45 96
4.
Conclusions
Smoking
negatively
affects
erectile
function,
and
current
knowledge most
strongly
suggests
that
smoking
increases
the
risk
of
ED
occurrence
showing
a
dose–response
correlation
with
the
number
of
years
of
smoking
and
cigarettes
smoked.
Considerable
evidence
supports
the
concept
that
smoking-related ED
is mainly
associated with
endothelial
impairment,
reduction
in
NO
availability,
and
an
imbalance
between
oxidative
and
antioxidative
reac-
tions
increasing
oxidative
stress.
Although
several
studies
have
demonstrated
that
smoking
cessation
significantly
enhances
indices of
sexual health
including
long-termmale
smokers
and
irrespective
of
baseline
erectile
impairment,
the
current
evidence
base
lacks
prospective
evaluation
of
this
relationship.
Passive
secondhand
cigarette
smoking,
especially
with
long-term
exposure,
can
also
have
a
negative
impact
on
erectile
function.
Further
investigation
into
the
impact
of
smoking
on
various
demographic
and
clinical
subgroups
of
ED
patients
(eg,
by
age
or
comorbid-
ities)
is
needed.
Author
contributions:
Paolo
Verze
had
full
access
to
all
the
data
in
the
study
and
takes
responsibility
for
the
integrity
of
the
data
and
the
accuracy
of
the
data
analysis.
Study
concept and design:
Verze, Margreiter, Esposito, Montorsi, Mulhall.
Acquisition
of
data:
Verze, Margreiter.
Analysis
and
interpretation
of
data:
Verze, Margreiter.
Drafting
of
the manuscript:
Verze, Margreiter.
Critical
revision
of
the
manuscript
for
important
intellectual
content:
Mulhall.
Statistical
analysis:
Mulhall.
Obtaining
funding:
None.
Administrative,
technical,
or material
support:
None.
Supervision:
Verze, Margreiter,
Esposito, Montorsi, Mulhall.
Other
(specify): None.
Financial
disclosures:
Paolo
Verze
certifies
that
all
conflicts
of
interest,
including
specific
financial
interests
and
relationships
and
affiliations
relevant
to
the
subject matter
or materials discussed
in
the manuscript
(eg, employment/affiliation, grants or
funding,
consultancies, honoraria,
stock ownership or options, expert
testimony,
royalties, or patents filed,
received,
or
pending),
are
the
following: None.
Funding/Support
and
role
of
the
sponsor:
None.
References
[1]
NIH Consensus Conference. Impotence. NIH Consensus Develop- ment Panel on Impotence. JAMA 1993;270:83–90.[2]
Lewis RW, Fugl-Meyer KS, Corona G, et al. Definitions/epidemiolo- gy/risk factors for sexual dysfunction. J Sex Med 2010;7:1598–607.
[3]
Gades NM, Nehra A, Jacobson DJ, et al. Association between smok- ing and erectile dysfunction: a population-based study. Am J Epi- demiol 2005;161:346–51.
[4]
Feldman HA, Johannes CB, Derby CA, et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 2000;30:328–38.
[5]
Mannino DM, Klevens RM, Flanders WD. Cigarette smoking: an independent risk factor for impotence? Am J Epidemiol 1994;140: 1003–8.[6]
Austoni E, Mirone V, Parazzini F, et al. Smoking as a risk factor for erectile dysfunction: data from the Andrology Prevention Weeks 2001–2002 a study of the Italian Society of Andrology (s.I.a.). Eur Urol 2005;48:810–7, discussion 817–8.
[7]
Mirone V, Imbimbo C, Bortolotti A, et al. Cigarette smoking as risk factor for erectile dysfunction: results from an Italian epidemiolog- ical study. Eur Urol 2002;41:294–7.[8]
Millett C, Wen LM, Rissel C, et al. Smoking and erectile dysfunction: findings from a representative sample of Australian men. Tob Control 2006;15:136–9.
[9]
He J, Reynolds K, Chen J, et al. Cigarette smoking and erectile dysfunction among Chinese men without clinical vascular disease. Am J Epidemiol 2007;166:803–9.
[10]
Chew KK, Bremner A, Stuckey B, Earle C, Jamrozik K. Is the relation- ship between cigarette smoking and male erectile dysfunction independent of cardiovascular disease? Findings from a population-based cross-sectional study. J Sex Med 2009;6:222–31.[11]
Wu C, Zhang H, Gao Y, et al. The association of smoking and erectile dysfunction: results from the Fangchenggang Area Male Health and Examination Survey (FAMHES). J Androl 2012;33:59–65.[12]
Celermajer DS, Sorensen KE, Georgakopoulos D, et al. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation 1993;88:2149–55.[13]
Tostes RC, Carneiro FS, Lee AJ, et al. Cigarette smoking and erectile dysfunction: focus on NO bioavailability and ROS generation. J Sex Med 2008;5:1284–95.[14]
Zhang WZ, Venardos K, Chin-Dusting J, Kaye DM. Adverse effects of cigarette smoke on NO bioavailability: role of arginine metabolism and oxidative stress. Hypertension 2006;48:278–85.[15]
Orosz Z, Csiszar A, Labinskyy N, et al. Cigarette smoke-induced proinflammatory alterations in the endothelial phenotype: role of NAD(P)H oxidase activation. Am J Physiol Heart Circ Physiol 2007; 292:H130–9.
[16]
Shabsigh R, Fishman IJ, Schum C, Dunn JK. Cigarette smoking and other vascular risk factors in vasculogenic impotence. Urology 1991; 38:227–31.
[17]
Rosen MP, Greenfield AJ, Walker TG, et al. Cigarette smoking: an independent risk factor for atherosclerosis in the hypogastric- cavernous arterial bed of men with arteriogenic impotence. J Urol 1991;145:759–63.Table
2
–
Characteristics,
outcomes,
and
covariates
of
studies
assessing
the
risk
of
smoking
cessation
and
erectile
function
recovery
Study
Sample
size,
n
Age
range,
yr
Follow-up
Measurements
Outcomes
Guay
et
al,
1998
[26]10
32–62
24
h,
1 mo
NPT
and
PT
Significant
improvement
for
both
indices
Sighinolfi
et
al,
2007
[27]20
31–48
24
h,
36
h
PD
50%
PSV
and
60%
EDV
improvement
Pourmand
et
al,
2004
[28]281
30–60
1
yr
IIEF-5
25%
improvement
in
IIEF-5
Harte
et
al,
2012
[29]65
23–60
4 wk
IIEF
and
PT
75%
improvement
in
IIEF
and
>
30%
change
in
PT
EDV = end-diastolic
velocity;
IIEF =
International
Index
of
Erectile
Function;
NPT = nocturnal
penile
tumescence;
PD = penile
Doppler;
PSV = peak
systolic
velocity;
PT = penile
tumescence.
E U R O P E A N
U R O L O G Y
F O C U S
1
( 2 0 1 5
)
3 9 – 4 6
45