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Territo A, Belmonte M, Cocci A, Ruiz-Castañe E, Castiglione F, Mantica G, Prudhomme T, Pecoraro A, Piana A, Bañuelos Marco B, Dönmez MI, Esperto F, Russo GI, Campi R, Breda A, López-Abad A. Response to Comment on: Is it safe to implant a penile prosthesis in a solid organ transplant recipient? A systematic review. Int J Impot Res 2025:10.1038/s41443-025-01050-5. [PMID: 40229588 DOI: 10.1038/s41443-025-01050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 01/08/2025] [Accepted: 03/14/2025] [Indexed: 04/16/2025]
Affiliation(s)
- Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Mario Belmonte
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Eduard Ruiz-Castañe
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Fabio Castiglione
- King's College London, London, UK
- Department of Urology, King's College London Hospital NHS Foundation Trust, London, UK
- Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Guglielmo Mantica
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16131, Genova, Italy
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Alberto Piana
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - Beatriz Bañuelos Marco
- Department of Urology, Kidney Transplantation and Reconstructive Urology. Hospital Universitario Clinico San Carlos, Madrid, Spain
| | - Muhammet Irfan Dönmez
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | | | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alicia López-Abad
- Department of Urology, Virgen de la Arrixaca University Hospital, Murcia, Spain
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Territo A, Belmonte M, Cocci A, Ruiz-Castañe E, Castiglione F, Mantica G, Prudhomme T, Pecoraro A, Piana A, Marco BB, Dönmez MI, Esperto F, Russo GI, Campi R, Breda A, López-Abad A. Is it safe to implant a penile prosthesis in a solid organ transplant recipient? A systematic review. Int J Impot Res 2025; 37:18-26. [PMID: 39026089 DOI: 10.1038/s41443-024-00939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/09/2024] [Accepted: 06/14/2024] [Indexed: 07/20/2024]
Abstract
Solid organ transplant recipients exhibit an elevated incidence of erectile dysfunction, attributed to comorbidities and specific factors associated with organ failure. While treatment mirrors the general population's, response rates are lower, and there is a heightened concern about implanting a penile prosthesis in immunocompromised patients due to the potential occurrence of severe complications. The aim of this study was to assess the safety of penile prostheses in this population. Among fourteen included studies, ten were case reports or series of cases, and four were non randomized case-control studies with non-transplanted patients as controls. Complications affected 34 patients (11.15%), with mechanical device failures in 18 cases (5.9%) and infections in 13 cases (4.26%). Most infections required hospitalization, antibiotic treatment, and prosthesis removal, with two cases of life-threatening Fournier's gangrene. Case-control studies revealed no differences in overall reoperation rates between transplant recipients and controls. However, pelvic organ transplant recipients undergoing three-piece prosthesis implantation showed higher complications rates related to reservoir issues. Despite limited evidence, case-control studies demonstrated a generally low/moderate risk of bias within each specific domain, although overall bias was moderate/severe. As a result, clinicians may mitigate concerns regarding penile prosthesis implantation in solid organ transplant recipients.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Mario Belmonte
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Eduard Ruiz-Castañe
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Fabio Castiglione
- King's College London, London, UK
- Department of Urology, King's College London Hospital NHS Foundation Trust, London, UK
- Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Guglielmo Mantica
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16131, Genova, Italy
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Alberto Piana
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - Beatriz Bañuelos Marco
- Department of Urology, Kidney Transplantation and Reconstructive Urology. Hospital Universitario Clinico San Carlos, Madrid, Spain
| | - Muhammet Irfan Dönmez
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | | | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alicia López-Abad
- Department of Urology, Virgen de la Arrixaca University Hospital, Murcia, Spain
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Pozzi E, Ramasamy R. Comment on: Safety of penile prosthesis implantation in solid organ transplant recipients: a systematic review. Int J Impot Res 2024:10.1038/s41443-024-00995-3. [PMID: 39488669 DOI: 10.1038/s41443-024-00995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 10/18/2024] [Accepted: 10/22/2024] [Indexed: 11/04/2024]
Affiliation(s)
- Edoardo Pozzi
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
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El Hennawy HM, Safar O, Al Faifi AS, Shalkamy O, Ali MA, Ali HH, El Madawie MZ, Thamer S, Almurayyi M, Zaitoun MF, Elzubair LGA, Elatreisy A. Renal Transplantation Enhances the Sildenafil Citrate Effectiveness in Patients with Erectile Dysfunction. A Single-Center Perspective. Transplant Proc 2024; 56:1266-1272. [PMID: 38971700 DOI: 10.1016/j.transproceed.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/24/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE To assess the efficacy and safety of Sildenafil citrate in the treatment of ED in (HD) compared to post-RT patients. PATIENTS AND METHODS A concurrent cohort prospective study to evaluate the efficacy of Sildenafil in the treatment of ED in 24 HD patients (Group A) and 13 patients with persistent ED one-year post-RT (Group B). The initial dose of Sildenafil was 25 mg, increased to 50 mg if there is an adequate response. An Arabic-translated International Index of Erectile Function (IIEF) questionnaire was completed one week before and after Sildenafil treatment. An IIEF erectile function score of 26 or an improvement of at least 10 points for the total IIEF score was considered a favorable response to Sildenafil. RESULTS Group A included 22 patients with a mean age of 47.32 ± 7.013 years, whereas Group B included 13 patients with a mean age of 56.87 ± 9.612 years. The overall efficacy rate of Sildenafil was 40.9% and 76.9% in groups A and B, respectively. The post-treatment IIEF5-15 score increased from 11.1 ± 5.99 to 12.5 ± 6.41 (p = .458) and from 11.82 ± 7.534 to 21.91 ± 5.700 (p = .002) in groups A and B, respectively. In both groups, the duration of HD had no impact on ED improvement except in the post-RT non-responder subgroup. Hypertension, gastrointestinal symptoms, and flushing were both groups' most common side effects. CONCLUSION RT could enhance the response to sildenafil in treating patients with ED. The outcome is better in younger post-RT patients with moderate and severe erectile dysfunction and shorter dialysis duration.
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Affiliation(s)
- Hany M El Hennawy
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia.
| | - Omar Safar
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia
| | - Abdullah S Al Faifi
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia
| | - Osama Shalkamy
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia; Urology Department, Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Mohammed Abdelrahim Ali
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia
| | - Hossam Hassanen Ali
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia
| | - Mahmoud Z El Madawie
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia
| | - Saad Thamer
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia
| | - Muath Almurayyi
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia
| | - Mohammad F Zaitoun
- Pharmacy Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia
| | - Lina G A Elzubair
- Laboratory Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Kingdom of Saudi Arabia
| | - Adel Elatreisy
- Urology Department, Faculty of Medicine, Al Azhar University, Cairo, Egypt
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Dumanski SM, Eckersten D, Piccoli GB. Reproductive Health in Chronic Kidney Disease: The Implications of Sex and Gender. Semin Nephrol 2022; 42:142-152. [PMID: 35718362 DOI: 10.1016/j.semnephrol.2022.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Chronic kidney disease (CKD) is frequently accompanied by reproductive health challenges in females and males alike. Progression of CKD is associated with escalating impairment of the hypothalamic-pituitary-gonadal axis, which facilitates evolving ovarian, testicular, and sexual dysfunction. Common clinical reproductive health complications in CKD include abnormal menstruation, impaired sexual health, and reduced fertility. Though sex-specific factors, such as sex hormones and gonadal function, have a strong influence on reproductive health outcomes in CKD, a person's gender and gendered experience also have important implications. Institutionalized gender, gendered perceptions of health, and health care-seeking behaviors, as well as adherence to medical care, all have critical effects on reproductive health in CKD. This review endeavors to explore the implications of both sex and gender on overall reproductive health in individuals living with CKD.
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Affiliation(s)
- Sandra M Dumanski
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada; Libin Cardiovascular Institute, Calgary, Canada; Alberta Kidney Disease Network, Alberta, Canada.
| | - Dag Eckersten
- Department of Nephrology, Lund University, Skane University Hospital, Malmo, Sweden
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Abstract
Sex and gender often are used interchangeably, but are two distinct entities, with sex being the biological attribute and gender including the social, psychological, and cultural aspects of one's identity. Kidney transplantation has been proven to be the best treatment for end-stage kidney disease, improving both quality of life and life-expectancy for most patients. However, gender disparities in access to and outcomes of kidney transplantation remain despite the plethora of evidence showing the advantages of kidney transplantation to our patients. Data have shown that women are less likely to be waitlisted for a kidney transplant and to receive a deceased donor or a living donor kidney. On the other hand, women are more likely than men to become living kidney donors. Although some state the latter is the result of the female gender to nurture and care for loved ones, others believe this observation is because women often are incompatible with their spouse or child because pregnancy is a strong sensitizing event, which stems from the biological rather than the social differences between the sexes. Influence of sex and gender is not limited to access to kidney transplantation, but rather exist in other areas of transplant medicine, such as the difference observed in transplant outcomes between the sexes, variability in immunosuppression metabolism, and even in more contemporary areas such as recent data showing sex-based differences in outcomes of kidney transplant recipients with coronavirus disease-2019, with males having an increased incidence of acute kidney injury and death.
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Affiliation(s)
- Goni Katz-Greenberg
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Silvi Shah
- Division of Nephrology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH.
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Effects of renal transplantation on erectile dysfunction: a systematic review and meta-analysis. Int J Impot Res 2022; 34:456-466. [PMID: 34103695 PMCID: PMC9293755 DOI: 10.1038/s41443-021-00419-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/24/2021] [Accepted: 02/12/2021] [Indexed: 02/04/2023]
Abstract
Erectile dysfunction (ED) is a major global health burden commonly observed in patients with end-stage renal disease (ESRD). Although renal transplantation improves the problem in some patients, it persists in ≈20-50% of recipients. Studies regarding the effects of kidney transplantation on ED present contradictory findings. We performed a systematic review to summarise the effects of kidney transplantation on ED. A systematic literature search was performed across PubMed, Cochrane, and Scopus databases in April 2020. We included all prospective studies that investigated the pre and posttransplant international index of erectile function (IIEF-5) scores in recipients with ED. Data search in PubMed and Google Scholar produced 1326 articles; eight were systematically reviewed with a total of 448 subjects. Meta-analysis of IIEF-5 scores showed significant improvements between pre and post transplantation. Our findings confirm that renal transplantation improves erectile function. Furthermore, transplantation also increases testosterone level. However, the evidence is limited because of the small number of studies. Further studies are required to investigate the effects of renal transplantation on erectile function.
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Dick B, Greenberg JW, Polchert M, Natale C, Hellstrom WJG, Raheem OA. A Systematic Review of Penile Prosthesis Surgery in Organ Transplant Recipients. Sex Med Rev 2021; 9:636-640. [PMID: 32641224 DOI: 10.1016/j.sxmr.2020.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is an increased prevalence of erectile dysfunction in patients with solid organ transplant (SOT) compared with the general population. Many of these patients may become refractory to medical treatment of erectile dysfunction and penile prosthesis (PP) is often recommended. Concerns regarding the safety of PP in patients with SOT are due to their immunosuppressed state. OBJECTIVE We aim to review all current literature on the outcomes of patients with SOT who have received PP. METHODS A PubMed search was performed to identify articles pertaining to the outcomes of PP in patients with SOT. RESULTS We identified and included 14 studies that report on outcomes of PP placement in 143 patients with SOT and 191 non-SOT controls from interval period from 1979 to 2019. Studies included retrospective cohort studies, case series, and case reports. Compared with non-SOT controls who had PP, aggregate analysis demonstrated that patients with SOT who had PP did not develop significantly increased overall complications. However, they were significantly more likely to experience future surgical complications. CONCLUSION Our aggregate analysis demonstrated that patients with SOT are not at a significantly increased risk of overall complications when receiving a PP. Nevertheless, there is an increased risk of experiencing PP injury during subsequent surgeries, which may be mitigated by the earlier involvement of a urologist. Given the lack of recent data, large studies are prerequisite to further evaluate the safety and overall outcome of PP surgery in patients with SOT. Dick B, Greenberg JW, Polchert M, et al. A Systematic Review of Penile Prosthesis Surgery in Organ Transplant Recipients. Sex Med Rev 2021;9:636-640.
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Affiliation(s)
- Brian Dick
- Department of Urology, Tulane University, New Orleans, LA, USA
| | | | | | - Caleb Natale
- Department of Urology, Tulane University, New Orleans, LA, USA
| | | | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, LA, USA.
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Validation and Adaptation of the "Modified Transplant Symptom Occurrence and Symptom Distress Scale" for Kidney Transplant Recipients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197348. [PMID: 33050107 PMCID: PMC7579451 DOI: 10.3390/ijerph17197348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023]
Abstract
The aim was to adapt and validate the Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-59R) for kidney transplant recipients undergoing immunosuppressive therapy in Korea. The MTSOSD-59R has been used with solid organ transplant recipients globally to assess the adverse effects of immunosuppressive medication. A descriptive cross-sectional design was used. MTSOSD-59R was first translated, and pilot tested. Next, content validity was established with nine organ transplant experts. Then, from October 2017 to October 2018, the Korean MTOSOSD-59R was administered to a convenience sample of 122 kidney transplant recipients recruited from a single center. Ridit analysis was used to measure symptom occurrence and distress. The known-group approach was used to test the construct validity using Mann-Whitney U tests for between-group comparisons. The content validity index for MTSOSD-59R was 0.98, and known-group validity was confirmed. The split-half Spearman-Brown corrected reliability coefficient was 0.902 for symptom occurrence and 0.893 for symptom distress. The four most frequent and distressing symptoms were fatigue, lack of energy, thinning hair, and erectile dysfunction (male). Results suggest this Korean MTSOSD-59R adaptation has adequate language, construct validity, and reliability to gather meaningful information from kidney transplant recipients in Korea.
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Nikoobakht M, Behtash N, Ramezani-Binabaj M, Jelveh-Moghaddam E, Fakhr Yasseri A, Dialameh H. Comparison of sexual function changes in recipients of kidney transplant in females receiving kidney from the living donor and deceased donor. Urologia 2020; 87:203-208. [PMID: 32370652 DOI: 10.1177/0391560320913402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM Chronic renal failure can result in different sexual and reproductive problems for women. Due to lack of information about sexual dysfunction of women with transplanted kidney and superiority of either living or deceased donor, we designed this retrospective cohort study to compare sexual function changes in recipients of kidney transplant in two groups receiving kidney from the living donor and deceased donor using Female Sexual Function Index score. METHODS AND MATERIALS We included 55 female patients who underwent kidney transplant from 22 May 2015 to 22 May 2016 in Sina Hospital (Tehran, Iran). Laboratory factors, including creatinine, blood urea nitrogen, hemoglobin, fasting blood glucose, triglyceride, cholesterol, low-density lipoprotein, and high-density lipoprotein, were evaluated before and after the transplantation. Female Sexual Function Index questionnaire was used to evaluate sexual function of the patients before the transplant, 3 months after the transplant, and 9 months after the transplant. RESULTS Our results revealed that there is significant improvement in the Female Sexual Function Index score of the patients after the transplant (p-value < .001). However, we found no significant difference between the scores of the patients with living donor and deceased donor (p-value > .05). Patients' age, creatinine level, low-density lipoprotein, and diastolic blood pressure are negative predictors of Female Sexual Function Index scores.
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Affiliation(s)
- Mohammadreza Nikoobakht
- Department of Urology, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Behtash
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Erfan Jelveh-Moghaddam
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hossein Dialameh
- Department of Urology, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Payne K, Popat S, Lipshultz LI, Thirumavalavan N. The Prevalence and Treatment of Erectile Dysfunction in Male Solid Organ Transplant Recipients. Sex Med Rev 2019; 9:331-339. [PMID: 31859242 DOI: 10.1016/j.sxmr.2019.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a prevalent and under-recognized complaint among male solid organ transplant recipients. Most research on this topic has focused on kidney transplant recipients alone. In this review, we integrate current research on ED across all types of solid organ transplant recipients and assess the success of current methods of ED treatment in transplant populations. AIM To review the current literature addressing the prevalence and treatment of ED in the male solid organ transplant population. METHODS A literature search was conducted using PubMed to identify relevant studies. Search terms included "organ transplant" and "erectile dysfunction." Titles and abstracts were reviewed for relevance. References from identified articles were also searched and included, if appropriate. MAIN OUTCOME MEASURES Review of peer-reviewed literature. RESULTS The prevalence of ED among transplant recipients is higher than that in the general population: 39.8-86.2% in liver transplant recipients, 54-66% in renal transplant recipients, 71-78% in heart transplant recipients, and 79% in simultaneous pancreas-kidney transplant recipients. Phosphodiesterase-5 inhibitors have up to 80% efficacy in treating ED in kidney transplant recipients. Intracavernosal injections have been used with success rates of 60-70% in cardiac and renal transplant recipients. Penile prostheses have also been shown to be safe and effective across transplant types. A low incidence of infection has been reported in several case series, although there is concern for an increased rate of mechanical complications in pelvic organ transplant recipients. Accordingly, placement of a two-piece or malleable prosthesis or ectopic reservoir placement with a three-piece inflatable prosthesis is suggested in this population. CONCLUSION ED is highly prevalent among male solid organ transplant recipients and should be routinely screened in this population. Current modalities of ED treatment used in the general population are safe and effective in solid organ transplant recipients, although success rates are often lower than those in the general population. Payne K, Popat S, Lipshultz LI, et al. The Prevalence and Treatment of Erectile Dysfunction in Male Solid Organ Transplant Recipients. Sex Med Rev 2021;9:331-339.
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Affiliation(s)
| | - Shreeya Popat
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Nannan Thirumavalavan
- Urology Institute, University Hospitals/Case Western Reserve University School of Medicine, Cleveland, OH.
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Mota RL, Fonseca R, Santos JC, Covita AM, Marques N, Matias P, Simões H, Ramos C, Machado D, Cardoso J. Sexual Dysfunction and Satisfaction in Kidney Transplant Patients. J Sex Med 2019; 16:1018-1028. [PMID: 31010779 DOI: 10.1016/j.jsxm.2019.03.266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/10/2019] [Accepted: 03/20/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION 10% of the world's population suffers from chronic kidney disease. Kidney transplants provide an improvement in the quality of life of those patients. Sexual dysfunction is common after kidney transplantation, and its etiology is presumed to be multifactorial. It has a negative impact on sexual satisfaction and health-related quality-of-life. The integration of a new organ into the body can imply an adjustment of body image, which may eventually have a negative influence on intimacy and sexual behaviors. AIM To evaluate male sexual function, sexual satisfaction, and body image satisfaction among a convenience sample of patients who have had a kidney transplant. METHODS This is a cross-sectional study that included 460 patients, from a single healthcare center, who had undergone a kidney transplant procedure >4 weeks ago. A total of 112 respondents (mean = 55.5 years, SD = 11.4) answered the questionnaires properly. MAIN OUTCOME MEASURES All recruited patients answered a self-reported sociodemographic questionnaire, in addition to the International Index of Erectile function, the New Scale of Sexual Satisfaction, the Brief Symptom Inventory, and the Body Image Scale. RESULTS A correlation was found between sexual function and sexual satisfaction (r = 0.598, P < .001, n = 112), as well as between body image satisfaction and sexual function (r = -0.193, P = .042, n = 112). The length of time after a kidney transplant (≤ or >36 months) was not associated with a difference in sexual functioning or sexual satisfaction. CLINICAL IMPLICATIONS This study showed the obvious implications of sexual function on sexual satisfaction, which should alert healthcare professionals to the importance of identifying and managing sexual dysfunction in patients with chronic kidney disease, to optimize their global and sexual health satisfaction. STRENGTH & LIMITATIONS This study identified a high prevalence of sexual dysfunction among kidney transplant recipients. This should reinforce the need for the medical community to evaluate the quality-of-life domains of patients with chronic disease. There is still a lack of information concerning any longitudinal evaluation of kidney transplant patients' sexual function and the effects that this surgery has on sexuality. CONCLUSIONS This study corroborated the severe effects that kidney transplant patients often report regarding their sexuality. Among the patients who participated in the study, sexual function proved to be relevant in relation to sexual satisfaction. Mota RL, Fonseca R, Santos JC, et al. Sexual Dysfunction and Satisfaction in Kidney Transplant Patients. J Sex Med 2019;16:1018-1028.
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Affiliation(s)
- Renato Lains Mota
- Urology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal.
| | - Rita Fonseca
- Urology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - José Carlos Santos
- Urology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - Ana Mateus Covita
- Urology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | | | - Patricia Matias
- Nephrology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Carnaxide, Portugal
| | - Hélder Simões
- Endocrinology Department at Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Catarina Ramos
- Instituto Universitário Egas Moniz, ISPA- Instituto Universitário; ISPA - Instituto Superior de Psicologia Aplicada, Lisbon, Portugal
| | - Domingos Machado
- Nephrology Department at Centro Hospitalar de Lisboa Ocidental, EPE, Carnaxide, Portugal
| | - Jorge Cardoso
- Instituto Universitário Egas Moniz, ISPA- Instituto Universitário; ISPA - Instituto Superior de Psicologia Aplicada, Lisbon, Portugal
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Kleinclauss F, Timsit MO, Thuret R. [Sexuality, fertility and pregnancy after kidney transplantation]. Prog Urol 2016; 26:1122-1131. [PMID: 27665408 DOI: 10.1016/j.purol.2016.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 11/15/2022]
Abstract
AIMS To describe sexuality and fertility alterations secondary to chronic kidney disease and their outcomes after renal transplantation. MATERIAL AND METHODS An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords: erectile dysfunction; impotence; sexuality; pregnancy; fertility; renal transplantation. Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 706 articles. After reading titles and abstracts, 76 were included in the text, based on their relevance. RESULTS The observed prevalence of erectile dysfunction is high in men with chronic kidney disease. The causes of erectile dysfunction are numbers and its origin is often multifactorial. Most of the time, kidney transplantation improves sexuality and the management of erectile dysfunction in transplanted men is similar to the general population. Improvement in sexuality in men and women after kidney transplantation may conduct to pregnancy. The outcomes of pregnancy after transplantation are quite good in absence of risk factors such as time to pregnancy less than 1 year after transplantation, uncontrolled high blood pressure, and decreased renal function of the graft. Adaptation of immunosuppression may be required to avoid any teratogenicity for the fetus. CONCLUSION Kidney transplantation improves sexuality and fertility in men and women with chronic kidney disease.
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Affiliation(s)
- F Kleinclauss
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France.
| | - M-O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - R Thuret
- Service d'urologie et transplantation rénale, CHU de Montpellier, 34090 Montpellier, France; Université de Montpellier, 34000 Montpellier, France
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Riátiga D, Salgado Sánchez LE, Quiroz Y. Efecto del trasplante renal en la percepción de la función sexual de los pacientes con insuficiencia renal terminal. UROLOGÍA COLOMBIANA 2015. [DOI: 10.1016/j.uroco.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Papadopoulou E, Varouktsi A, Lazaridis A, Boutari C, Doumas M. Erectile dysfunction in chronic kidney disease: From pathophysiology to management. World J Nephrol 2015; 4:379-387. [PMID: 26167462 PMCID: PMC4491929 DOI: 10.5527/wjn.v4.i3.379] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 12/27/2014] [Accepted: 05/28/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) is encountered in millions of people worldwide, with continuously rising incidence during the past decades, affecting their quality of life despite the increase of life expectancy in these patients. Disturbance of sexual function is common among men with CKD, as both conditions share common pathophysiological causes, such as vascular or hormonal abnormalities and are both affected by similar coexisting comorbid conditions such as cardiovascular disease, hypertension and diabetes mellitus. The estimated prevalence of erectile dysfunction reaches 70% in end stage renal disease patients. Nevertheless, sexual dysfunction remains under-recognized and under-treated in a high proportion of these patients, a fact which should raise awareness among clinicians. A multifactorial approach in management and treatment is undoubtedly required in order to improve patients’ quality of life and cardiovascular outcomes.
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Suzuki E, Nishimatsu H, Oba S, Takahashi M, Homma Y. Chronic kidney disease and erectile dysfunction. World J Nephrol 2014; 3:220-229. [PMID: 25374815 PMCID: PMC4220354 DOI: 10.5527/wjn.v3.i4.220] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/22/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
Erectile dysfunction (ED) is a common condition among male chronic kidney disease (CKD) patients. Its prevalence is estimated to be approximately 80% among these patients. It has been well established that the production of nitric oxide from the cavernous nerve and vascular endothelium and the subsequent production of cyclic GMP are critically important in initiating and maintaining erection. Factors affecting these pathways can induce ED. The etiology of ED in CKD patients is multifactorial. Factors including abnormalities in gonadal-pituitary system, disturbance in autonomic nervous system, endothelial dysfunction, anemia (and erythropoietin deficiency), secondary hyperparathyroidism, drugs, zinc deficiency, and psychological problems are implicated in the occurrence of ED. An improvement of general conditions is the first step of treatment. Sufficient dialysis and adequate nutritional intake are necessary. In addition, control of anemia and secondary hyperparathyroidism is required. Changes of drugs that potentially affect erectile function may be necessary. Further, zinc supplementation may be necessary when zinc deficiency is suspected. Phosphodiesterase type 5 inhibitors (PDE5Is) are commonly used for treating ED in CKD patients, and their efficacy was confirmed by many studies. Testosterone replacement therapy in addition to PDE5Is may be useful, particularly for CKD patients with hypogonadism. Renal transplantation may restore erectile function. ED is an early marker of cardiovascular disease (CVD), which it frequently precedes; therefore, it is crucial to examine the presence of ED in CKD patients not only for the improvement of the quality of life but also for the prevention of CVD attack.
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Lasaponara F, Sedigh O, Pasquale G, Bosio A, Rolle L, Ceruti C, Timpano M, Negro CLA, Paradiso M, Abbona A, Segoloni GP, Fontana D. Phosphodiesterase type 5 inhibitor treatment for erectile dysfunction in patients with end-stage renal disease receiving dialysis or after renal transplantation. J Sex Med 2013; 10:2798-814. [PMID: 23346948 DOI: 10.1111/jsm.12038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The phosphodiesterase type 5 (PDE5) inhibitors are generally well tolerated and effective for treating erectile dysfunction (ED), including in patients with significant comorbidity. Because of this benign safety profile, investigators have used PDE5 inhibitors to treat patients with ED and severe renal disease or those who have received renal transplants. AIM To assess safety and efficacy of PDE5 inhibitors in patients receiving dialysis or renal transplants. MAIN OUTCOME MEASURES Erectile function as assessed by the International Index of Erectile Function (IIEF) and Global Assessment Questions; adverse events (AEs). METHODS We reviewed published studies of PDE5 inhibitors in patients receiving dialysis or renal transplants. RESULTS In double-blind, placebo-controlled studies in patients receiving dialysis or renal transplants, sildenafil significantly improved erectile function as assessed by the IIEF, and 75-85% of patients reported improved erectile function on Global Assessment Questions; efficacy was more variable in less well-controlled studies. In >260 patients undergoing dialysis who received sildenafil in clinical studies, there were only six reported discontinuations because of AEs (headache [N=3], headache and nausea [N=1], gastrointestinal [N=1], and symptomatic blood pressure decrease [N=1]). In approximately 400 patients with renal transplants who received sildenafil, only three patients discontinued because of AEs. Vardenafil improved IIEF scores of up to 82% of renal transplant recipients in randomized, controlled studies (N=59, total), with no reported discontinuations because of AEs. Limited data also suggest benefit with tadalafil. CONCLUSIONS ED is common in patients undergoing renal dialysis or postrenal transplant and substantially affects patient quality of life. Sildenafil and vardenafil appear to be efficacious and well tolerated in patients receiving renal dialysis or transplant.
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Burra P, Germani G, Masier A, De Martin E, Gambato M, Salonia A, Bo P, Vitale A, Cillo U, Russo FP, Senzolo M. Sexual dysfunction in chronic liver disease: is liver transplantation an effective cure? Transplantation 2010; 89:1425-1429. [PMID: 20463637 DOI: 10.1097/tp.0b013e3181e1f1f6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The goal of liver transplantation is not only to ensure patient long-term survival but also to offer the opportunity to achieve psychologic and physical integrity. Quality of life after liver transplantation may be affected by unsatisfactory sexual function. Before liver transplantation, sexual dysfunction and sex hormone disturbances are reported in men and women mainly due to abnormality of physiology of the hypothalamic-pituitary-gonadal axis and, in some cases, origin of liver disease. Successful liver transplantation should theoretically restore hormonal balance and improve sexual function both in men and women, thus improving the reproductive performance. However, after transplantation, up to 25% of patients report persistent sexual dysfunction, and approximately one third of patients describe the appearance of de novo sexual dysfunction. Despite the described high prevalence of this condition, epidemiologic data are relatively scant. Further studies on pathophysiology and risk factors in the field of sexual function after liver transplantation along with new strategies to support and inform patients on the waiting list and after surgery are needed.
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Affiliation(s)
- Patrizia Burra
- Department of Surgical and Gastroenterological Sciences, Multivisceral Transplant Unit, Gastroenterology, University of Padova, Padova, Italy.
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Tavallaii SA, Mirzamani M, Heshmatzade Behzadi A, Assari S, Khoddami Vishteh HR, Hajarizadeh B, Einollahi B. Sexual function: a comparison between male renal transplant recipients and hemodialysis patients. J Sex Med 2009; 6:142-8. [PMID: 19170845 DOI: 10.1111/j.1743-6109.2008.01047.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION For all the studies into the sexual health of kidney transplant recipients, there is a paucity of controlled studies regarding the difference in the sexual relationship of kidney transplant recipients and end-stage renal disease (ESRD) patients under hemodialysis. AIM We compared the sexual function of kidney transplant recipients and ESRD patients under hemodialysis in male patients. MAIN OUTCOME MEASURES The patients' sexual function was assessed using the Relationship and Sexuality Scale. METHOD In this case-controlled study, 89 male renal transplant recipients and 25 male hemodialysis patients were randomly selected from the outpatient clinic of Baqiyatallah Hospital, Tehran, Iran, in 2006. The two groups were not significantly different in terms of age, living place, level of education, duration of ESRD (months), ESRD cause, and somatic comorbidities (Ifudu index). RESULTS The renal transplant patients in comparison with the hemodialysis group reported a better overall sexual relationship (17.3 +/- 0.6 vs. 21.6 +/- 1.4; P = 0.001), and all subscales including sexual function (9.9 +/- 0.3 vs. 11.4 +/- 0.6; P = 0.03), sexual frequency (6.3 +/- 0.3 vs. 7.4 +/- 0.6; P = 0.04), and sexual fear (1.1 +/- 0.2 vs. 2.8 +/- 0.5; P = 0.001). In addition, kidney recipients had significantly more sexual intercourse in a 2-week period prior to the study (P = 0.008). CONCLUSIONS In our male population, kidney transplant recipients, in comparison with the ESRD patients under hemodialysis, reported a better sexual relationship.
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Lasaponara F, Paradiso M, Abbona A, Sedigh O, Ferrando U. Penile Prosthesis Implantation in Kidney-Transplanted Patients. Urologia 2009. [DOI: 10.1177/039156030907600209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most kidney transplantations are performed on middle-aged men for whom problems of sexual potency are still of great importance. Although a functional renal graft improves the problem in some patients and others resolve with oral or intracavernous therapy, about 20% of patients do not have a good response. In non-responders, tricomponent penile prosthesis implantation is possible. In the last 10 years we have implanted with no complications 7 tricomponent AMS 700 prostheses in patients not otherwise responding. Our good results confirm that patients with kidney transplantation should be considered good candidates to the penile prosthesis if the erectile dysfunction persists after different therapies.
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Affiliation(s)
- F. Lasaponara
- SC di Urologia 3, Dipartimento di Nefro-Urologia; ASO Molinette, Torino
| | - M. Paradiso
- SC di Urologia 3, Dipartimento di Nefro-Urologia; ASO Molinette, Torino
| | - A. Abbona
- SC di Urologia 3, Dipartimento di Nefro-Urologia; ASO Molinette, Torino
| | - O. Sedigh
- SC di Urologia 3, Dipartimento di Nefro-Urologia; ASO Molinette, Torino
| | - U. Ferrando
- SC di Urologia 3, Dipartimento di Nefro-Urologia; ASO Molinette, Torino
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Barroso LVS, Miranda EP, Cruz NI, Medeiros MAS, Araújo ACO, Mota Filho FHA, Medeiros FC. Analysis of sexual function in kidney transplanted men. Transplant Proc 2009; 40:3489-91. [PMID: 19100420 DOI: 10.1016/j.transproceed.2008.07.141] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 07/07/2008] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Sexual dysfunction among renal failure and kidney transplant patients remains controversial. The aim of this study was to evaluate sexual functions of men on hemodialysis compared with patients undergoing kidney transplantation. MATERIALS AND METHODS Our study was based on 36 end-stage renal disease (ESRD) patients undergoing hemodialysis versus 32 kidney transplanted patients. A control group was composed of 23 healthy patients. The patients underwent an anamnesis, a physical examination, and the International Index of Erectile Function about sexual performance. Statistical analysis was performed by Student's t-test or the chi-square test with the level of significance set at P < .05. Data are reported as mean values +/- standard error of the means. RESULTS The mean scores of the control, ESRD, and transplanted group were, respectively: for erectile function, 27.4 +/- 0.5, 22.4 +/- 1.3, 23.4 +/- 1.3; for orgasmic function, 9.5 +/- 0.1, 7.6 +/- 0.5, 8.9 +/- 0.5; for sexual desire function 9.4 +/- 0.1, 7.1 +/- 0.3, 9.0 +/- 0.5; for intercourse satisfaction 12.8 +/- 0.3, 9.4 +/- 0.7, 11.0 +/- 0.7; and for satisfaction related to sexual life 9.2 +/- 0.2, 7.7 +/- 0.3, 8.6 +/- 0.6, proving that there were significant differences regarding orgasmic function, sexual desire, and intercourse satisfaction. CONCLUSION It was possible to conclude from our study that kidney transplants do improve sexual function of patients with ESRD on hemodialysis.
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Affiliation(s)
- L V S Barroso
- Federal University of Ceara, Faculty of Medicine, Fortaleza, Ceara, Brazil
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24
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Heneghan MA, Selzner M, Yoshida EM, Mullhaupt B. Pregnancy and sexual function in liver transplantation. J Hepatol 2008; 49:507-19. [PMID: 18715668 DOI: 10.1016/j.jhep.2008.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Michael A Heneghan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
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Mirone V, Longo N, Fusco F, Verze P, Creta M, Parazzini F, Imbimbo C. Renal transplantation does not improve erectile function in hemodialysed patients. Eur Urol 2008; 56:1047-53. [PMID: 18835084 DOI: 10.1016/j.eururo.2008.09.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 09/16/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Effects of renal transplantation (RT) on erectile dysfunction (ED) is a controversial issue. OBJECTIVE To verify the efficacy of RT in restoring erectile function (EF) in hemodialysed patients. DESIGN, SETTING, AND PARTICIPANTS We conducted a prospective, interventional, nonrandomised study from September 2001 to September 2005 on 78 hemodialysed male patients undergoing RT. EF was evaluated during the baseline visit and 1 yr after RT, using the International Index of Erectile Function (IIEF) questionnaire. A subanalysis was performed by splitting the total cohort into two age groups: <45 yr and ≥45 yr. INTERVENTION RT was performed. MEASUREMENTS EF was evaluated using the IIEF scoring system. RESULTS AND LIMITATIONS Before RT, 68 patients with a mean total IIEF score of 42.46 complained about ED. One year after RT, 71 patients reported ED, and the mean total IIEF score had decreased to 39.97. The mean pre-RT IIEF EF domain score was 18.48, and it decreased to 17.55 after RT. Patients aged≥45 yr reported no significant variations in any IIEF domain, while patients aged<45 yr reported a significant decrease in mean total IIEF score due to variations in domain scores for erectile function, sexual desire, and overall satisfaction. In the younger age group, we found significant differences between baseline and post-RT IIEF scores in dyslipidaemic patients and in those patients using immunosuppressive (methylprednisolone and cyclosporin) or antihypertensive (ACE-inhibitors, β-blockers, and Ca-antagonists) drugs. The main limitations were the absence of any aetiological characterisation of ED and the small number of patients. CONCLUSIONS After RT, EF worsens in patients<45 yr but is not modified in patients≥45 yr.
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Affiliation(s)
- Vincenzo Mirone
- Department of Urology, University Federico II of Naples, Naples, Italy
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26
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Chatterjee R, Deng J, Pellerin D, Todd-Pokropek A, Neild GH, Lees WR, Rodeck CH. Feasibility of dynamic 3-D color Doppler ultrasound for imaging penile vascular change in renal transplant patients with erectile dysfunction responding to sildenafil. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:885-91. [PMID: 18295391 DOI: 10.1016/j.ultrasmedbio.2007.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 10/16/2007] [Accepted: 11/21/2007] [Indexed: 05/25/2023]
Abstract
Renal transplant recipients (RTRs) have a high incidence of erectile dysfunction (ED). Differentiation of penile vasculogenic impotence from other causes is important for treatment. Conventional 2-D color Doppler assessment after intracavernosal stimulant injection often fails to produce reliable results because of limited views by the cross-sectional imaging and the painful procedure. In comparison to the findings in three healthy volunteers, we determined cavernosal vascular hemodynamics in eight RTRs with ED before and after oral sildenafil by using live 3-D ultrasound and dynamic 3-D color Doppler. Results showed that, before sildenafil, penile arterial flow signals could only be reliably detected in one patient. After sildenafil, all had reliably detectable flow with grades II to III erection. Our data suggest that 3-D volumetric changes of the penis and its vasculature during erection can be studied by this technique and that this method could be useful for the evaluation of new drugs and therapeutic biofeedback.
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Affiliation(s)
- Ratna Chatterjee
- Department of Obstetrics and Gynaecology, University College London, London, UK.
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Awad M, da Silva E, Souza E, Damião R. Clinical Outcome of Long-Term Renal Transplant Survivors: A Nephrourologic Approach. Transplant Proc 2008; 40:714-7. [DOI: 10.1016/j.transproceed.2008.02.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jacobs SC, Nogueira JM, Phelan MW, Bartlett ST, Cooper M. Transplant recipient renal function is donor renal mass- and recipient gender-dependent. Transpl Int 2007; 21:340-5. [PMID: 18086285 DOI: 10.1111/j.1432-2277.2007.00617.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The effect of both donor renal mass and gender on renal function, in both gender recipients, was examined. Qualifying consecutive living-donor renal transplants (n = 730) were stratified into 4 donor-recipient groups: female-female (n = 177), male-female (n = 151), female-male (n = 240), male-male (n = 162). Groups were equivalent in age, race, body mass index (BMI), match, ischemia time, operative time, and estimated glomerular filtration rate (eGFR). Female recipients had lower serum creatinine (Cr(s)). Male recipients had higher Cr(s) wherever they received a female allograft. Male recipients of male kidneys had a higher eGFR than all other groups for 3 years. Renal function of the recipient correlated with the renal mass of the donor within each group. Male and female kidneys functioned equivalently in the female-recipient environment. Large nephron-mass male donor kidneys function more poorly in female recipients. The male kidney loses 15-20 ml/min eGFR in the female host. The diminished graft function may be related to androgen deprivation. Female and male donor kidneys function equivalently in the male recipient if adjusted for renal mass transplanted. Female kidneys improve eGFR by 7-10 ml/min by being transplanted into a male environment. Donor renal mass and gender affect recipient graft function Expectations of ultimate recipient renal function should take into account both the gender and mass disparity of the donor-recipient pair.
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Affiliation(s)
- Stephen C Jacobs
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Tavallaii SA, Fathi-Ashtiani A, Nasiri M, Assari S, Maleki P, Einollahi B. ORIGINAL RESEARCH—PSYCHOLOGY: Correlation Between Sexual Function and Postrenal Transplant Quality of Life: Does Gender Matter? J Sex Med 2007; 4:1610-8. [PMID: 17672846 DOI: 10.1111/j.1743-6109.2007.00565.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Subjective health perceptions affect sexual function differently in males and females; such differences, however, have not hitherto been studied comprehensively in kidney-transplant recipients. AIM This study sought to investigate gender effect on the correlation between sexual function and quality-of-life (QOL) subdomains in kidney-transplant recipients by evaluating intercourse frequency (IF) and intercourse satisfaction (IS). METHODS In a cross-sectional study, 124 married kidney-transplant recipients, who were randomly selected, were interviewed. The bivariate correlations between QOL subdomains, and IF and IS were analyzed with the Pearson test in the males and females, separately. MAIN OUTCOME MEASURE The IF and IS using the relationship and sexuality scale, and also the QOL using Short Form 36 (SF-36) were assessed. RESULTS Sixty-seven subjects (54%) reported having no intercourse within the preceding months. Fifty subjects (40%) reported having no intercourse satisfaction. While IF and IS correlated with the total SF-36 score in the males (r = 0.252 and 0.263, P < 0.05), there was no such correlation in the females. In the males, IS correlated with physical health (r = 0.281, P < 0.05) and physical function (r = 0.274, P < 0.05), and there was a correlation between IF and role limitation due to emotional problems (r = 0.250, P < 0.05). In the females, whereas IF correlated with general health (r = 0.372, P < 0.05) and mental health (r = 0.305, P < 0.05), there was no correlation between IS and QOL subdomains (P > 0.05). CONCLUSION Sexual function and satisfaction seem to be correlated with mental and physical health in female and male kidney-transplant recipients, respectively. Although in the two genders, both physical and mental health should be equally evaluated; improving of the sexual function may be better achieved through different approaches.
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Affiliation(s)
- Seyed Abbas Tavallaii
- Behavioral Sciences Research Center, Baqiyatallah Medical Sciences University, Tehran, Iran.
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Salonia A. Sildenafil citrate: a safe and effective treatment for erectile dysfunction after renal transplantation? NATURE CLINICAL PRACTICE. NEPHROLOGY 2007; 3:80-1. [PMID: 17251995 DOI: 10.1038/ncpneph0397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Accepted: 11/27/2006] [Indexed: 05/13/2023]
Affiliation(s)
- Andrea Salonia
- Ospedale San Raffaele, Department of Urology, Via Olgettina 60, Milan 20132, Italy.
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Abstract
Erectile dysfunction is common in male kidney transplant recipients. Interference with the physiology of erections can be attributed to recipient co-morbidities, the renal transplant operation, medication adverse effects, relationship problems and changes in mental health. A treatment-oriented evaluation of erectile dysfunction allows the development of treatment plans that are patient-specific. Hypo-gonadal men whose hormone parameters do not improve after renal transplantation may respond to testosterone replacement therapy. Use of recommended doses of the phosphodiesterase-5 inhibitor sildenafil does not significantly modify trough concentrations of the calcineurin inhibitors ciclosporin and tacrolimus or result in impaired renal allograft function. Tacrolimus has been shown to increase the peak concentration and prolong the elimination half-life of sildenafil in kidney transplant recipients. Daily administration of sildenafil has resulted in decreased blood pressure in kidney transplant recipients with treated hypertension and tacrolimus immunosuppression. Intracavernosal injections of alprostadil, with or without papaverine and phentolamine, are effective treatments for erectile dysfunction after renal transplantation and have not resulted in alterations of ciclosporin concentrations or in deterioration of renal function. Penile prostheses can be successfully implanted after pelvic organ transplantation without significant risk of infection.
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Affiliation(s)
- John M Barry
- Division of Urology and Renal Transplantation, The Oregon Health and Science University, Portland, Oregon 97239, USA.
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Sharma RK, Prasad N, Gupta A, Kapoor R. Treatment of erectile dysfunction with sildenafil citrate in renal allograft recipients: a randomized, double-blind, placebo-controlled, crossover trial. Am J Kidney Dis 2006; 48:128-33. [PMID: 16797395 DOI: 10.1053/j.ajkd.2006.04.061] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Accepted: 04/10/2006] [Indexed: 01/29/2023]
Abstract
BACKGROUND Erectile dysfunction (ED) is observed frequently in patients with end-stage renal disease, hemodialysis patients, and renal allograft recipients. There are few studies of sildenafil use in renal allograft recipients. METHODS The study is designed as a randomized, double-blind, placebo-controlled, crossover trial. Efficacy was assessed by using the self-administered International Index of Erectile Function (IIEF), a 15-question validated measure of ED, and a global efficacy question (Did the treatment improve your erection?). RESULTS Thirty-two eligible renal transplant recipients were included in this study. After treatment with sildenafil citrate, patients had significantly better scores in 13 of 15 questions, except for questions 11 (desire frequency; P = 0.39) and 12 (desire level; P = 0.61). Treatment efficacy assessed through questions 3 (penetration ability; P < 0.001) and 4 (maintenance frequency; P < 0.001) was significantly better after sildenafil therapy. There were no significant differences between baseline and post-placebo treatment scores, except for question 13 (relationship satisfaction). Patients treated with sildenafil had significantly better scores in 4 domains compared with baseline, but a difference was not observed in the sexual desire domain (P = 0.32). There were no significant differences in scores between placebo and baseline in any domain. On the global efficacy question, 81.3% of patients showed improvement compared with 18.7% with placebo. There were no differences in areas under the curve and maximum cyclosporine concentrations before and after sildenafil therapy. No patient discontinued the drug because of side effects except for 1 patient with visual hallucination. CONCLUSION Treatment with sildenafil in renal transplant recipients is a valid option with an effective response.
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Affiliation(s)
- Raj K Sharma
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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Habwe VQ. Posttransplantation Quality of Life: More Than Graft Function. Am J Kidney Dis 2006; 47:S98-110. [PMID: 16567244 DOI: 10.1053/j.ajkd.2005.12.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Accepted: 12/09/2005] [Indexed: 11/11/2022]
Abstract
Whereas newer immunosuppressive therapies have increased patient and graft survival, long-term treatment with these drugs has been linked to medical and physical complications that may impact on posttransplantation quality of life. Immunosuppression-related physical side effects that can alter appearance--including hirsutism, gingival hyperplasia, weight gain, cushingoid facies, hand tremors, alopecia, and skin disorders--are among the most bothersome to patients and may have serious psychosocial implications. In addition, physical side effects may influence patient adherence to their prescribed treatment regimens and result in more serious complications, such as acute rejection, graft loss, rehospitalization, and even mortality. Therefore, strategies for minimizing side effects of immunosuppressive therapy and improving medication adherence are integral to better long-term transplant recipient management.
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Affiliation(s)
- Violet Q Habwe
- Washington Nephrology Associates, Washington, DC 20037, USA.
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Shamsa A, Motavalli SM, Aghdam B. Erectile function in end-stage renal disease before and after renal transplantation. Transplant Proc 2006; 37:3087-9. [PMID: 16213314 DOI: 10.1016/j.transproceed.2005.08.067] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Erectile function in end-stage renal disease (ESRD) and renal transplant patients is a challenging issue. In this study we evaluated the prevalence of erectile dysfunction (ED) according to standard questionnaires and paraclinical tests including Rigiscan. MATERIALS AND METHODS We conducted a prospective, interventional, nonrandomized study of 15 consecutive male patients who underwent living donor renal transplants from March 2003 to June 2004. Before and after living donor transplantation we did hormone assays, blood ionogram and biochemistry, complete blood counts, u/a, international index of erection function 5 (IIEF-5), erection dysfunction intensive score (EDIS) tests as well as Rigiscan. RESULTS The patient ages were between 21 and 50 (average 35.26) years, with an average length of ESRD of 4.31 years. Of the patients, 73.33% were smokers; 46.66% had ED; and 40%, hypertension. The most common blood groups were B-positive and O-positive (33.3% each). Mean testosterone and prolactin levels showed significant decreases after renal transplantation (P = .001 and P = .005, respectively). Mean blood glucose also decreased significantly (P = .035), despite previous reports that immunosuppressive drugs cause pseudodiabetes mellitus, mean cholesterol and triglyceride levels decreased after renal transplantation (P = .013, P = .0668, respectively). Urinalysis did not differ significantly after renal transplantation. Mean urea and creatinine levels were decreased significantly by renal transplantation (P = .000 and P = .003, respectively), but neither the mean values of uric acid nor the blood cell count were significantly different (P = .374). Mean hemoglobin and hematocrit levels were increased by renal transplantation, but it was not significant (P = .297 and P = .187, respectively). Mean potassium and phosphorus level were significantly decreased (P = .049 and P = .047, respectively), but mean sodium and calcium levels were not significantly altered (P = .773 and P = .536, respectively). Mean total and direct bilirubin and liver enzymes and alkaline phosphatase and LDH also did not change significantly. IIEF-5 was improved in 11 cases, unchanged in two cases, and worsened in another two cases. Nocturnal penile tumescence (Rigiscan test) was also improved in 11 cases, unchanged in three cases, and worsened in one case. The prevalence of erectile function was increased according to the EDIS question. CONCLUSION Erectile function was improved after successful live donor renal transplant.
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Affiliation(s)
- A Shamsa
- Department of Urology & Kidney Transplantation, Mashaad University of Medical Science, Ghaem Hospital, Mashaad, Iran.
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Fuller TF, Liefeldt L, Dragun D, Tüllmann M, Loening SA, Giessing M. Urologische Betreuung von Patienten vor und nach Nierentransplantation. Urologe A 2006; 45:53-9. [PMID: 16292480 DOI: 10.1007/s00120-005-0964-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with end-stage renal disease awaiting kidney transplantation require regular urological evaluation. The urologist's main task is early diagnosis and treatment of genitourinary malignancies and evaluation of the lower urinary tract. Furthermore, urologists are often confronted with the question of whether or not to perform pretransplant urological surgery, i.e., native nephrectomy for polycystic kidney disease. Urological care after kidney transplantation involves diagnosis and treatment of ureteral complications, malignancies, lower urinary tract symptoms, and last but not least erectile dysfunction, which has a prevalence of 20-50% among kidney transplant recipients. For the evaluation and follow-up of the living kidney donor, international guidelines have been developed in recent years to also help the urologist to perform a correct evaluation and follow-up of the kidney donor.
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Affiliation(s)
- T F Fuller
- Klinik für Urologie, Campus Mitte, Charité, Universitätsmedizin, Schumannstrasse 20-21, 10017 Berlin.
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