The Link Between Cigarette Smoking and Erectile Dysfunction: A Systematic Review

Context: Cigarette smoking is an established risk factor for erectile dysfunction (ED). To what extent smoking affects erectile function, however, remains debated. Objective: To integrate the available evidence regarding the impact of smoking status and smoking exposure on prevalence, severity, and progression in patients with ED. Evidence acquisition: A systematic search of the literature was conducted using the Medline, Embase, and Scopus databases limited to articles published in English between January 1998 and October 2014. We selected 13 articles according to predefined inclusion criteria and the Preferred Reporting Items for Systematic Reviews and Meta-analysis. Evidence synthesis: Most of the studies demonstrated an association between smoking and ED. Evidence was also found supporting the beneficial effect of smoking cessation on the restoration of erectile function. We noted marked heterogeneity in patient populations and smoking categorizations across studies, precluding conduct of a meta-analysis. Considerable evidence exists to support the hypothesis/theory that smoking-related ED is mainly associated with endothelial impairment, reduction in nitric oxide availability, and imbalance between oxidative and antioxidative reactions increasing oxidative stress. Passive secondhand cigarette smoking, especially with a long-term exposure, can also have a negative impact on erectile function. Conclusions: Smoking is strongly associated with ED. Endothelial dysfunction together with increased oxidative stress represent major pathophysiologic mechanisms, and smoking cessation may mitigate this effect. Patient summary: Current smoking is significantly associated with erectile dysfunction, and smoking cessation has a beneficial effect on the restoration of erectile function. (c) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.