Erectile dysfunction in ankylosing spondylitis: a systematic review and meta-analysis

BACKGROUND: The prevalence of erectile dysfunction (ED) in ankylosing spondylitis (AS) patients was reported rarely and with small sample. AIM: The study sought to explore the prevalence of ED in men with AS and to determine whether AS is a risk factor for ED. METHODS: A systematic search was conducted in the China National Knowledge Infrastructure, Wanfang, VIP Database, CBM, PubMed, Web of Science, and Cochrane Library. The search was restricted to the articles published up to October 2022. Assessment tools adapted for prevalence studies were used to evaluate the quality of cross-sectional studies, and the quality of case-control studies was assessed by Newcastle–Ottawa scale. The relative risk (RR) and the standard mean difference (SMD) were used to evaluate the association between AS and ED. The subgroup analyses were conducted to identify the resources of heterogeneity. The sensitivity analysis was performed to assess the stability of the pooled estimates. Data were analyzed and graphed using STATA 16.0. OUTCOMES: The pooled prevalence of ED in AS patients was calculated and the RR and the SMD were used to evaluate the association between AS and ED. RESULTS: A total of 393 AS patients, enrolled in the 8 included studies, were assessed for the prevalence of ED. The pooled ED prevalence estimate was 44% (95% confidence interval [CI], 25% to 63%, P < .001) with the statistical heterogeneity (I(2) = 95.1%, P < .001). After pooling the data for RR, the results showed that men with AS were at a significantly higher risk for ED when compared with the general population without AS (RR, 2.04; 95% CI, 1.28 to 3.25, P = .003; heterogeneity: I(2) = 72.6%, P = .003). The pooled results of 5 studies, which provided the International Index of Erectile Function (IIEF) score, demonstrated that patients with AS had significantly lower values in the IIEF erectile function domain as compared with the healthy control subjects (SMD, −0.60; 95% CI, −0.80 to −0.41; P < .001; heterogeneity: I(2) = 34.4%, P = .192). Additionally, the other domain of the IIEF also showed lower values when compared with the general population without AS (P < .05). CLINICAL IMPLICATIONS: The present meta-analysis provides evidence of the management of ED in men with AS. STRENGTHS AND LIMITATIONS: This is the first meta-analysis to provide the prevalence of ED in AS patients and to demonstrate that AS is a risk factor for ED. However, the results after pooling the included studies showed significant heterogeneity. CONCLUSION: Our meta-analysis demonstrated the high prevalence of ED in men with AS and that AS is a potential risk factor for ED.