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      Increased risk of erectile dysfunction in men with multiple sclerosis: an Italian cross-sectional study

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          Abstract

          Introduction

          Sexual dysfunctions (SDs) are common, but often underestimated symptoms in men with multiple sclerosis (MS). The most common sexual complaint in a multiple sclerosis male is erectile dysfunction (ED). The aim of this observational, cross-sectional study was to assess the prevalence of erectile dysfunction (ED) and its relationship with neurological disability, depression, urodynamic findings and lower urinary tract symptoms (LUTS) in these patients.

          Material and methods

          From January 2014 to January 2016, there were 101 consecutive male patients with a diagnosis of Multiple Sclerosis according to the McDonald revised criteria and stable sexual relationships were included. Patients were evaluated with the International Index of Erectile Function (IIEF-15), Sexual Quality of Life Questionnaire-Male version (SQoL-M), International Prostate Symptom Score (I-PSS) and the Beck Depression Inventory-II (BDI-II). Neurological impairment was assessed using the Expanded Disability Status Scale (EDSS). The presence of Detrusor Overactivity (DO), Detrusor Underactivity (DU) and Detrusor Sphincter Dyssynergia (DSD), was defined by International Continence Society (ICS) criteria.

          Results

          Erectile dysfunction (ED) defined according to the erectile function (EF)-subdomain score ≤25 was present in 75 patients (74.25%). Univariate regression analysis showed that Sexual Quality of Life Questionnaire-Male version (P <0.0001), age (P = 0.021), Expanded Disability Status Scale score (P = 0.001), Beck Depression Inventory-IIscore (P = 0.001),International Prostate Symptom Score (P = 0.001), Detrusor Underactivity (P = 0.002), Multiple Sclerosis-Secondary Progressive (P = 0.002) was significantly associated with erectile dysfunction. All significant findings in univariate analysis were then entered into a multiple logistic regression model. The results indicated that the Beck Depression Inventory-II score (P = 0.011) and International Prostate Symptom Score (P = 0.043) were the only independent predictive factors of erectile dysfunction onset in these patients.

          Conclusions

          Hence, in order to provide an effective approach and management for erectile dysfunction all the mentioned symptoms and clinical variables should be kept in mind.

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          Most cited references33

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          Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis.

          Evan Atlantis, Thomas Sullivan (2012)
          Depression is frequently associated with sexual dysfunction in both men and women. To examine whether depression predicts sexual dysfunction and, conversely, whether sexual dysfunction predicts depression. A systematic review and meta-analysis was conducted. PubMed and EMBASE biomedical answers electronic databases were searched for relevant studies up to November 2011. Reference lists of relevant articles were hand-searched and expert opinions were sought. Studies identified for inclusion had to be prospective cohort studies in adult populations that reported an association between depression and sexual dysfunction variables. Odds ratios (ORs), prioritized where available, or relative risks (RRs) were pooled across studies using random-effects meta-analysis models. Eight citations included for review yielded six studies on depression and risk of sexual dysfunction in 3,285 participants followed for 2-9 years, and six studies on sexual dysfunction and risk of depression in 11,171 participants followed for 1-10 years. Depression increased the risk of sexual dysfunction in pooled unadjusted (RR/OR 1.52 with 95% confidence intervals [1.02, 2.26]) and adjusted (RR/OR 1.71 [1.05, 2.78]) meta-analyses but not in the partially adjusted model (RR/OR 1.41 [0.90, 2.23]). There was significant heterogeneity between studies, but after removal of a single outlying study was diminished and the pooled partially adjusted, RR/OR increased to 1.69 (1.15, 2.47). Sexual dysfunction increased the odds of depression in the pooled unadjusted (OR 2.30 [1.74, 3.03]), adjusted (OR 3.12 [1.66, 5.85]), and partially adjusted (OR 2.71 [1.93, 3.79]) meta-analyses; heterogeneity was significant only in the adjusted model. Meta-regression analyses did not detect significant sources of heterogeneity in either examination. Clinicians should be aware of a bidirectional association between depression and sexual dysfunction. Patients reporting sexual dysfunction should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for sexual dysfunction. © 2012 International Society for Sexual Medicine.
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            Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients.

            W Ranieri, Lisa Beck, Jane Steer … (1998)
            To ascertain the dimensions of the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) in clinically depressed outpatients, exploratory factor analyses were performed with the BDI-II responses of 210 adult (> or =18 years) outpatients who were diagnosed with DSM-IV depressive disorders. Two factors representing Somatic-Affective and Cognitive dimensions were found whose compositions were comparable to those previously reported by Beck, Steer, and Brown (1996) for psychiatric outpatients in general. A subsequent confirmatory factor analysis supported a model in which the BDI-II reflected one underlying second-order dimension of self-reported depression composed of two first-order factors representing cognitive and noncognitive symptoms. The clinical utility of using subscales based on these two latter first-order symptom dimensions was discussed.
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              The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated.

              D Campagnolo, R. Marrie, T Tyry … (2009)
              Mental comorbidity is common in multiple sclerosis (MS), but some studies suggest that mental comorbidity may be underrecognized and undertreated. Using the North American Research Committee on MS Registry, we assessed the frequency of mental comorbidities in MS and sociodemographic characteristics associated with diagnosis and treatment of depression. We queried participants regarding depression, anxiety, bipolar disorder, and schizophrenia. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD); a score>or=21 indicated probable major depression. Mental comorbidity affected 4264 (48%) responders; depression most frequently (4012, 46%). Among participants not reporting mental comorbidity, 751 (16.2%) had CESD scores>or=21 suggesting undiagnosed depression. Lower socioeconomic status was associated with increased odds of depression (Income $15,000-30,000 vs >$100,000 OR 1.34; 1.11-1.62), undiagnosed depression (Income $15,000-30,000 vs >$100,000 OR 1.52; 1.08-2.13), and untreated depression (
              Article 0 comments Cited 58 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cent European J Urol
                Journal ID (iso-abbrev): Cent European J Urol
                Journal ID (publisher-id): CEJU
                Title: Central European Journal of Urology
                Publisher: Polish Urological Association
                ISSN (Print): 2080-4806
                ISSN (Electronic): 2080-4873
                Publication date (Electronic): 04 August 2017
                Publication date (Print): 2017
                Volume: 70
                Issue: 3
                Pages: 289-295
                Affiliations
                [1 ]Urology Service, University of Campania L. Vanvitelli, Naples, Italy
                [2 ]Doctorate Research Program, Magna Graecia University of Catanzaro, Catanzaro, Italy
                [3 ]Department of Urology and Andrology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
                [4 ]Division of Urology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
                [5 ]Urogynecology San Carlo – IDI-Hospital Rome, Rome, Italy
                Author notes
                Corresponding author Raffaele Balsamo, University of Campania, L. Vanvitelli, Urology Service, Via Pansini 5, Naples, Italy. phone: +39 339 1367999. r.bals@ 123456virgilio.it
                Article
                Publisher ID: 1380
                DOI: 10.5173/ceju.2017.1380
                PMC ID: 5656369
                SO-VID: 32ef62a4-1b0a-4236-990c-70a0622983b3
                Copyright © Copyright by Polish Urological Association
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                Date received : 12 April 2017
                Date revision received : 30 July 2017
                Date accepted : 04 August 2017
                Categories
                Subject: Original Paper

                Keywords: erectile dysfunction,multiple sclerosis,lower urinary tract symptoms,urodynamic,international index of erectile function
                Data availability:
                Keywords: erectile dysfunction, multiple sclerosis, lower urinary tract symptoms, urodynamic, international index of erectile function

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