Positive Correlation between Left Hemisphere Lesion and Erectile Dysfunction in Post-Stroke Patients

Authors

  • Thomas Eko Purwata Department of Neurology, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia
  • Dedy Andaka Department of Neurology, Siloam Hospital, Bali, Indonesia
  • AABN Nuartha Department of Neurology, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia
  • Candra Wiratni Department of Neurology, Wangaya Hospital, Bali, Indonesia
  • Ketut Sumada Department of Neurology, Wangaya Hospital, Bali, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2019.125

Keywords:

Stroke, Left hemisphere lesion, Erectile dysfunction, Parasympathetic nervous system

Abstract

BACKGROUND: Stroke is a serious health condition and the leading cause of disability, including erectile dysfunction (ED). The mechanisms and factors that predict ED in stroke are not fully elucidated. Several studies have shown a relationship between the location of the lesion in stroke with the onset of ED. The left hemispheric lesion was believed to disrupt the parasympathetic nervous system which is responsible for the regulation of erection. Stroke attack in this region therefore can be the underlying reason for ED. However, there are still contradictory findings in this area, and very few studies attempted to look at this problem, particularly among Asian male.

AIM: We would like to evaluate the association between left hemisphere lesion after ischemic stroke and the subsequent risk of developing ED.

METHODS: The study was conducted in the neurology polyclinic of Sanglah and Wangaya Hospital from February to August 2013. Subjects are all post-stroke patients who visited the neurology polyclinic of Sanglah and Wangaya Hospital that met inclusion and exclusion criteria.

RESULTS: There is a significant positive correlation (p < 0.05) between left hemisphere lesions and ED in stroke patients with a correlation coefficient (r) = 0.361 which means weak correlation and p = 0.032.

CONCLUSION: Left hemisphere lesions positively correlated with ED in stroke patients. Further longitudinal research is needed to see whether left hemisphere lesion in post-stroke patients is a risk factor for ED.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Truelsen T, Mähönen M, Tolonen H, Asplund K, Bonita R, Vanuzzo D. Trends in stroke and coronary heart disease in the WHO MONICA Project. Stroke. 2003; 34(6):1346-52. https://doi.org/10.1161/01.STR.0000069724.36173.4D PMid:12738889 DOI: https://doi.org/10.1161/01.STR.0000069724.36173.4D

Mukherjee D, Patil CG. Epidemiology and the global burden of stroke. World neurosurgery. 2011; 76(6):S85-90. https://doi.org/10.1016/j.wneu.2011.07.023 PMid:22182277 DOI: https://doi.org/10.1016/j.wneu.2011.07.023

Ebrahim S. Conference report. International journal of epidemiology. 2001; 30(1):189. https://doi.org/10.1093/ije/30.1.189 PMid:11171886 DOI: https://doi.org/10.1093/ije/30.1.189

Kulshreshtha A, Anderson LM, Goyal A, Keenan NL. Stroke in South Asia: a systematic review of epidemiologic literature from 1980 to 2010. Neuroepidemiology. 2012; 38(3):123-9. https://doi.org/10.1159/000336230 PMid:22433930 DOI: https://doi.org/10.1159/000336230

Kusuima Y, Venketasubramanian N, Kiemas LS, Misbach J. Burden of stroke in Indonesia. International Journal of Stroke. 2009; 4(5):379-80. https://doi.org/10.1111/j.1747-4949.2009.00326.x PMid:19765126 DOI: https://doi.org/10.1111/j.1747-4949.2009.00326.x

Kimura M, Murata Y, Shimoda K, Robinson RG. Sexual dysfunction following stroke. Compr Psychiatry. 2001; 42(3):217-222. https://doi.org/10.1053/comp.2001.23141 PMid:11349241 DOI: https://doi.org/10.1053/comp.2001.23141

Pistoia F, Govoni S, Boselli C. Sex after stroke: A CNS only dysfunction? Pharmacological research. 2006; 54(1):11-8. https://doi.org/10.1016/j.phrs.2006.01.010 PMid:16513364 DOI: https://doi.org/10.1016/j.phrs.2006.01.010

Bener A, Al-Hamaq AO, Kamran S, Al-Ansari A. Prevalence of erectile dysfunction in male stroke patients, and associated co-morbidities and risk factors. International urology and nephrology. 2008; 40(3):701-8. https://doi.org/10.1007/s11255-008-9334-y PMid:18246439 DOI: https://doi.org/10.1007/s11255-008-9334-y

Jackson G. Erectile dysfunction and cardiovascular disease. Arab journal of urology. 2013; 11(3):212-6. https://doi.org/10.1016/j.aju.2013.03.003 PMid:26558084 PMCid:PMC4442980 DOI: https://doi.org/10.1016/j.aju.2013.03.003

Jung JH, Kam SC, Choi SM, Jae SU, Lee SH, Hyun JS. Sexual dysfunction in male stroke patients: correlation between brain lesions and sexual function. Urology. 2008; 71(1):99-103. https://doi.org/10.1016/j.urology.2007.08.045 PMid:18242374 DOI: https://doi.org/10.1016/j.urology.2007.08.045

Duits A, Van Oirschot N, Van Oostenbrugge RJ, Van Lankveld J. The relevance of sexual responsiveness to sexual function in male stroke patients. The journal of sexual medicine. 2009; 6(12):3320-6. https://doi.org/10.1111/j.1743-6109.2009.01419.x PMid:19678879 DOI: https://doi.org/10.1111/j.1743-6109.2009.01419.x

Thompson SB, Walker L. Sexual Dysfunction after Stroke. Underestimating the Importance of Psychological and Physical Issues. Webmed Central Physical Medicine. 2011; 2(9):12.

Daniel K, Wolfe CD, Busch MA, McKevitt C. What are the social consequences of stroke for working-aged adults? A systematic review. Stroke. 2009; 40(6):e431-40. https://doi.org/10.1161/STROKEAHA.108.534487 PMid:19390074 DOI: https://doi.org/10.1161/STROKEAHA.108.534487

Suffren S, Braun CM, Guimond A, Devinsky O. Opposed hemispheric specializations for human hypersexuality and orgasm?. Epilepsy & Behavior. 2011; 21(1):12-9. https://doi.org/10.1016/j.yebeh.2011.01.023 PMid:21482195 DOI: https://doi.org/10.1016/j.yebeh.2011.01.023

Wittling W, Block A, Genzel S, Schweiger E. Hemisphere asymmetry in parasympathetic control of the heart. Neuropsychologia. 1998; 36(5):461-8. https://doi.org/10.1016/S0028-3932(97)00129-2 DOI: https://doi.org/10.1016/S0028-3932(97)00129-2

Tokgözoglu SL, Batur MK, Topçuoglu MA, Saribas O, Kes S, Oto A. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke. 1999; 30(7):1307-11. https://doi.org/10.1161/01.STR.30.7.1307 PMid:10390300 DOI: https://doi.org/10.1161/01.STR.30.7.1307

Avnon Y, Nitzan M, Sprecher E, Rogowski Z, Yarnitsky D. Autonomic asymmetry in migraine: augmented parasympathetic activation in left unilateral migraineurs. Brain. 2004; 127(9):2099-108. https://doi.org/10.1093/brain/awh236 PMid:15282213 DOI: https://doi.org/10.1093/brain/awh236

Coslett HB, Heilman KM. Male sexual function: impairment after right hemisphere stroke. Archives of Neurology. 1986; 43(10):1036-9. https://doi.org/10.1001/archneur.1986.00520100048013

Agarwal A, Jain DC. Male sexual dysfunction after stroke. The Journal of the Association of Physicians of India. 1989; 37(8):505-7. PMid:2621184

Sikiru L, Shmaila H, Yusuf GS. Erectile dysfunction in older male stroke patients: correlation between side of hemiplegia and erectile function. Afr J Reprod Health. 2009; 13(2):49-54. PMid:20690247

Boldrini P, Basaglia N, Calanca MC. Sexual changes in hemiparetic patients. Archives of Physical Medicine and Rehabilitation. 1991; 72(3):202-7. PMid:1998454

Korpelainen JT, Nieminen P, Myllyla VV. Sexual functioning among stroke patients and their spouses. Stroke. 1999; 30(4):715-719. https://doi.org/10.1161/01.STR.30.4.715 PMid:10187867 DOI: https://doi.org/10.1161/01.STR.30.4.715

Supit W. Stroke Caused Erectile Dysfunction without Differences of Right and Left Brain Hemispheric Lesion. (Thesis) Denpasar: Udayana, 2004.

Pangkahila WI. Evaluation of transurethral application of alprostadil for erectile dysfunction in Indonesians. Asian J Androl. 2000; 2(3):233-236. PMid:11225984

Roumeguere T, Wespes E, Carpentier Y, Hoffmann P, Schulman CC. Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk. Eur Urol. 2003; 44(3):355-359. https://doi.org/10.1016/S0302-2838(03)00306-3 DOI: https://doi.org/10.1016/S0302-2838(03)00306-3

Hood S, Kirby M. Review: Risk factor assessment of erectile dysfunction. The British Journal of Diabetes & Vascular Disease. 2004; 4(3):157-161. https://doi.org/10.1177/14746514040040030401 DOI: https://doi.org/10.1177/14746514040040030401

Wespes E, Amar E, Hatzichristou D, Hatzimouratidis K, Montorsi F, Pryor J, Vardi Y. EAU Guidelines on erectile dysfunction: an update. European urology. 2006; 49(5):806-15. https://doi.org/10.1016/j.eururo.2006.01.028 PMid:16530932 DOI: https://doi.org/10.1016/j.eururo.2006.01.028

Omer B, Ian E. Diagnosis and investigation of men with erectile dysfunction. The Journal of Men's Health and Gender. 2005; 2(1):79-86. https://doi.org/10.1016/j.jmhg.2005.01.005 DOI: https://doi.org/10.1016/j.jmhg.2005.01.005

Lue TF. Erectile dysfunction. New England Journal of Medicine. 2000; 342(24):1802-13. https://doi.org/10.1056/NEJM200006153422407 PMid:10853004 DOI: https://doi.org/10.1056/NEJM200006153422407

Choi-Kwon S, Kim JS. Poststroke emotional incontinence and decreased sexual activity. Cerebrovascular Diseases. 2002; 13(1):31-7. https://doi.org/10.1159/000047743 PMid:11810008 DOI: https://doi.org/10.1159/000047743

Paraskevas KI, Bessias N, Pavlidis P, Maras D, Papas TT, Gekas CD, Andrikopoulos V. Erectile dysfunction in stroke patients: a multifactorial problem with important psychosocial consequences. International urology and nephrology. 2008; 40(4):1113-4. https://doi.org/10.1007/s11255-008-9425-9 PMid:18683073 DOI: https://doi.org/10.1007/s11255-008-9425-9

Gaete JM, Bogousslavsky J. Post-stroke depression. Expert Rev Neurother. 2008; 8(1):75-92. https://doi.org/10.1586/14737175.8.1.75 PMid:18088202 DOI: https://doi.org/10.1586/14737175.8.1.75

Bhogal SK, Teasell R, Foley N, Speechley M. Lesion location and poststroke depression: systematic review of the methodological limitations in the literature. Stroke. 2004; 35(3):794-802. https://doi.org/10.1161/01.STR.0000117237.98749.26 PMid:14963278 DOI: https://doi.org/10.1161/01.STR.0000117237.98749.26

Carson AJ, MacHale S, Allen K, Lawrie SM, Dennis M, House A, Sharpe M. Depression after stroke and lesion location: a systematic review. The Lancet. 2000; 356(9224):122-6. https://doi.org/10.1016/S0140-6736(00)02448-X DOI: https://doi.org/10.1016/S0140-6736(00)02448-X

Utomo E, Blok BF, Pastoor H, Bangma CH, Korfage IJ. The measurement properties of the fiveâ€item International Index of Erectile Function (IIEFâ€5): a Dutch validation study. Andrology. 2015; 3(6):1154-9. https://doi.org/10.1111/andr.12112 PMid:26453539 DOI: https://doi.org/10.1111/andr.12112

Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999; 11(6):319-326. https://doi.org/10.1038/sj.ijir.3900472 PMid:10637462 DOI: https://doi.org/10.1038/sj.ijir.3900472

Derouet H, Lehmann J, Stamm B, Lühl C, Römer D, Georg T, Isenberg E, Gebhardt T, Stoeckle M. Age dependent secretion of LH and ACTH in healthy men and patients with erectile dysfunction. European urology. 2002; 41(2):144-54. https://doi.org/10.1016/S0302-2838(01)00033-1 DOI: https://doi.org/10.1016/S0302-2838(01)00033-1

Moreira ED, Jr., Lbo CF, Diament A, Nicolosi A, Glasser DB. Incidence of erectile dysfunction in men 40 to 69 years old: results from a population-based cohort study in Brazil. Urology. 2003; 61(2):431-436. https://doi.org/10.1016/S0090-4295(02)02158-1 DOI: https://doi.org/10.1016/S0090-4295(02)02158-1

Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. The Mini-Mental State Examination and Montreal Cognitive Assessment in persons with mild subacute stroke: relationship to functional outcome. Arch Phys Med Rehabil. 2011; 92(5):792-798. https://doi.org/10.1016/j.apmr.2010.12.034 PMid:21530727 DOI: https://doi.org/10.1016/j.apmr.2010.12.034

Naess H, Waje-Andreassen U, Thomassen L, Myhr KM. High incidence of infarction in the left cerebral hemisphere among young adults. J Stroke Cerebrovasc Dis. 2006; 15(6):241-244. https://doi.org/10.1016/j.jstrokecerebrovasdis.2006.06.003 PMid:17904082 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2006.06.003

Icks A, Scheer M, Genz J, Giani G, Glaeske G, Hoffmann F. Stroke in the diabetic and non-diabetic population in Germany: relative and attributable risks, 2005-2007. J Diabetes Complications. 2011; 25(2):90-96. https://doi.org/10.1016/j.jdiacomp.2010.05.002 PMid:20619691 DOI: https://doi.org/10.1016/j.jdiacomp.2010.05.002

Phe V, Roupret M. Erectile dysfunction and diabetes: a review of the current evidence-based medicine and a synthesis of the main available therapies. Diabetes Metab. 2012; 38(1):1-13. https://doi.org/10.1016/j.diabet.2011.09.003 PMid:22056307 DOI: https://doi.org/10.1016/j.diabet.2011.09.003

Austoni E, Mirone V, Parazzini F, Fasolo CB, Turchi P, Pescatori ES, Ricci E, Gentile V. Smoking as a risk factor for erectile dysfunction: data from the andrology prevention weeks 2001–2002: a study of the Italian Society of Andrology (SIA). European urology. 2005; 48(5):810-8. https://doi.org/10.1016/j.eururo.2005.03.005 PMid:16202509 DOI: https://doi.org/10.1016/j.eururo.2005.03.005

Katsiki N, Ntaios G, Vemmos K. Stroke, obesity and gender: a review of the literature. Maturitas. 2011; 69(3):239-243. https://doi.org/10.1016/j.maturitas.2011.04.010 PMid:21602002 DOI: https://doi.org/10.1016/j.maturitas.2011.04.010

Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, Creager MA, Culebras A, Eckel RH, Hart RG, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42(2):517-584. https://doi.org/10.1161/STR.0b013e3181fcb238 PMid:21127304 DOI: https://doi.org/10.1161/STR.0b013e3181fcb238

Braun CM, Dumont M, Duval J, Hamel I, Godbout L. Opposed left and right brain hemisphere contributions to sexual drive: a multiple lesion case analysis. Behav Neurol. 2003; 14(1-2):55-61. https://doi.org/10.1155/2003/123757 PMid:12719639 PMCid:PMC5497559 DOI: https://doi.org/10.1155/2003/123757

Winder K, Seifert F, Kohrmann M, Crodel C, Kloska S, Dorfler A, Hosl KM, Schwab S, Hilz MJ. Lesion mapping of stroke-related erectile dysfunction. Brain. 2017; 140(6):1706-1717. https://doi.org/10.1093/brain/awx080 PMid:28430885 DOI: https://doi.org/10.1093/brain/awx080

Winder K, Linker RA, Seifert F, Deutsch M, Engelhorn T, Dörfler A, Lee D-H, Hösl KM, Hilz MJ. Insular multiple sclerosis lesions are associated with erectile dysfunction. Journal of Neurology. 2018; 265(4):783-792. https://doi.org/10.1007/s00415-018-8763-5 PMid:29392463 DOI: https://doi.org/10.1007/s00415-018-8763-5

Coslett H, Heilman KM. Male sexual function: Impairment after right hemisphere stroke. Archives of Neurology. 1986; 43(10):1036-1039. https://doi.org/10.1001/archneur.1986.00520100048013 PMid:3753264 DOI: https://doi.org/10.1001/archneur.1986.00520100048013

Published

2019-02-13

How to Cite

1.
Purwata TE, Andaka D, Nuartha A, Wiratni C, Sumada K. Positive Correlation between Left Hemisphere Lesion and Erectile Dysfunction in Post-Stroke Patients. Open Access Maced J Med Sci [Internet]. 2019 Feb. 13 [cited 2024 Apr. 25];7(3):363-8. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2019.125

Issue

Section

B - Clinical Sciences