Disfunção sexual após correção aberta de aneurisma da aorta abdominal: 16 anos de experiência em um centro quaternário e revisão da literatura

Schmid, Bruno Pagnin; Muce, Marcelo Vezzi; Bocos, Rodrigo Gonzalez; Menezes, Fábio Hüsemann

doi:10.1590/1677-5449.202301352

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ORIGINAL ARTICLE • J. Vasc. Bras. 23 • 2024 • https://doi.org/10.1590/1677-5449.202301352 linkcopiar

Disfunção sexual após correção aberta de aneurisma da aorta abdominal: 16 anos de experiência em um centro quaternário e revisão da literatura

Autoria SCIMAGO INSTITUTIONS RANKINGS

Contexto A correção aberta de aneurisma da aorta abdominal (AAA) pode causar disfunção sexual (DS) em homens.

Objetivos Determinar a prevalência de DS após correção aberta de AAA, determinar se a técnica de reconstrução aórtica pode estar correlacionada com o surgimento de DS e resumir os achados mais relevantes da literatura relacionados a esse tema.

Métodos Estudo retrospectivo de todos os pacientes submetidos a correção aberta de AAA entre 1995 e 2010 num centro quaternário. A DS foi avaliada por meio de questões baseadas no escore International Index of Erection Function no pré-operatório e 3 meses após a cirurgia. A análise estatística foi realizada com os testes do qui-quadrado, exato de Fisher e t de Student.

Resultados Cem pacientes foram incluídos (idade média = 66.4 anos). Atividade sexual normal, atividade sexual ausente, disfunção erétil (DE) e ejaculação retrógrada (ER) com função erétil preservada foram observadas em 36%, 21%, 18% e 24% dos pacientes, respectivamente. O grupo de pacientes com atividade sexual ausente foi significativamente mais velho (idade média = 72.3 anos vs. 64.5 anos, p < 0.001). A DE foi mais prevalente em pacientes submetidos a enxerto aorto-bifemoral (p = 0.032), enquanto a ER foi mais prevalente em pacientes submetidos a enxerto aorto-aórtico (p = 0.007).

Conclusões A DS é uma condição frequente e intimamente associada à reconstrução aórtica empregada. A literatura apresenta resultados contraditórios sobre qual correção de AAA (aberta ou endovascular) resulta em mais DS, mas demonstra a importância de técnicas com preservação das artérias hipogástricas e do plexo hipogástrico superior.

Palavras-chave:
aneurisma; disfunção erétil; ejaculação

Questions from the International Index of Erectile Function
1. How often were you able to get an erection during sexual activity?
2. When you attempted sexual intercourse, how often were you able to penetrate (enter) your partner?
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?
4. How much have you enjoyed sexual intercourse?
5. When you had sexual stimulation or intercourse, how often did you ejaculate?
6. How satisfied have you been with your overall sex life?

	No sexual activity (Total = 21)	Normal activity (Total = 34)	ED (Total = 18)	RE (Total = 27)
Aorto-aortic (Total=26)/ percentage of group	4/ 15.4%	7/ 30%	2/ 7.7%	13/ 50%
Aorto-biiliac (Total=50)/ percentage of group	12/ 24%	21/ 42%	6/ 12%	11/ 22%
Aorto-monoiliac (Total=14)/ percentage of group	2/ 14.3%	6/ 42.86%	5/ 35.71%	1/ 7.14%
Aorto-bifemoral (Total=10)/ percentage of group	3/ 30%	0/ 0%	5/ 50%	2/ 20%

Sexual status	Age in years (mean)	No sexual activity vs. other groups (mean age/number of patients)	p-value *
No activity (Total = 21)	72.3	72.3 years (21 patients)	< 0.001
Normal activity (Total = 34)	63.9	64.5 years (79 patients)
ED (Total = 18)	63.7
RE (Total = 27)	65.8

Author	Study Design	Number of patients/studies	Main results
Kalteis et al.¹⁷	Retrospective	106 (82 EVAR vs. 24 EVAR with IIA embolization)	EVAR with IIA embolization was associated with new onset ED (17.3% vs. 42.9%; p = 0.043).
	Single-center
	EVAR vs. EVAR with IIA embolization
Majd et al.¹⁸	Prospective	100 (70 EVAR vs 30 OR)	Increase of ED in both groups (53.3.% OR vs. 58.8% EVAR, p = 0.412).
	Single-center
	OR vs. EVAR
Machado et al.¹⁹	Retrospective	171	ED was more frequent in the elderly group (p<0.05)
	Single-center
	EVAR (patients were divided according to age groups < 70, 70-80, and > 80 years)
Shin et al.²⁰	Retrospective	14	No cases of ED
	Single-center
	EVAR (bifurcated-bifurcated repair)
Bosanquet et al.²¹	Meta-analysis	2671	Higher rates of ED after coiling (11.6% Coils vs. 3.03% Plugs)
Bosanquet et al.²¹	EVAR (coils vs. plugs)	2671
Regnier et al.²²	Meta-analysis	29 studies	Post-operative ED prevalence= (OR 7.4 to 79% vs. EVAR 4.7 to 82%). Post-operative RE prevalence= (OR 3.3 to 9% vs. Laparoscopic repair 6 to 6.6%)
Kudo et al.²³	Narrative Review	NR	Emphasized the importance of preservation of blood flow from IIA and of adequate preservation of the superior hypogastric plexus and lumbar splanchnic nerves
Gallitto et al.¹⁶	Retrospective	115 (58 EVAR, 57 OR)	RE occurred more often in OR patients (31%) than in EVAR patients (2%) (P = 0.001).
	Single-center
	EVAR vs. OR
van Schaik et al.²⁴	A questionnaire-based study aiming to analyze care for sexual health by medical specialists	101	A gap exists in knowledge of pathophysiology and anatomy. Vascular surgeons lack sexual counseling skills
Dariane et al.²⁵	Prospective. Multicenter.	25 (8 EVAR/ 13 Laparoscopic repair)	RE is frequent in both groups (Laparoscopic=61.5%/ EVAR=12.5%) Laparoscopic AAA repair caused no onset of ED or SD
Dariane et al.²⁵	EVAR vs. Laparoscopic repair	25 (8 EVAR/ 13 Laparoscopic repair)
Schmid et al. (This study)	Retrospective	100	The aorto-bifemoral configuration was the technique most associated with ED (p=0.03) and the aorto-aortic configuration was the technique most associated with RE (p= 0.01). OR is associated with 64% of SD, 24% of RE, 18% of ED, and 21% of no sexual activity
	Single-center
	OR (aorto-bifemoral bypass vs. Aorto-aortic vs. aorto-biiliac vs. aorto-monoiliac)

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[1] ED = erectile dysfunction, RE = retrograde ejaculation.