The relationship between hyperuricemia and erectile dysfunction: a scoping review

Recent studies suggest an association between hyperuricemia (HUA) and erectile dysfunction (ED), yet controversy remains regarding whether HUA is an independent risk factor. The proposed mechanisms include HUA-induced oxidative stress, inflammation, and metabolic syndrome, leading to pathophysiological changes. To explore this, we conducted a scoping review following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews) guidelines. We performed literature searches in PubMed, Web of Science, and other databases, using the Newcastle-Ottawa Scale (NOS) and Appraisal tool for Cross-Sectional Studies (AXIS) for quality assessment. We included 16 clinical studies (n = 295,705) published between 2014 and 2025, comprising 13 cross-sectional and 3 cohort studies. A positive correlation between HUA and ED was supported by 15 of the 16 studies (93.8%). Among these, five demonstrated the association persisted after adjusting for confounding factors, while two identified HUA as an independent factor. The three cohort studies were all rated as high quality (NOS score 9/9). An exploratory pooled analysis of these high-quality studies revealed that patients with gout had a 16% increased risk of developing ED (HR (Hazard Ratio) = 1.16, 95% CI (confidence interval) 1.104–1.219, p < 0.001). This estimate should be interpreted cautiously due to the limited number of studies and heterogeneity. In conclusion, a significant association exists between HUA and erectile function, though the relationship remains complex. The pathophysiology may involve an “oxidative stress-inflammation-metabolism” triad. While controlling uric acid levels shows potential for the prevention and treatment of ED, further research is required before this approach can be supported for routine clinical application.

Hyperuricemia; Erectile dysfunction; Oxidative stress; Nitric oxide; Endothelial dysfunction; Scoping review

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