Rédacteurs : Johan Nguyen, Henri Truong
Sommaire
Erectile Dysfunction
Dysfonction érectile : évaluation de l'acupuncture
4. Systematic Reviews and Meta-Analysis
| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture |
| ☆☆ | Evidence for effectiveness of acupuncture |
| ☆ | Limited evidence for effectiveness of acupuncture |
| Ø | No evidence or insufficient evidence |
4.1. Abdi 2021
Abdi F, Alimoradi Z, Roozbeh N, Amjadi MA, Robatjazi M. Does acupuncture improve sexual dysfunction? A systematic review. J Complement Integr Med. 2021 Oct 1;20(1):1-16. https://doi.org/10.1515/jcim-2021-0194
| Objectives | Sexual dysfunction can adversely affect the quality of life and interpersonal relationships. nowadays, a lot of attention is paid to traditional Chinese medicine with better curative effects and less adverse events. Recent studies have implied the promising effect of acupuncture on sexual function. This systematic review evaluate the effectiveness and safety of acupuncture in treating female and male sexual dysfunction. |
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| Content | PubMed, Cochrane Central of Controlled Trials (CENTRAL), EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Scopus, and Google Scholar were searched up to 2021. No limitation to language and date. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). |
| Summary | Among 160 initially assessed papers, 13 articles were included. The findings showed that acupuncture improve sexual dysfunction in domains of desire, libido, erectile dysfunction and impotency. Most studies did not report any serious side effects from acupuncture, and only three studies reported minor adverse events. |
| Outlook | The available evidence indicate that acupuncture has positive on improvement of sexual dysfunction with no serious side effects. Although acupuncture has gained increasing popularity for the management of sexual dysfunction, high methodological quality evidence regarding its efficacy is lacking. |
4.2. Leisegang 2021
Leisegang K, Finelli R. Alternative medicine and herbal remedies in the treatment of erectile dysfunction: A systematic review. Arab J Urol. 2021;19(3):323-339. [221863]. https://doi.org/10.1080/2090598x.2021.1926753
| Objectives | To systematically review and discuss the current evidence from placebo-controlled clinical trials that investigated the use of alternative medicines and herbal remedies in the management of erectile dysfunction (ED). |
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| Methods | A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-based systematic review using specific keyword combinations was conducted on the PubMed and Scopus databases. Randomised controlled trials investigating herbal medicine in at least one group and using the International Index of Erectile Function (IIEF) as an outcome in patients primarily diagnosed with ED were included for review. |
| Results | Following the literature search, screening and eligibility analysis, a total of 42 articles were included. The 42 articles were categorised as single herb extractions (n = 14), combination herbal formula (n = 5), combination of herbal formula and non-herbal nutraceuticals (n = 7), non-herbal nutraceuticals (n = 5), acupuncture and moxibustion (n = 2), diet and nutrition (n = 3), exercise (n = 5), and topical treatments (n = 1). Based on the results, Korean ginseng, Pygnogenol and Prelox, Tribulus terrestris, Lepidium meyenii, L-arginine, acupuncture and lifestyle interventions were the more predominantly investigated treatments interventions for ED. |
| Conclusions | Panax ginseng, Pygnogenol, Prelox and Tribulus terrestris have promising evidence as herbal products, alongside L-arginine as a nutritional supplement, for ED based on IIEF outcomes, and warrant further clinical investigation. The mechanisms of action remain unclear, but each of these appears to in part increase nitric oxide synthesis. Importantly, improved diet and exercise should be considered, particularly in patients with obesity or diabetes mellitus. |
4.3. Jiang 2018
Jiang Rongmin, Qu You, Wang Tao , Wan Yunli, Xu Wenbin. [Meta-analysis of clinical effectiveness of the acupuncture treatment for erectile dysfunction]. The Chinese Journal of Human Sexuality. 2018;2:82-85. [201795].
| Objectives | To evaluate the clinical effectiveness of the acupuncture treatment for erectile dysfunction (ED). |
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| Methods | According to the strict inclusion criteria, randomized controlled trial (RCT) which had been published regarding acupuncture for erectile dysfunction were searched in databases (such as CNKI,WAN FANG DATA,VIP).The software of Cochrane Hand book 5.1.0 were used to evaluate the bias risk. Revman 5.3 was applied for statistical analysis. |
| Results | 589 patients in 6 researches were included. The result suggested that both using acupuncture alone and acupuncture combined with traditional Chinese medicine can improve the IIEF-5 score of patients. However, the clinic effective rates could not be combined due to the significant difference among the including groups. |
| Conclusion | Although the current evidence can confirm the therapeutic effect of acupuncture for erectile dysfunction, the including articles are short of rigorous design and objective indicators, so the conclusion should be treated with caution. |
4.4. Cui 2016
Cui X, Zhou J, Qin Z, Liu Z. Acupuncture for erectile dysfunction: a systematic review. Biomed Res Int. 2016;2016:2171923. [176601].
| Objective | Acupuncture is increasingly used to treat patients with erectile dysfunction (ED), and our systematic review aimed to evaluate the current evidence for the efficacy and safety of acupuncture in treating ED. |
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| Methods | An electronic searchwas conducted in eight databases to identify randomized controlled trials (RCTs) of acupuncture for treating erectile dysfunction that were published in English and Chinese. The Cochrane Risk of Bias tool was used to assess the risk of bias. |
| Results | Three RCTs with a total of 183 participants met the inclusion criteria. One trial showed the beneficial effects of acupuncture compared with sham acupuncture while the others did not. One trial suggested that acupuncture combined with psychological therapy was superior to psychological therapy alone. However, the overall methodological and reporting quality of the studies was low. The safety of acupuncture for ED was unclear because there were too few reports on this topic. |
| Conclusion | The available evidence supporting that acupuncture alone improves ED was insufficient and the available studies failed to show the specific therapeutic effect of acupuncture. |
4.5. Lee 2009
Lee MS, Shin BC, Ernst E. Acupuncture for treating erectile dysfunction: a systematic review. BJU Int. 2009;104:366-70. 153134
| Objective | We evaluated the current evidence for the use of acupuncture to treat erectile dysfunction (ED). |
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| Methods | Systematic searches were conducted in 15 electronic databases, with no language restrictions. Hand-searches included conference proceedings and our files. All clinical studies of acupuncture as a treatment for ED were considered for inclusion, and their methodological quality was assessed using the Jadad score. |
| Results | Of the four studies included, one randomized controlled trial (RCT) showed beneficial effects of acupuncture compared with sham acupuncture in terms of response rate, while another RCT found no effects of acupuncture. The remaining two studies were uncontrolled clinical trials. Collectively these data showed that RCTs of acupuncture for ED are feasible but scarce. Most investigations had methodological flaws, e.g. inadequate study design, poor reporting of results, small sample size, and publication without appropriate peer review process. |
| Conclusion | The evidence is insufficient to suggest that acupuncture is an effective intervention for treating ED. Further research is required to investigate whether there are specific benefits of acupuncture for men with ED. |
5. Overviews of Systematic Reviews
5.1. Ernst 2011
Ernst E, Posadzki P, Lee MS. Complementary and alternative medicine (CAM) for sexual dysfunction and erectile dysfunction in older men and women: an overview of systematic reviews. Maturitas. 2011;70(1):37-41. [169139].
| Background | Older patients with sexual dysfunction (SD) and/or erectile dysfunction (ED) often use complementary and alternative medicine (CAM). |
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| Aim | The aim of this overview of systematic reviews is to critically evaluate the evidence for or against the effectiveness of CAM. |
| Methods | Six electronic databases were searched to identify all relevant systematic reviews (SRs). Their methodological quality was assessed independently by two reviewers using the Oxman score. |
| Results- conclusions | Four SRs met our inclusion criteria. They evaluated: acupuncture, ginseng, maca and yohimbine. The methodological quality of all of the SRs was good. However, the primary studies were often associated with considerable risk of bias. Cautiously positive conclusions were drawn for yohimbine and ginseng as treatment options for ED. For acupuncture and maca the evidence was insufficient for ED and SD respectively. It is concluded that there is some encouraging evidence but more and better studies are required to establish the value of CAM for SD and ED. |
6. Clinical Practice Guidelines
| ⊕ positive recommendation (regardless of the level of evidence reported) Ø negative recommendation (or lack of evidence) |
6.1. Association Française d'Urologie, Société Francophone de Médecine Sexuelle (AFU/SFMS,France) 2024
Huyghe E, Kassab D, Graziana JP, Faix A, Grellet L, Schoentgen N, Boulenger de Hauteclocque A, Dupuis H, Chebbi A, Chelghaf I, Schirmann A, Freton L, Guillot-Tantay C, Lebâcle C, Roux S, Barkatz J, Ferretti L, Methorst C, Akakpo W, Madec FX, Burte C. Therapeutic management of erectile dysfunction: the AFU/SFMS guidelines. Fr J Urol. 2024 Dec 5:102842. https://doi.org/10.1016/j.fjurol.2024.102842
| Many alternative or complementary treatments of ED have been proposed and tested (acupuncture, functional electrical stimulation and pelvic floor muscle strengthening, low frequency magnetic pulses, dynamic creative image synthesis). For all these treatments,evidence was insufficient to conclude on their effectiveness in ED management. ► Recommendations R7. It is not possible to recommend or to not recommend alternative or complementary therapies for ED management. |
Publications citées :
- [46] Cui X, Zhou J, Qin Z, Liu Z. Acupuncture for Erectile Dysfunction: A Systematic Review. BioMed research international. 2016;2016:2171923.
- [47] Tsai MY, Liu CT, Chang CC, Chen SY, Huang ST. Overview of the relevant literature on the possible role of acupuncture in treating male sexual dysfunction. Acupuncture in medicine : journal of the British Medical Acupuncture Society. 2014;32:406-10.
- [48] Lee MS, Shin BC, Ernst E. Acupuncture for treating erectile dysfunction: a systematic review. BJU international. 2009;104:366-70.
