Renal transplant: outcome
Erectile dysfunction after kidney transplantation: our 22 years of experience

https://doi.org/10.1016/j.transproceed.2004.02.014Get rights and content

Abstract

Aim

To evaluate the results of treatement of erectile dysfunction (ED) in kidney transplant recipients before and after the advent of sildenafil.

Materials and methods

From 1981 through 2002, 971 male patients of mean age 53.4 years received a renal graft. Erectile dysfunction (ED) was investigated in all patients at the first urologic visit posttransplantation. Psycho-sexual support was offered to all patients. Before sildenafil use (1998), our diagnostic approach was complex. From 1998 we tested: serum levels of testosterone, prolactin, and glucose with penile duplex ultrasonography and NPT reserved for selected cases.

Results

From 1981 through 1998, 365 male kidney transplant recipients (45%) reported ED. Only 169 patients chose to be treated: 27 responded to psycho-sexual therapy; 3 received testosterone with benefit; 133 had a good results from intracavernosal injection of vasoactive drugs; and 6 received a penile prosthesis. Since 1998, 126 patients reported ED (78.3%). Only 78 chose treatment: 24 patients had a satisfactory response to sildenafil (65% with 50 mg and 35% with 100 mg). PGE1 alone or in combination with papaverine and phentolamine produced a good response in 37 patients; 17 patients did not respond to pharmacotherapy; and 5 received a tricomponent penile prosthesis without complications. The side effects of sildenafil and PGE1 therapy were similar to those reported in the literature.

Conclusions

ED is an important problem in male renal transplant recipients. Cultural resistance to treatment is common. However, treatment with sildenafil citrate and intracavernosal self-injection of PGE1 are well accepted, and prosthetic devices may help in resistant cases.

Section snippets

Materials and methods

From 1981 through 2002, the 971 renal transplants performed in males among 1590 local cases were evaluated by the urologist in an outpatient setting using detailed clinical and transplantation history, as well as complete physical examination. The immunosuppressive therapy was Cyclosporine and Azathioprine in the first period, and FK-506 and Mycophenolate Mophetil in the later period combined with low doses corticosteroids. Detailed analysis of the sexual history included the frequency of

Results

Among 971 male kidney transplant recipients, 591 reported ED (mean age, 55.1 years; mean time on dialysis before transplantation, 42 months; mean time after transplantation, 16 months) including 244 who chose to undergo treatment. All patients had received a single renal graft and the external iliac artery had been used for the vascular anastomosis. From 1981 through 1998 (the advent of sildenafil), 365 of 810 male kidney transplant recipients (45%) reported ED. Only 166 patients chose to be

Discussion

Up to half of the patients with chronic renal failure suffer from ED.1 The causes are unclear. Among the many factors discussed are changes in the hypothalamic-pituitary axis, decreased testosterone production, possibly as a result of the effect of uremic toxins on the testes7 and hyperprolactinemia, which occurs in more than half of the patients. Other factors include decreased zinc levels and resistance to the peripheral action of androgens. Polyneuropathy (due to uremia, to underlying

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