid Organ Transplant Recipients. Sex Med Rev 2019; 9:331-339. [PMID: 31859242 DOI: 10.1016/j.sxmr.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a prevalent and under-recognized complaint among male solid organ transplant recipients. Most research on this topic has focused on kidney transplant recipients alone. In this review, we integrate current research on ED across all types of solid organ transplant recipients and assess the success of current methods of ED treatment in transplant populations. AIM To review the current literature addressing the prevalence and treatment of ED in the male solid organ transplant population. METHODS A literature search was conducted using PubMed to identify relevant studies. Search terms included "organ transplant" and "erectile dysfunction." Titles and abstracts were reviewed for relevance. References from identified articles were also searched and included, if appropriate. MAIN OUTCOME MEASURES Review of peer-reviewed literature. RESULTS The prevalence of ED among transplant recipients is higher than that in the general population: 39.8-86.2% in liver transplant recipients, 54-66% in renal transplant recipients, 71-78% in heart transplant recipients, and 79% in simultaneous pancreas-kidney transplant recipients. Phosphodiesterase-5 inhibitors have up to 80% efficacy in treating ED in kidney transplant recipients. Intracavernosal injections have been used with success rates of 60-70% in cardiac and renal transplant recipients. Penile prostheses have also been shown to be safe and effective across transplant types. A low incidence of infection has been reported in several case series, although there is concern for an increased rate of mechanical complications in pelvic organ transplant recipients. Accordingly, placement of a two-piece or malleable prosthesis or ectopic reservoir placement with a three-piece inflatable prosthesis is suggested in this population. CONCLUSION ED is highly prevalent among male solid organ transplant recipients and should be routinely screened in this population. Current modalities of ED treatment used in the general population are safe and effective in solid organ transplant recipients, although success rates are often lower than those in the general population. Payne K, Popat S, Lipshultz LI, et al. The Prevalence and Treatment of Erectile Dysfunction in Male Solid Organ Transplant Recipients. Sex Med Rev 2021;9:331-339.
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Affiliation(s)
| | - Shreeya Popat
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Nannan Thirumavalavan
- Urology Institute, University Hospitals/Case Western Reserve University School of Medicine, Cleveland, OH.
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Neurocognitive impairment is associated with erectile dysfunction in cirrhotic patients. Dig Liver Dis 2019; 51:850-855. [PMID: 31031175 DOI: 10.1016/j.dld.2019.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is common in patients with chronic diseases. It is evaluated using the International Index of Erectile Function (IIEF5) questionnaire. The relationship between ED and cirrhosis is complex. The aims of our study were (1) to assess the prevalence of ED in cirrhosis and (2) to evaluate factors associated with ED, with a special focus on minimal hepatic encephalopathy (MHE). METHODS We performed a prospective, observational study. Patients with cirrhosis were invited to complete the IIEF5 questionnaire. The exclusion criteria were clinical hepatic encephalopathy (HE) and dementia. MHE was evaluated by the psychometric hepatic encephalopathy test score (PHES) and the critical flicker frequency (CFF). RESULTS Between April 2016 and April 2017, 87 patients were included (age: 55 [51-57] years, Child-Pugh score: 8 [7-9], MELD score: 13 [11-16]. Minimal HE was diagnosed in 33% of the patients according to the PHES and in 44% of the patients according to the CFF. ED was diagnosed in 74/87 patients (85%) when compared to 12.5% in healthy controls (p < 0.001). In a multivariate analysis, the independent factors associated with ED were age, Child-Pugh and MELD scores. Significant correlations were identified between the IIEF5 and each component of the PHES. CONCLUSION ED should be systematically screened in cirrhotics, especially in patients with MHE.
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Chan MY, Chok KSH, Fung JYY, Ng SL, Yiu MK, Lo CM. Prospective Study on Sexual Dysfunction in Male Chinese Liver Transplant Recipients. Am J Mens Health 2019; 13:1557988319835139. [PMID: 30836839 PMCID: PMC6440053 DOI: 10.1177/1557988319835139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In patients with end-stage liver disease, hypogonadism and erectile dysfunction are often seen. This study was to determine the incidence of erectile dysfunction before and after liver transplantation (LT) with correlation to change in sex hormone levels from a Chinese cohort. This prospective longitudinal study was registered with The University of Hong Kong Clinical Trials Centre (HKUCTR-1563). The Institutional Review Board approval number is UW-12-273. The study period was from January 2012 to December 2016. Adult male patients with end-stage liver disease enlisted for LT were recruited on informed written consent. All recruited patients were to complete a cross-sectional cohort questionnaire—International Index of Erectile Function, version 5 (IIEF5)—and to receive serum sex hormone checks before and after LT. Twenty-eight patients who underwent LT were included in the analysis. The included patients had significantly reduced prolactin (p < .001) and 17-beta-estradiol (p = .024) after LT. There was also a significant drop of IIEF5 score at 1 month after LT, but the score returned to pre-LT level at 6 months. This study demonstrated that there was improvement in sex hormone levels after LT, namely, normalization of estradiol level and lowering of prolactin and progesterone levels. However, improvement in sex hormone levels did not translate into improvement of erectile dysfunction.
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Affiliation(s)
- Miu Yee Chan
- 1 Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Kenneth Siu Ho Chok
- 2 Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.,3 State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong SAR, China
| | - James Yan Yue Fung
- 3 State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong SAR, China.,4 Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Sau Loi Ng
- 1 Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Ming Kwong Yiu
- 2 Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Chung Mau Lo
- 2 Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.,3 State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong SAR, China
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Peng JK, Hepgul N, Higginson IJ, Gao W. Symptom prevalence and quality of life of patients with end-stage liver disease: A systematic review and meta-analysis. Palliat Med 2019; 33:24-36. [PMID: 30345878 PMCID: PMC6291907 DOI: 10.1177/0269216318807051] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND: End-stage liver disease is a common cause of morbidity and mortality worldwide, yet little is known about its symptomatology and impact on health-related quality of life. AIM: To describe symptom prevalence and health-related quality of life of patients with end-stage liver disease to improve care. DESIGN: Systematic review. DATA SOURCES: We searched eight electronic databases from January 1980 to June 2018 for studies investigating symptom prevalence or health-related quality of life of adult patients with end-stage liver disease. No language restrictions were applied. Meta-analyses were performed where appropriate. RESULTS: We included 80 studies: 35 assessing symptom prevalence, 41 assessing health-related quality of life, and 4 both. The instruments assessing symptoms varied across studies. The most frequently reported symptoms were as follows: pain (prevalence range 30%–79%), breathlessness (20%–88%), muscle cramps (56%–68%), sleep disturbance (insomnia 26%–77%, daytime sleepiness 29.5%–71%), and psychological symptoms (depression 4.5%–64%, anxiety 14%–45%). Erectile dysfunction was prevalent (53%–93%) in men. The health-related quality of life of patients with end-stage liver disease was significantly impaired when compared to healthy controls or patients with chronic liver disease. Compared with compensated cirrhosis, decompensation led to significant worsening of both components of the 36-Item Short Form Survey although to a larger degree for the Physical Component Summary score (decrease from average 6.4 (95% confidence interval: 4.0–8.8); p < 0.001) than for the Mental Component Summary score (4.5 (95% confidence interval: 2.4–6.6); p < 0.001). CONCLUSION: The symptom prevalence of patients with end-stage liver disease resembled that of patients with other advanced conditions. Given the diversity of symptoms and significantly impaired health-related quality of life, multidisciplinary approach and timely intervention are crucial.
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Affiliation(s)
- Jen-Kuei Peng
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.,2 Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,3 Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Nilay Hepgul
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Irene J Higginson
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Wei Gao
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Chiang HC, Chien YC, Lin PY, Lee HL, Chen YL. Assessing men with erectile dysfunction before and after living donor liver transplantation in real-world practice: Integrating laboratories into clinical settings. PLoS One 2018; 13:e0206438. [PMID: 30458009 PMCID: PMC6245674 DOI: 10.1371/journal.pone.0206438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 10/13/2018] [Indexed: 12/22/2022] Open
Abstract
Objective To evaluate the predictive role of the Model for End-Stage Liver Disease (MELD) score concerning changes in testosterone levels following living donor liver transplantation (LDLT) and the effects of LDLT on total testosterone and sex hormone-binding globulin (SHBG) levels, the free androgen index (FAI) and erectile function in LDLT recipients. Participants 41 adult male recipients of LDLT were evaluated before transplantation and six months after LDLT. Main outcome measures We evaluated the effects of LDLT on total testosterone and SHBG levels, the FAI and erectile function in LDLT recipients. In this prospective study, MELD score, serum total testosterone, SHBG levels and FAI were measured in the morning of the operation day and 1 month, 3 months and 6 months after LDLT. The 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire was administered before LDLT and six months after LDLT to evaluate erectile function. Results The main outcome measure was dynamic parameter changes of total testosterone, SHBG, FAI and erectile dysfunction. The mean FAI value before LDLT was 16.75±10.10. The mean FAI was significantly higher 1 month (32.75±15.56; p < 0.01), 3 months (25.23±10.26; p < 0.01) and 6 months (29.16±11.05; p < 0.01) after LDLT. Mean IIEF-5 scores significantly increased after LDLT (from 11.7±7.7 before LDLT to 14.7±7.5, p< 0.01). Conclusions MELD score correlates with severity of hypogonadism in men with end-stage liver disease. LDLT results in a reduction in serum levels of SHBG, an increase in FAI and improvement in erectile function.
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Affiliation(s)
- Heng-Chieh Chiang
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Chemical Engineering, Chung Yuan Christian University, Chungli, Taiwan
| | - You-Chiuan Chien
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ping-Yi Lin
- Transplant Medicine & Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsiu-Ling Lee
- Transplant Medicine & Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Yao-Li Chen
- Transplant Medicine & Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- * E-mail:
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Magro JTJ, Mendes KDS, Galvão CM. Sexual aspects of liver transplant candidates and recipients: evidence available in the literature1. Rev Lat Am Enfermagem 2018; 26:e3033. [PMID: 30183871 PMCID: PMC6136547 DOI: 10.1590/1518-8345.2744.3033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/16/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the evidence available in the literature on the alterations in the sexuality of candidates and recipients of liver transplantation. METHOD integrative review of the literature with search for primary studies in the databases MEDLINE (via PUBMED), CINAHL e LILACS, published in English, Portuguese and Spanish. RESULTS the 16 primary studies included were grouped into three categories: 1) female sexuality (n=5), 2) male sexuality (n=5) and 3) male and female sexuality (n=6). In category 1, the subjects investigated were contraception, pregnancy, sexual dysfunction, presence of gynecological symptoms and sexually transmitted infections. In category 2, the main focus of the studies was erectile dysfunction, sexual desire and satisfaction, and consequences of the immunosuppressive regimen with mycophenolic acid in men. In category 3, the evaluation of sexual function was the main topic. CONCLUSION the scientific evidence generated provides support to encourage health professionals to incorporate the topic of sexuality in the routine of care. Knowledge gaps were identified and new studies should be conducted in order to implement interventions to prevent, minimize and/or control changes related to the patient's sexuality.
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Affiliation(s)
- Jennifer Tatisa Jubileu Magro
- MSc, RN, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Karina Dal Sasso Mendes
- PhD, RN, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Cristina Maria Galvão
- PhD, Full Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Abstract
Infertility affects up to 12% of all men, and sexual dysfunction occurs frequently in men of reproductive age, causing infertility in some instances. In infertile men, hypoactive sexual desire and lack of sexual satisfaction are the most prevalent types of sexual dysfunction, ranging from 8.9% to 68.7%. Erectile dysfunction and/or premature ejaculation, evaluated with validated tools, have a prevalence of one in six infertile men, and orgasmic dysfunction has a prevalence of one in ten infertile men. In addition, infertile men can experience a heavy psychological burden. Infertility and its associated psychological concerns can underlie sexual dysfunction. Furthermore, general health perturbations can lead to male infertility and/or sexual dysfunction. Erectile dysfunction and male infertility are considered proxies for general health, the former underlying cardiovascular disorders and the latter cancerous and noncancerous conditions. The concept that erectile dysfunction in infertile men might be an early marker of poor general health is emerging. Finally, medications used for general health problems can cause sperm abnormalities and sexual dysfunction. The treatment of some causes of male infertility might improve semen quality and reverse infertility-related sexual dysfunction. In infertile men, an investigation of sexual, general, and psychological health status is advisable to improve reproductive problems and general health.
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Affiliation(s)
- Francesco Lotti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Gariani K, Toso C, Philippe J, Orci LA. Effects of liver transplantation on endocrine function: a systematic review. Liver Int 2016; 36:1401-11. [PMID: 27163168 DOI: 10.1111/liv.13158] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/04/2016] [Indexed: 02/13/2023]
Abstract
Patients with chronic liver disease (CLD) often experience secondary endocrine dysfunction. Therefore, because the liver plays a major role in endocrine function, liver transplantation (LT) may also be beneficial for the restoration of hormonal regulation. This systematic review collects and interprets the available literature on the effect of LT on endocrine and sexual function in adult patients. A systematic review was conducted by searching Pubmed (including Medline) and EMBASE for studies published from database inception until November 2015. We collected all relevant studies that discussed changes in hormonal and sexual function after LT. Studies were included if they assessed the effect of LT on sexual function or one of the following components of the hormone/endocrine axis: the hypothalamus-pituitary-gonadal axis, growth hormone (GH), insulin-like growth factor-1 (IGF-1) or thyroid function. The results are reported according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Twenty-one studies with a total of 1274 patients were included. The results collected from the included studies suggested that LT improves the hormonal perturbation associated with CLD by restoring physiological levels of circulating GH, IGF-1, testosterone, estradiol, prolactin, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Thyroid function was not affected by LT, and sexual function was partially improved after LT. This systematic review suggests that LT is associated with an improvement in endocrine and sexual function in patients with CLD. This information should encourage clinicians who treat CLD patients to identify endocrine disturbances in this population, inform their patients of the effects of LT and assess post-transplantation improvements.
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Affiliation(s)
- Karim Gariani
- Division of Endocrinology, Diabetology, Hypertension and Nutrition, Department of Department of Medical Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Christian Toso
- Division of Abdominal and Transplantation Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jacques Philippe
- Division of Endocrinology, Diabetology, Hypertension and Nutrition, Department of Department of Medical Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Lorenzo A Orci
- Division of Abdominal and Transplantation Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Hepato-Pancreato-Biliary Centre, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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