Article

Analysis of Sexual Function in Kidney Transplanted Men

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Abstract

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. 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. 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. 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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... 42 Moreover, sexual dysfunction is a frequent, common and multifactorial problem in patients with Chronic Renal Failure. 43,44 Sexual disorders significantly affect the quality of life of men and their partners, while they have a negative impact not only on their self esteem but also on their interpersonal relationships. 43,45 It has been asserted that physical activity improves the quality of life of patients on dialysis, provided that it is progressive and individualized according to patient's limitations (type of exercise, frequency, timing, intensity of exercise) and their pathophysiological condition. ...
... 43,44 Sexual disorders significantly affect the quality of life of men and their partners, while they have a negative impact not only on their self esteem but also on their interpersonal relationships. 43,45 It has been asserted that physical activity improves the quality of life of patients on dialysis, provided that it is progressive and individualized according to patient's limitations (type of exercise, frequency, timing, intensity of exercise) and their pathophysiological condition. 40,46 AIM The aim of this study was to investigate the psychological impact of dialysis on the quality of life of patients with End Stage Renal Failure ...
... According to previous studies, sexual dysfunction was a frequent, common and multifactorial problem for patients with ESRD, since 50% of men and 55% of women undergoing hemodialysis reported difficulty in achieving orgasm and sexual dysfunction. 43,44 The results of this study disagree with those of previous studies, which reflect a better quality in their sex life. This may happen because the largest percentage of the sample in the present study is over 55 years old and is not in the reproductive age where the sexual desire is developed. ...
Article
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Background: Patients' compliance consists a complex and multidimensional health issue, globally. At least three terms are used to describe the behavior of medication- taking. Aim: The aim of the present study was to review a conceptual analysis of patients' compliance to treatment. Method and Material: The methodology included research of studies published in electronic databases such as Pub Med, Medline, WHO, PsychInfo, Cochrane National Council on Patient Information and Education and Dovepress. The search covered the period 1970-2011. Results: Literature includes terminology analysis of terms 'patients' compliance and non-compliance', 'patients' adherence and non-adherence' and 'patients' concordance'. Approximately 115 articles were identified. The present sample comprises 43 articles analyzing the terminology of these terms. 11 of these are mentioned in the attitude of Nursing Science to the controversy about the terms. Conclusions: Compliance can be defined in various ways. The interpretation of the term depends on the philosophical context in which the concept is settled. The patient-centered approach facilitates the creation of an alliance between patient-therapist.
... 42 Moreover, sexual dysfunction is a frequent, common and multifactorial problem in patients with Chronic Renal Failure. 43,44 Sexual disorders significantly affect the quality of life of men and their partners, while they have a negative impact not only on their self esteem but also on their interpersonal relationships. 43,45 It has been asserted that physical activity improves the quality of life of patients on dialysis, provided that it is progressive and individualized according to patient's limitations (type of exercise, frequency, timing, intensity of exercise) and their pathophysiological condition. ...
... 43,44 Sexual disorders significantly affect the quality of life of men and their partners, while they have a negative impact not only on their self esteem but also on their interpersonal relationships. 43,45 It has been asserted that physical activity improves the quality of life of patients on dialysis, provided that it is progressive and individualized according to patient's limitations (type of exercise, frequency, timing, intensity of exercise) and their pathophysiological condition. 40,46 AIM The aim of this study was to investigate the psychological impact of dialysis on the quality of life of patients with End Stage Renal Failure ...
... According to previous studies, sexual dysfunction was a frequent, common and multifactorial problem for patients with ESRD, since 50% of men and 55% of women undergoing hemodialysis reported difficulty in achieving orgasm and sexual dysfunction. 43,44 The results of this study disagree with those of previous studies, which reflect a better quality in their sex life. This may happen because the largest percentage of the sample in the present study is over 55 years old and is not in the reproductive age where the sexual desire is developed. ...
... Sexual dysfunction is a frequent and common problem in patients with CRF as 50% of men with ESRD and 55% of women undergoing dialysis report difficulty achieving orgasm. 48,49 A casecontrol study of Yun Seob Song et al., 50 on sexual function and quality of life of women in Korea with CRF on dialysis, reports that 70% of patients display sexual dysfunction. According to that study, sexual dysfunction is higher in women on haemodialysis or peritoneal clearance due to the lack of sexual interest. ...
... 51 Also, sexual disorders greatly affect the quality of life of many men and their partners and have negative impact on their self esteem and on their interpersonal relationships. 48 This condition has been shown to be significantly more common in men and women with renal disease than in the general population. 52 Men more often have problems with the features of sexual dysfunction, such as difficulty in sexual arousal, erectile dysfunction, premature or delayed ejaculation and difficulty in achieving orgasm. ...
Article
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Background: Chronic Renal Failure (CRF) is a public health problem that tends to take dimensions of epidemic and has serious impact on quality of patient's life. Aim: The aim of the present study was to review the literature and to explore the psychological impact of dialysis on the quality of life of people with chronic renal failure. Material - Method: Literature review based on studies and reviews derived from international (Medline, PubMed, Cinahl, Scopus) and Greek (Iatrotek) data bases concerning psychological problems of people with renal failure. The collection of data conducted from March to December 2012. Also, were used keywords such as haemodialysis, psychological factors, social status, economic status, renal failure, quality of life, as well as articles by the National Documentation Centre, which provided valid and documented data from global research and epidemiology. Results: According to the literature, Chronic Renal Failure is associated with long-term psychological effects on patients undergoing haemodialysis. A chronic illness, such as kidney failure, is a continuous process since these patients try to accept their new image and to adapt their lifestyle to dialysis treatment. Patients with kidney disease undergoing regular dialysis face difficulties in maintaining their employment, their social life, their financial flexibility and their limitation of liquids and foods. Conclusion: Complexity and chronic nature of the disease affect the quality of life of patients with CRF and their health and reduce their life expectancy. So, the role of the Nephrology Nurse is highly important for the implementation of effective nursing interventions and psychological support during their treatment.
... This problem develops commonly within the first months of dialysis and tends to regress as dialysis is maintained. In a study carried out with male patients undergoing dialysis treatment, it was established that problems such as anorgasmia and decreased sexual desire and satisfaction are quite common (Barroso et al., 2008). In studies carried out with female patients, it was stated that sexual complaints are twice as high compared with the rest of the population (Prescott, Eidemak, Harrison, & Molsted, 2014). ...
... Lack of sexual desire, decrease in sexual performance, orgasm problems and dyspareunia due to vaginal dryness are common problems occurring in female patients (Arslan & Ege, 2009;Mor et al., 2013;Noohi et al., 2010;Peng et al., 2005;Şahin & Ertekin, 2009). Similarly, in male dialysis patients, decrease in sexual desire and satisfaction, anorgasmia and erectile dysfunction are common (Al Khallaf, 2010;Barroso et al., 2008;Şahin & Ertekin, 2009;Yılmaz et al., 2009). In the study, by Yılmaz and Özaltın (2010), of patients undergoing peritoneal dialysis, sexual dysfunction was found in 53.6% of female patients and in 28.1% of male patients. ...
Article
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Aims and objectives To evaluate personality characteristics and psychological symptoms believed to have an effect on the sexual functions and performances of patients undergoing dialysis treatment. Background Chronic renal failure is a life‐threatening condition which can often have a poor prognosis. The loss of vital kidney function and other complications can affect almost all age groups. Design A quantitative descriptive study. Methods The study sample included 225 patients selected randomly from patients who have undergone dialysis treatment for at least 3 months at a dialysis centre in a university hospital. In this study, the Golombok Rust Inventory of Sexual Satisfaction (GRISS), the Eysenck Personality Inventory (EPI) and the Brief Symptom Inventory (BSI) were used. Results In the correlation test, made to investigate the relation between the patients’ sexual satisfaction and their personalities, a significant positive relation was found between the communication subscale of the GRISS and the Lie dimension of the EPI, and a significant negative relation was found between the Communication subscale of the GRISS and the Lie dimension of the EPI, and between the Vaginismus and Orgasm subscales of the GRISS and the Extroversion dimension of the EPI. Conclusion Results showed that sexual problems, in the areas of nonsensuality, anorgasmia, avoidance and communication, are associated with extroversion and psychological symptoms. Relevance to clinical practice Sexual health and the psychological well‐being of patients with renal failure is an important issue that should be considered in nursing practice. Nurses should take the psychological problems of patients and their relations with partners into account and consider these problems in a holistic manner within the framework of nursing practice. They would then be able to play an effective role in intervening at an early stage and would be better equipped to help and control the psychological and sexual problems that some patients may experience.
... The effects of kidney transplantation on pre-existing sexual dysfunction are controversial. Previous studies have shown improvement in erectile dysfunction after kidney transplantation 14,15 but a recent study looked at both erectile and ejaculatory J o u r n a l P r e -p r o o f function prospectively in kidney transplant recipients. 16 The mean IIEF score significantly decreased at 6 months and remained unchanged at 12 months after transplant. ...
Article
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Sexual dysfunction is defined as any abnormality in sexual arousal, libido, intercourse, orgasm, or satisfaction. It is prevalent in patients with chronic and end-stage kidney disease, with 70% to 84% of men and 30% to 60% of women reporting some form of sexual dysfunction. Although kidney transplantation improves the overall quality of life for patients receiving dialysis, it can have unexpected effects on sexual function owing to the use of immunosuppressive medications and comorbid illnesses. It is important to recognize these adverse effects and pre-emptively discuss them with patients to help mitigate consequent psychosocial discontent. Women of reproductive age will often recover fertility after kidney transplantation and therefore need to be empowered to prevent unwanted pregnancies and plan for a safe pregnancy if desired. Complications such as preeclampsia, pregnancy-induced hypertension, gestational diabetes, ectopic pregnancy, still birth, low birth weight, and preterm birth are more common in pregnant women with a kidney transplant. Careful monitoring for infection, rejection, and immunosuppressive dose adjustment along with comanagement by a high-risk obstetrician is of utmost importance. Breast-feeding is safe with most immunosuppressive medications and should be encouraged.
... A study by Barroso et al. compared men on dialysis and after renal transplant and found no difference in the prevalence of erectile dysfunction. They did, however find significant difference in ability to achieve orgasm, libido, and overall sexual satisfaction (23). Other studies have also found no difference in erectile dysfunction after renal transplantation (24,25). ...
Article
Hypogonadism is a common problem in the end-stage renal disease (ESRD) and renal transplant population. It has widespread systemic effects and has been linked with mortality in dialysis patients and at the time of renal transplant. The etiology is likely multifactorial and most patients are afflicted by various comorbidities that can contribute to hypogonadism. Clinical manifestations are mostly nonspecific. We review the approach to the diagnosis of hypogonadism, focusing on both laboratory values and clinical signs and symptoms. We review treatment with testosterone replacement in this population and highlight various studies that tend to have small sample sizes. Though these studies provide insight into testosterone replacement, the need for larger studies is emphasized to better understand the effects and safety of therapy.
... While several studies have suggested that erectile function significantly improves after successful renal transplantation, [5][6][7][8] especially when the surgery is performed at a younger age, 5 other studies have shown minimal effects of transplantation on erectile performance or even deterioration. [9][10][11][12] The overall prevalence of ED after KT remains high, ranging from 48.9% 13 to 55.7%. 11 The potential causative effects of ED in transplant recipients may include anxiety, medication side effects, impaired penile vascularity and failure to resolve hormonal abnormalities or underlying disease comorbidities. ...
Article
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Reduced cavernosal arterial inflow has been hypothesized to be the likely cause of erectile dysfunction after kidney transplants in recipients revascularized through end-to-end anastomosis to the internal iliac artery, suggesting that end-to-side anastomosis at the external iliac artery is preferable. The aim of this study was to prospectively evaluate the effect of the use of the external iliac artery on erectile function, hormone profiles and penile blood flow by evaluating changes in penile colour Doppler ultrasound parameters in a consecutive series of 22 recipients before and after end-to-side external iliac artery transplantation. The mean International Index of Erectile Function-Erectile Function (IIEF-EF) domain score decreased significantly 3 months after transplant (18.09±6.33 vs. 22.50±7.09, P=0.01). The reduction in peak systolic velocity (PSV) was significant for the cavernous artery homolateral to the side of transplant (42.60±18.77 vs. 52.01±19.91, P=0.01). The mean postoperative end diastolic velocity (EDV) did not differ significantly from the preoperative value (P=0.74). No statistical differences were found in the serum levels of testosterone or prolactin. Kidney grafts anastomosed at the external iliac artery produced significant (P=0.01) reductions in arterial inflow at the homolateral cavernosal artery that remained above the normal threshold. Whether these haemodynamic changes can explain the worsening of postoperative erectile function remains to be proven.
... In a longitudinal study of 39 pre-menopausal women in a stable heterosexual relationship, 41% reported being sexually active while on dialysis, while 88% subsequently reported being sexually active after kidney transplantation; although, this study was small and limited by marked attrition during follow-up [61]. Cross-sectional studies similarly suggest that male kidney transplant recipients have less erectile dysfunction function and greater sexual desire and activity than individuals on dialysis [62][63][64] although such studies are profoundly confounded by indication (i.e. men with better health are more likely to receive a transplant). ...
Article
Full-text available
People with chronic kidney disease (CKD) have a high symptom burden and experience poorer quality of life than the general population. People with CKD frequently report fatigue, anorexia, pain, sleep disturbance, itching and restless legs. Depression and sexual dysfunction may also be common in CKD, although questions about optimal diagnosis and treatment remain unanswered. People with kidney disease identify lifestyle and the impact of CKD on family and psychosocial supports as key priorities and rate symptoms such as sexual dysfunction and psychological distress as severe. Here, we outline the current state of research underlying depression and sexual dysfunction in this population focusing on prevalence, diagnosis, screening, outcomes and interventions and suggest areas requiring additional specific research.
... They also found that the level of testosterone significantly increased, whereas levels of FSH, LH and prolactin significantly decreased after renal transplantation. Furthermore, erectile function was compared between patients on dialysis therapy and renal transplant recipients in several studies, and erectile function was reportedly better in renal transplant recipients [108][109][110] . However, ED is still common in renal transplant recipients (approximately 50%) [111,112] , and the prevention of the occurrence of CVD seems necessary in these patients to maintain erectile function [113,114] . ...
Article
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.
... Ayrıca asteni, anemi, üremi, sıklıkla kullanılan antihipertansif tedaviler, yorgunluk gibi çeşitli faktörlerin de cinsel işlev bozukluğuna neden olduğu bildirilmektedir (6). Yapılan çalışmalarda erkeklerde hemodiyaliz tedavisi alan hastaların tamamına yakınında (%86) libidoda azalma, cinsel ilişki sırasında gecikmiş veya yetersiz boşalma, oligospermi ve sperm hareketliliğinde azalma, anor-gasmi, cinsel istek ve tatmin azalması sorunlarının oldukça yaygın olduğu tespit edilmiştir (11). Kadın hastalarla yapılan çalışmalarda ise, cinsel şikayetlerin nüfusun geri kalanına göre iki kat daha yüksek olduğu belirtilmiştir (12). ...
... Sexual function post-operatively may be limited by graft malfunction, preexisting comorbid conditions of diabetes mellitus, hypertension, smoking and dyslipidemia, duration of dialysis before transplantation, effects of immunosuppressive or hypertension therapy and is associated with the original cause of kidney insufficiency [10,64] . The influence of haemodialysis duration before kidney transplantation observed by Rebollo et al [10] may be owing to the longer duration of peripheral vascular disease, and thus, prolonged vascular damage and hormonal changes in dialysis patients. ...
Article
Full-text available
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.
... In 2007, Anantharaman et al. found that successful KT may restore normal sexual function, especially in younger patients (17) . In 2008, Barroso et al. stated that kidney transplants improve sexual function of patients compared with ESRD on hemodialysis (18) . These data differed from those of other authors who found persistent abnormalities of the HPG axis function in KT recipients with well functioning allografts (19;20) . ...
... In 2007, Anantharaman et al. found that successful KT may restore normal sexual function, especially in younger patients (17) . In 2008, Barroso et al. stated that kidney transplants improve sexual function of patients compared with ESRD on hemodialysis (18) . These data differed from those of other authors who found persistent abnormalities of the HPG axis function in KT recipients with well functioning allografts (19;20) . ...
Article
Full-text available
This study was designed to shed a light on the reproductive function in men and women after successful kidney transplantation (KT). Forty five adult patients (25 men and 20 women) were included; these patients met the inclusion criteria (serum creatinine ≤ 1.4 mg/dl; glomerular filtration rate (GFR) ≥ 60 ml/min at least 3 months after KT). Twenty two healthy individuals (12 men and 10 women) were included as control group. Assessment of the renal function tests [blood urea, serum creatinine, and GFR] and determination of the level of the reproductive hormones [luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (PRL) in men and women; and testosterone and 17-β-estradiol (E2) in the men and the women, respectively] had been carried out. The correlation between level of these hormones and the renal function tests was also studied in the patients. The results of the renal function tests showed that patients had higher blood urea and serum creatinine than the controls, while GFR was lower in the patients as compared to controls. Regarding to the reproductive hormones, it was found there were no significant differences in levels of LH, FSH and testosterone between men patients and men controls, while PRL was significantly (P<0.05) higher in the male patients as compared to the male controls. The results revealed that no significant differences in levels of LH, FSH and E2 between women patients and women controls, while PRL was significantly (P<0.01) higher in the female patients than the female control. When the correlation between the level of the reproductive hormones and the renal function tests was studied in men and women kidney transplanted patients, the findings showed that a significant negative correlation (r=-0.48, P<0.05) and a highly significant negative correlation (r=-0.74, p<0.01) were found between levels of FSH and serum creatinine in men and women patients, respectively. While a significant positive correlation was found between levels of PRL and blood urea in each of men (r=0.48, P<0.05) and women (r=0.49, P<0.05) patients.
... Renal transplantation has also proven to improve sperm motility without changing morphology or sperm count. Additionally, post transplantation serum levels of testosterone significantly increase, while LH, FSH and prolactin significantly decrease (98,99). In addition to the normalization of hormonal and metabolic functions post-transplant, there is a significant improvement of psychosocial parameters in transplant recipients, which likely impacts sexual function as well (100). ...
Article
Full-text available
Erectile dysfunction (ED) is a prevalent and pertinent condition in the chronic kidney disease (CKD) population. It has a multifactorial etiology, including disruptions of the hypothalamic-pituitary-gonadal axis, the endothelial paracrine signaling system, calcium and vitamin D homeostasis, along with several other factors. Efficacy of treatment of ED in the CKD population is comparable to non-CKD patients across multiple modalities, including PDE5 inhibitors, vacuum erectile devices, intracavernosal injections and penile prostheses. Renal transplant improves the contributing comorbid conditions that lead to ED in CKD patients; thus rates of ED are improved post-transplant. It is important to note that there is a small percentage of patients with persistent ED after renal transplantation.
... Notably, some ailments or conditions may interfere with patients' sexual health. For example, diabetes, heart and vascular diseases, neurological disorders, cancers, and aging has been reported to affect sexual functioning [7][8][9][10][11][12][13]. Informing patients with the influence of diseases on their sexual health can relieve patients' concerns. ...
Article
Objectives The objective of this scoping review was to explore patients’ and providers’ perspectives on sexual health communication. Methods A literature search was conducted in three databases, Medline (OVID), CINAHL (Ebsco), and PsycINFO (Ebsco) covering January 1, 2000—May 12, 2020. A coding sheet with a list of questions was created in Qualtrics to extract information from each article. Results Thirty-three (33) studies were included in this review. The findings indicated that 1) the current sexual health discussion does not meet the needs of the patients; and 2) patients and providers hold uniquely different perspectives on the importance of the discussion, the responsibility of conversation initiation, and the comfort level of the discussion. Conclusions There remains a significant gap between providers’ perceptions and patients’ needs regarding sexual health discussion. More efforts should be made to promote the necessary sexual health communication. Practice Implications Providers should initiate the discussion when necessary because it is very likely that patients welcome the discussion. Medical education and training should incorporate sexual health into its curricula to enhance health care professionals’ abilities in addressing sexual health issues. Providers should model a sense of openness and comfort in conversation to encourage patients to discuss sexual health.
... As far as hormonal treatment goes, previous studies have found a positive correlation between the hormonal profile of KTRs and sexual function, confirming that the normalization of posttransplantation prolactin and testosterone levels yields several benefits, as well as shifting drug administration, as shown in Table 1 [76]. Interestingly, Chatterjee and colleagues reported that the administration of testosterone replacement therapy and sildenafil in KTRs with hypogonadism promotes an effective response, thereby underlining the importance of evaluating the gonadal function in KTRs with ED [77]. ...
Article
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Patients with kidney transplantation often have a worse quality of life than the general population. One of the reasons for this, in male patients, is the high prevalence of erectile dysfunction. This is mainly due to the presence of comorbidities, surgery for kidney transplantation, adverse drug effects, psychological changes related to chronic disease, as well as hyperprolactinemia and hypogonadism. Whenever these endocrine dysfunctions occur after kidney transplantation, they must be corrected with appropriate treatment, i.e., testosterone replacement therapy. Administration of the phosphodiesterase-5 inhibitor (PDE5i) sildenafil at the recommended posology does not significantly alter the pharmacokinetics of the calcineurin inhibitors cyclosporin A or tacrolimus and does not impair kidney allograft function. Tacrolimus increases the peak concentration and prolongs the half-life of PDE5i in kidney transplant patients and, therefore, daily administration cannot be recommended due to the significant drop in blood pressure. Intracavernous injection or topical application of alprostadil can be a second-line option for the treatment of erectile dysfunction after kidney transplantation, which does not alter cyclosporine concentrations and does not deteriorate kidney function. Finally, penile prostheses can be successfully implanted following pelvic organ transplantation after eliminating the risk of infection associated with surgery.
... Ayrıca asteni, anemi, üremi, sıklıkla kullanılan antihipertansif tedaviler, yorgunluk gibi çeşitli faktörlerin de cinsel işlev bozukluğuna neden olduğu bildirilmektedir (6). Yapılan çalışmalarda erkeklerde hemodiyaliz tedavisi alan hastaların tamamına yakınında (%86) libidoda azalma, cinsel ilişki sırasında gecikmiş veya yetersiz boşalma, oligospermi ve sperm hareketliliğinde azalma, anor-gasmi, cinsel istek ve tatmin azalması sorunlarının oldukça yaygın olduğu tespit edilmiştir (11). Kadın hastalarla yapılan çalışmalarda ise, cinsel şikayetlerin nüfusun geri kalanına göre iki kat daha yüksek olduğu belirtilmiştir (12). ...
Article
Die Lebensqualität nierentransplantierter Patienten rückt zunehmend in den Mittelpunkt des Interesses. Einen nicht zu unterschätzenden Einfluss haben hierbei auch Fragen der Sexualität. Ein Großteil der dialysepflichtigen Patienten leidet unter verschiedenartigsten Störungen der Sexualfunktion, dies betrifft ca. 50% der männlichen und einen noch größeren Anteil der weiblichen Patienten. Im Vordergrund stehen bei Frauen Libido- und Zyklusstörungen, bei Männern Erektionsstörungen. Nach erfolgreicher Nierentransplantation erreicht eine Vielzahl der betroffenen Frauen eine Normalisierung der Sexualfunktion während Potenzstörungen bei Männern häufig persistieren. Hier ist heute aber in vielen Fällen eine effektive medikamentöse Therapie möglich. Frauen können bei stabiler Transplantatfunktion nach Nierentransplantation unter enger ärztlicher Kontrolle eine erfolgreiche Schwangerschaft anstreben. The quality of life of patients after kidney transplantation is of increasing interest. In this connection, issues of sexuality are meaningful too. Many patients with end-stage kidney disease suffer from sexual disorders. More than 50% of the male patients on dialysis and even more females are affected by disturbances such as erectile dysfunction and loss of libido or abnormal menstrual cycles. After successful kidney transplantation most symptoms in women are improved, whereas in men disturbances in erectile function often persist or even deteriorate. In these patients treatment with inhibitors of phosphodiesterase type 5 is a valid option with an effective response. In women with stable graft function pregnancy can be achieved successfully. Nevertheless, pregnant kidney allograft recipients should be considered as high-risk patients needing special care under the supervision of a team of obstetricians and nephrologists.
Article
Few studies have reported the relationship between duration of dialysis and effect of kidney transplantation on sex hormone levels and erectile dysfunction (ED) in Chinese patients. Our study included 24 patients with uremia who underwent kidney transplantation. Erectile function in these patients was assessed using the 5-item version of the International Index of Erectile Function (IIEF-5), and serum sex hormone levels were measured pre- and post-transplantation. Post-transplantation changes in IIEF-5 scores were analyzed according to duration of dialysis. Twenty-one (87.5%) and 11 (45.9%) of the 24 patients suffered from varying degrees of ED during the pre- and post-transplantation periods, respectively. The pre- vs. post-transplantation IIEF-5 scores were significantly different (p < 0.05) among patients who had undergone dialysis for less than six months. Following transplantation, serum levels of prolactin and β-estradiol decreased significantly (24.35 ± 11.62 vs. 13.93 ± 7.16 ng/mL, p = 0.027; 42.20 ± 15.04 vs. 17.7 ± 7.15 pg/mL, p = 0.000, respectively), whereas levels of testosterone increased (3.07 ± 0.94 vs. 6.54 ± 3.14 ng/mL, p = 0.004). Successful kidney transplantation can significantly ameliorate ED in Chinese patients, especially in individuals with a shorter time on dialysis. Changes in sex hormone levels may contribute to this improvement in ED.
Article
The impact of sexual dysfunction (SD) on mental and physical health after heart transplantation (HTx) has not been established. We investigated the relationship of SD on quality of life (QoL), physical and mental health, and depressive symptoms after HTx. We evaluated SD according to the International Index of Erectile Dysfunction and the Female Sexual Function Index. QoL, physical and mental health were assessed using: 1) Short Form 12 Health Survey Questionnaire, 2) Quality of Life Enjoyment and Satisfaction Questionnaire--Short Form, and two depressive symptoms questionnaires: 1) Beck Depression Inventory-II and 2) Quick Inventory Depressive Symptomatology-Self Report. We enrolled patients who were greater than 6 months post HTx. Patients unable to read English, had pelvic surgery or trauma, urogenital abnormalities, or sexually inactive were excluded. Out of 79 subjects that were screened, 33 men and 6 women participated (mean age 61.4 + 1.4). Response rates were at least 82% for all questionnaires. Overall prevalence of SD was 61%, with 78% of men being affected and 50% of women. There was no significant difference in measures between genders. HTx recipients with SD reported significantly worse QoL on measures of physical health when compared to those without SD. After HTx, patients suffering from SD had significantly worse general health (P = 0.02) and physical health (P = 0.02), including physical functioning (P = 0.01) and physical role limitation (P = 0.01). In contrast, mental health and depressive symptoms after HTx were not significantly different between those with and without SD. After HTx a high prevalence of SD remains among both men and women. Patients with SD had worse general and physical health but not depressive symptoms when compared to those without SD. The contributing factors may be more related to physical rather than psychological causes.
Article
To investigate the prevalence of erectile dysfunction (ED) in living donors before and after nephrectomy in China. From January 2006 to December 2008, erectile function of 94 living donors was evaluated before and after nephrectomy by International Index of Erectile Function, version 5 (IIEF-5). A subanalysis was performed by splitting the total cohort into 2 age groups: those <40 years of age (group 1, n = 21) and those >or=40 years of age (group 2, n = 73). Before and after nephrectomy, the prevalence of ED in group 1 was 9.5% and 19.0% respectively, and in group 2 was 38.4% and 56.2%. The difference between groups was statistically significant at the stage of preoperation (9.5% vs 38.4%, P = .012) and 12 months postoperation (19.0% vs 56.2% P = .003). Compared with the stage of preoperation, the prevalence of ED at the stage of postoperation was significantly increased at group 2 (38.4% vs 56.2%, P = .031), but not in group 1 (9.5% vs 19.0%, P = .663). The prevalence of ED increased in living donors aged more than 40 years after nephrectomy in China. The change in sexual function of these living donors after nephrectomy should cause clinicians' attention.
Article
The objectives of this study were to investigate the prevalence of erectile dysfunction (ED) among living donor kidney transplant (LDKT) recipients associated with chronic hepatitis B infection in China and to assess the effect of successful LDKT to improve ED. From January 2006 to May 2009, erectile function of 26 LDKT recipients associated with chronic hepatitis B infection (Group 1) was evaluated predialysis, during dialysis, and at 6 months posttransplantation using the International Index of Erectile Function, version 5 (IIEF-5). We enrolled 61 age-matched LDKT recipients without hepatitis B/C infection as a control group (Group 2). The prevalences of ED in Group 1 at predialysis, on dialysis, and 6 months posttransplantation were 23.1%, 80.7%, and 65.3%, respectively. Among Group 2, it was 4.9%, 72.1%, and 41.0%, respectively. The difference in ED between groups was significant at predialysis (P = .031) and 6 months posttransplantation (P = .037). Compared with the dialysis stage, the prevalence of ED at 6 months posttransplantation was significantly decreased in Group 2 (72.1% vs 41.0%; P = .001), but it was not significantly difference from Group 1 (80.7% vs 65.3%; P = .211). The incidence of ED among hepatitis B recipients was higher than among hepatitis B/C-negative patients at the predialysis and posttransplantation stages. Kidney transplantation is a key treatment to reduce the prevalence of ED among hepatitis B/C-negative recipients, but not those with hepatitis B.
Article
Sexual function is altered in patients with type 1 diabetes (T1D) and end-stage renal disease (ESRD), thus affecting quality of life. The present study aimed to analyze sexual function in patients with T1D and ESRD (T1D+ESRD) who received a simultaneous kidney-pancreas (KP) or kidney-alone (KD) transplantation. Ten KP, 10 KD, 9 T1D+ESRD patients and 11 healthy control subjects were evaluated according to the following parameters: (1) medical/sexual history and physical examination; (2) International Index of Erectile Function; (3) Beck's inventory for depression; (4) assessment of hormonal profile; (5) quantitative sensory testing of both hand and penile sensory thresholds; and (6) hemodynamic penile assessment. Controls and KP patients showed a higher rate of self-reported satisfactory erectile function as compared with KD and T1D+ESRD patients. Circulating androgens level resulted lower in both groups of transplanted patients and in patients with T1D+ESRD compared with healthy controls, albeit a relatively better profile was observed in KP. Both transplanted and T1D+ESRD patients showed peripheral hyposensitivity; however, healthy controls and KP showed better penile hemodynamic parameters compared with KD and T1D+ESRD. Our study demonstrates that sexual function, circulating sex steroids milieu, penile sensitivity, and hemodynamics are near-normalized for the most part in KP transplantation. Further studies are needed to assess the beneficial role and the overall impact of KP transplantation on sexual function in a long-term setting and a larger cohort of patients.
Article
Vascular erectile dysfunction (ED) is the expression of a systemic vascular disease and in particular of endothelial dysfunction. Dysfunctional endothelium plays also a significant role in the onset and progression of coronary artery vasculopathy (CAV). This pilot study was designed to evaluate the prevalence and pathogenesis of ED and its correlation with CAV in heart transplanted male. A total of 77 male heart transplanted patients (HTx) evaluated in our center (mean age 61.6 + 10.6 years) were enrolled in the study. All subjects underwent accurate medical history collection, including lifestyle (cigarette smoking, dietary and sedentary habits, drug intake, and erectile function before cardiac transplantation), physical examination (body mass index and arterial pressure), biochemical blood tests (fasting glucose, total cholesterol, high-density lipoprotein cholesterol, and triglycerides), and hormones (prolactin, luteinizing hormone and total testosterone). Furthermore, they were studied with penile, carotid, femoral echo-color Doppler ultrasonography and coronary angiogram. Incidence of ED was 24% before HTx and increased up to 65% after. Postischemic cardiomiopathy was an indication to HTx in ED group more frequently than in patients without ED (No-ED group) (45.1% vs. 20%). ED patients showed a lower peak systolic velocity, a higher cavernosal intima-media thickness (IMT), a higher prevalence of cavernosal plaques (26.7% vs. 5.2%, P < 0.05), peripheral vascular disease (60.87% vs. 26.1%, P < 0.05) and CAV (45.8% vs. 25.8%, P < 0.05) with respect to No-ED patients. Coronary flow reserve was significantly reduced in ED vs. No-ED patients (2.43 + 0.7 vs. 2.9 + 0.8, P < 0.04). Finally, cavernous plaque and testosterone plasma levels were statistically associated with CAV. We showed that ED is a frequent disease in HTx patients, more common when the original pathology is postischemic cardiomiopathy and associated with higher prevalence of cavernous plaques and CAV. Its evaluation should be integral to an HTx rehab program. Caretta N, Feltrin G, Tarantini G, D'Agostino C, Tona F, Schipilliti M, Selice R, Minicuci N, Gerosa G, and Foresta C. Erectile dysfunction, penile atherosclerosis, and coronary artery vasculopathy in heart transplant recipients. J Sex Med **;**:**-**.
Article
Background The effects of kidney transplantation on male sexual function are controversial. Aim To evaluate the impact of kidney transplantation on erectile and ejaculatory function and to assess a possible correlation between some selected characteristics of patients and their erectile and ejaculatory function after renal transplantation. Methods An observational retrospective analysis was conducted on male patients who had undergone kidney transplantation from January 2009 to April 2019. A prospectively maintained database was used to collect all data. Patients were evaluated before kidney transplant and 6 and 12 months after kidney transplant. Male patients undergoing renal transplantation for any cause who were sexually active with a stable partner were included in the study. Outcomes The main outcome measures included the International Index of Erectile Function (IIEF-15) and the 4-item version of Male Sexual Health Quality–Ejaculation Disorders (MSHQ-EjD Short Form) questionnaires. The first 3 questions of the MSHQ-EjD Short Form were used to assess the ejaculatory function, whereas the fourth question was used to evaluate the ejaculation bother. Results A total of 95 patients were eligible in the study. The evaluation of sexual function was available in 56 patients (58.9%). Mean IIEF-15 significantly decreased at 6 months (P < .001) remaining unchanged at 12 months (P = .228). Mean MSHQ-EjD Short Form (1–3) significantly decreased at 6-month follow-up (P < .001) and at 12-month follow-up (P = .024). Mean MSHQ-EjD Short Form (4) was significantly increased compared with the baseline at both 6 and 12 months (P < .05). IIEF-15 was significantly related to the MSHQ-EjD Short Form at 6-month and 12-month follow-up (P < .001). Age, diabetes, hypertension, smoking, pretransplantation testosterone, time for transplantation, baseline IIEF-15, and baseline MSHQ-EjD Short Form (1–3) were significantly associated (P < .05) with both IIEF-15 and the MSHQ-EjD Short Form (1–3) at 6-month and 12-month follow-up after kidney transplantation. Clinical Implications Improvement of knowledge regarding the effects of kidney transplantation on sexual function and about the patient characteristics related to sexual health after transplantation. Strength & Limitations This is the first article that analyzes in depth the ejaculatory function in patients who had undergone kidney transplantation assessing ejaculation with a validated questionnaire. The main limitation is the retrospective design of the study. Conclusion Kidney transplantation appears to have a negative impact on sexual health, significantly worsening both erectile and ejaculatory functions. Age, diabetes, hypertension, smoking, pretransplantation testosterone levels, time for transplantation, as well as erectile and ejaculatory function before transplant were significantly related to erectile and ejaculatory functions after renal transplantation. Spirito L, Manfredi C, Carrano R, et al. Impact of Kidney Transplantation on Male Sexual Function: Results from a Ten-Year Retrospective Study. J Sex Med 2020;XX:XXX–XXX.
Article
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.
Chapter
Chronic kidney disease (CKD) is a growing health problem worldwide affecting approximately 15 % of the adult population. The risk of dying is severalfolds higher than the risk of starting with renal replacement therapy (RRT), CVDs being the main cause of death. Among various risk factors and mechanisms, nitric oxide (NO) deficiency is particularly interesting. Currently with advances in medical care, the survival of CKD patients has been prolonged, and physical functioning and quality of life (QoL) became more important. CKD patients are likely to reveal various sexual dysfunctions prior to dialysis. Symptoms of this disturbing disability are reported with increasing frequency as renal function declines. Approximately 75 % of men undergoing dialysis have erectile dysfunction (ED) which is much higher than in other chronic diseases. ED is the main sexual problem associated with mental QoL in CKD men. The causes of such high prevalence are multifactorial and include physiological, psychological and iatrogenic factors. The pathogenesis of sexual and ED in CKD has been attributed to several risk factors, but to none of them conclusively. Importantly, ED as a serious handicap for normal life should be considered as a marker of endothelial dysfunction and atherosclerosis as well as an indicator of possible silent coronary heart disease.
Article
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.
Article
Currently in the medical literature there is controversy about the role and effects of renal transplantation (RTx) on the sexual functioning of patients with terminal chronic renal disease (TCRD). There is no clear evidence of the real impact of RTx on sexual functioning in these patients. This article makes a brief summary of the literature, describing the most important clinical concepts, evaluates results, and compares the impact of renal transplantation on sexual function before and after the procedure. Medline and the Embase database were consulted; Medical Subject Headings used were "Kidney Failure, Chronic," "Kidney Transplantation," "Sexual Dysfunction," "Pleasure," "Sexual Behavior," and "Quality of Life." Search was limited to articles within the last 15 years. Sexual dysfunction affects almost 87% of male and 60% to 80% of female patients; 40% to 78% of male patients with RTx report a sense of improvement on global sexual function, 25% to 30% of female patients of reproductive age with RTx report improvement in sexual performance and decreasing of menstrual cycle alterations. Fewer than 10% of patients receiving an RTx reported a decrease of sexual satisfaction. Despite controversy, reviewed results show significant improvement of sexual functioning after receiving an RTx. Those who report no improvement of sexual functioning may have conditions attributable to implicit characteristics of TCRD (age, neuroendocrine/metabolic problems) and/or RTx (immunosuppressive therapy). RTx improves sexual functioning by improving sexual desire and overall sexual satisfaction. Identified determinants associated with improvement of sexual functioning are decreased prolactin serum level, age younger than 45 years, and onset of dialysis less than 6 months.
Article
Resumen Objetivo Describir el efecto del trasplante renal sobre la percepción de la función eréctil presentada en pacientes con insuficiencia renal terminal. Materiales y métodos Se revisó la base de datos de trasplante del Hospital de San José, encontrando 23 pacientes trasplantados desde noviembre de 2009 hasta noviembre de 2013. Se excluyeron las mujeres, los pacientes con pérdida del injerto y con quienes no fue posible comunicarse, obteniendo 20 historias completas, a quienes se les aplicó la encuesta del International Index of Erectile Function (IIEF-5) de manera telefónica, evaluando el grado de disfunción eréctil (DE) que presentaban antes y al menos 6 meses después del trasplante renal. Resultados Se encuestó a 20 pacientes, cuyas edades oscilaban entre 20 y 69 años, con una media de 45,2 años. El 40% de los pacientes no tenían DE antes del trasplante. El 25% refirieron DE moderada, de los cuales el 60% mejoró; el 20% refirieron previo al trasplante DE leve, mejorando en el 50% de los casos. Tan solo el 10% refirieron DE leve-moderada y el 5% restante severa, la cual permaneció igual después del trasplante. Conclusión La prevalencia de DE en los pacientes con insuficiencia renal terminal encuestados es similar a la reportada en la literatura, y se corrobora que la mayoría de los pacientes con DE previa al trasplante mejoran con el injerto renal.
Article
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Introduction. The prevalence of erectile dysfunction in men with chronic kidney disease stage V is from 60 to 80%. At the same time, the prevalence of erectile dysfunction in patients after kidney transplantation remains high at up to 60%. One of the possible causes of erectile dysfunction after kidney transplantation is considered a decrease in arterial inflow to the cavernous bodies of the penis. Objectives. Тo evaluate the results of treatment of ED in patients after KT, depending on the vascular anastomosis. Materials and methods. 84 patients with a functioning kidney after transplantation were examined. All patients were divided into 3 groups: Group I – 38 patients undergoing KT with arterial vascular anastomosis with an internal iliac artery; Group II – 46 patients undergoing kidney transplantation with arterial vascular anastomosis to external iliac artery; Group III – 35 healthy volunteers (control group) with no history of urological diseases or surgical interventions on the pelvic organs. International Index of Erectile Function Index (IIEF-5) was used to assess erectile function. An ultrasound study with dopplerography of the penile arteries was performed before and after intracavernous pharmacological stress. For treating patients with erectile dysfunction after kidney transplantation were used PDE-5 inhibitors (Tadalafil® 5 mg daily for 3 months, then at a dose of 20 mg “on demand”), a special set of exercises for the muscles of the pelvic floor, vacuum therapy and physiotherapy with the device “Androgyne”. Results. Significant erectile function disorders were detected in 26 (68.4%) patients of group I, and in 31 (73.9%) patients of group II, according to data from the IIEF-5 questionnaire. Group I 27 (71.1%) patients were satisfied with sex life, group II – 39 (84.8%) by the end of the year. According to the Doppler ultrasound, after 12 months in patients of group I, the maximum systolic velocity of blood flow in the right and left cavernous artery of the penis was 25.0 ± 3.44 cm / s and 33.0 ± 3.56 cm / s, respectively. The difference in arterial inflow of 8 cm / s indicates a pronounced arterial perfusion of the penis in group I patients. At the same time, in patients of group II, the maximum systolic velocity was significantly higher than in group I and amounted to 40.1 ± 2.66 cm/s and 40.0 ± 2.77 cm/s, respectively. Conclusion. The data obtained indicate a decrease in the arterial inflow to the penis along the right cavernous artery in patients from group I, who underwent an arterial vascular anastomosis with an internal iliac artery during kidney transplantation.
Article
Objective: To study significance of the related biochemical indicator (Fasting blood-glucose, Triglyceride, Alanine aminotransferase, Creatinine) in aging males with ED. Methods: Total of 1591 men over 40 years old in Shanghai urban area, selected by multi-stage sampling methods, had been investigated by the questionnaire of erectile dysfunction and serum biochemical indicator assays. According to the score of International Index of Erectile Function (IIEF-5), 992 sexually active men in the overall population were divided into mild ED group, moderate ED grourp, severe ED group and normal group. The differences of the biochemical indictor levels among 4 groups, and the correlation between ED severity and levels of biochemical indicators were comparatively analyzed. Results: In 992 men, incidence of ED accounted for 78.83%, and no significant differences were found in the mean levels of ALT and Cr, between ED groups and the normal group, however a significant difference (P<0.01) in the mean level of FBG was found between severe/moderate ED group and mild ED/normal group. For the mean level of TG, there was a significant difference (P<0.01)between mild ED group and normal group, and there was also a significant difference(P<0.05) between moderate ED group and normal group. Moreover, the mean level of TG in mild ED goup was significantly lower (P<0.05) than moderate ED group, and the mean levels of TG in moderate ED group was significantly lower (P<0.05) than that of severe ED group. Conclusion: Hyperglycemia is an important risk factor for ocurrence of severe(moderate) ED in aging males. No correlation was found between hypertriglyceridemia and the morbidity of ED in aging males, but high level of serum TG in aging males with ED might aggravate the progression of ED.
Article
The quality of life of patients after kidney transplantation is of increasing interest. In this connection, issues of sexuality are meaningful too. Many patients with end-stage kidney disease suffer from sexual disorders. More than 50% of the male patients on dialysis and even more females are affected by disturbances such as erectile dysfunction and loss of libido or abnormal menstrual cycles. After successful kidney transplantation most symptoms in women are improved, whereas in men disturbances in erectile function often persist or even deteriorate. In these patients treatment with inhibitors of phosphodiesterase type 5 is a valid option with an effective response. In women with stable graft function pregnancy can be achieved successfully. Nevertheless, pregnant kidney allograft recipients should be considered as high-risk patients needing special care under the supervision of a team of obstetricians and nephrologists.
Article
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OBJETIVO: Avaliar a qualidade de vida sexual masculina antes e depois do transplante hepático. MÉTODOS: Foi enviado questionário de avaliação para 56 doentes masculinos, que tinham idade superior a 18 anos e que sobreviveram mais de seis meses após o transplante hepático. O questionário continha 15 perguntas com cinco ou seis alternativas de resposta para mensurar a função sexual masculina segmentada por cinco componentes: função erétil, função orgástica, desejo sexual, satisfação com a relação sexual e satisfação com a vida sexual como um todo. As respostas geraram valores numéricos, os quais foram agrupados dentro de cada domínio e comparados antes e depois do transplante hepático. RESULTADOS: Vinte e cinco doentes responderam completamente o questionário. Todas os cinco componentes da função sexual melhoraram após o transplante hepático, sendo que o escore da função erétil aumentou de 21,12±8,07 para 26,52±5,22 (p=0,004), da função orgástica de 7,28±3,05 para 9,36±1,47 (p=0,008), da função desejo sexual de 6,64±2,58 para 8,68±1,35 (p=0,005), da satisfação com relação sexual de 9,16±3,83 para 12,52±2,65 (p<0,0001) e da satisfação com a vida sexual de 7,12±2,64 para 9,24±1,65 (p=0,002). CONCLUSÕES: A disfunção sexual é comum em homens com hepatopatia crônica grave e o transplante hepático melhora todos os componentes da função sexual: função erétil, orgasmo, desejo sexual, satisfação na relação sexual e satisfação pessoal.
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The present study aims to prospectively compare the sexual function in males before and after vasectomy surgery using the international index of erectile function (IIEF). From October to December 2002, sixty-four patients who were candidates for male sterilization in the vasectomy program of the Urology Section at the General Hospital of the University of São Paulo were included. The same investigator applied the IIEF before and 90 days after the surgery. The mean scores obtained on pre and postoperative visits for all domains of sexual function were analyzed and compared with the Wilcoxon test. The mean patient age was 35 years (range from 25 to 48 years) and the mean number of children per man was 3. The total mean score of the IIEF was 64.06 before surgery and 65.64 after the procedure, with this difference considered statistically significant (p < 0.001). Sixty-seven per cent of the patients improved their scores, versus 17% and 16% who showed worsening or no change at all in IIEF scores following surgery, respectively. Of the 5 sexual function domains, desire and sexual satisfaction presented statistically significant improvement. This study showed that vasectomy caused a positive impact on sexual function, especially on desire and sexual satisfaction, in the majority of men undergoing surgery. There was no case of surgery-related erectile dysfunction.
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Sexual dysfunction is very common in liver transplantation candidates. Our objective is to determine the sexual life quality of males before and after liver transplantation. Questionnaire was sent to 56 males over 18 years of age with at least six-month survival after orthotopic liver transplantation. The self-administered questionnaire contained 15 questions with 5 or 6 alternatives to determine the male sexual function which may be divided into 5 domains: 1) erectile function; 2) orgasmic function; 3) sexual desire; 4) intercourse satisfaction; and 5) overall satisfaction with sexual life. Each answer received a score. Domains scores were computed by summing the scores for individual answers and they were compared before and after the liver transplantation. Twenty-five patients answered the questionnaire completely. All 5 sexual function domains improved after liver transplantation. The score of the erectile function increased from 21.12 +/- 8.07 to 26.52 +/- 5.22 (p=0.004), of the orgasmic function from 7.28 +/- 3.05 to 9.36 +/- 1.47 (p=0.008), of the sexual desire from 6.64 +/- 2.58 to 8.68 +/- 1.35 (p=0.005), of intercourse satisfaction from 9.16 +/- 3.83 to 12.52 +/- 2.65 (p<0.0001) and of overall satisfaction from 7.12 +/- 2.64 to 9.24 +/- 1.65 (p=0.002). Sexual dysfunction is common in males with severe chronic liver disease and liver transplantation improves all sexual function domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction.
Article
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Renal transplantation (RT) is the most common solid organ transplant procedure. Several studies have reported on gonadal function in male and female RT recipients with controversial results. Forty consecutive patients (20 male, 20 female) with a fully functioning allograft (serum creatinine 0.8-1.3 mg/dl) for at least 15 months after RT were included in the study. Their ages ranged from 23 to 44 years (median 38) and their post-RT follow-up lasted 15-86 months (median 23). FSH, LH, prolactin, 17-beta-estradiol, testosterone, androstenedione and dehydroepiandrostrone were determined in all patients and compared with a group of 80 healthy subjects. Pelvic ultrasonography was performed in all participants. Testosterone was below the normal range in 70% of male patients and within the lowest third in the remainder; a lack of LH increase indicated an inhibition of the reproductive axis. Male testosterone values were negatively influenced by calcineurine inhibitors treatment (P < 0.005), but positively influenced by a better graft function (P < 0.0001). Testicular and prostate volumes were reduced with respect to controls, with the latter related to circulating testosterone levels. Ten of the women (50%) had menstrual cycle disorders after RT, three being affected by transient, and three by persistent, amenorrhea. Another two patients had had transient polymenorrhea. In four women (20%), a premature ovarian failure was diagnosed. No relationship was found between female reproductive function and age, graft function or duration of the post-transplant period. Prolactin was lower in patients on calcineurin inhibitors (P < 0.01). Abnormalities of the reproductive system were frequent after successful RT in both genders.
Article
Partial or complete impotence is common in uremia. It is not clear whether the impotence is organic or psychogenic in nature and whether uremia itself or the state of chronic illness is responsible for it. We examined these questions, by psychiatric interviews and nocturnal penile tumescence (NPT), in 50 normal subjects, 48 patients with chronic uremia, including 23 patients treated with maintenance dialysis, and 22 patients with chronic illness and normal renal function. About 40 to 50% of patients with uremia, but not those with chronic illness and normal renal function, complained of erectile dysfunction and reported a significant decrease in frequency of intercourse. There were no significant differences between patients with uremia prior to initiation of therapy and those treated with maintenance hemodialysis. NPT declines after 40 years of age. In all age groups, NPT was significantly (P less than 0.01) lower in uremics than in normals or those with chronic illness. There was no correlation between erectile complaints, frequency of intercourse or NPT, and the presence or absence of depression. The frequency of intercourse correlated significantly (r = 0.68, P less than 0.01) with NPT in patients with uremia. Data indicate that 50% of male patients with uremia have partial or complete impotence, which is most probably organic in nature and is related to uremia or its metabolic or hormonal consequences rather than to the state of chronic illness.
Article
To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Article
A cross-sectional study of multifaceted male sexual function in 323 consecutive kidney transplant recipients was conducted by mail by means of the validated International Index of Erectile Function (IIEF). All five IIEF domains (IIEF-5), i.e., erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction, were scored for each responder. IIEF-5 scoring that conformed to the National Institutes of Health definition of erectile dysfunction (ED) was computed for all patients sexually active within the past 4 weeks. Two hundred and seventy-one patients replied. Compared to the controls used for IIEF psychometric validation, kidney transplant recipients gave lower erectile function (P<0.01) and intercourse satisfaction (P<0.05) scores, despite their being younger. ED, according to the IIEF-5 method, was demonstrated in 55.7% of the sexually active patients (n=212). Age, time on dialysis, and iterative transplants were significantly and negatively related to erectile dysfunction. IIEF proved to be a valuable means of unveiling highly prevalent erectile dysfunction in male kidney transplant recipients. The negative impact of the time on dialysis was emphasized in the results.
Article
To assess the effect of successful renal transplantation on semen variables, sexual function and sex hormone profiles in a clinical trial. Thirty patients on haemodialysis underwent renal transplantation; before and after surgery, their sperm density, motility and morphology were analysed, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin and testosterone levels measured and compared, and sexual function assessed using an abbreviated version of the International Index of Erectile Function (IIEF), with a successful outcome defined as a level of satisfaction of 4 or 5 on a 5-point scale. The paired t-test was used to assess the statistically significance of differences in all analyses. Sperm motility improved significantly (P < 0.001) but there were no significant changes in morphology or density (P = 0.33 and 0.068, respectively). Testosterone levels increased and FSH, LH and prolactin decreased significantly (P < 0.05) after renal transplantation. The IIEF showed that of the 30 patients, 14 were impotent before surgery and only six remained so afterward (P < 0.05). Although sperm morphology and density did not improve after renal transplantation, there were highly significant changes in sperm motility. Hormonal levels in patients on haemodialysis improved after transplantation and returned to nearly normal; sexual function was also significantly better. Further studies are needed to confirm these results.
Article
To evaluate the results of treatment of erectile dysfunction (ED) in kidney transplant recipients before and after the advent of sildenafil. 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. 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. 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.
Article
Prevalence and severity of erectile dysfunction increase with advancing age. Patients with end-stage renal disease (ESRD) experience disturbances in erectile function related to organic factors including as uremia, hypertension, endocrine, and nonorganic factors like depression. Recipients of kidney transplants show a high prevalence of erectile dysfunction, 32.2% to 50.7%. We conducted a study of the prevalence of erectile dysfunction among male renal transplant recipients using the International Index of Erectile Function. Among 182 men with kidney transplantations, there were 89 recipients (48.9%) with erectile dysfunction; 60 recipients had normal sexual function (32.9%); and whereas 33 recipients had no sexual activity.
Erectile dysfunction after kidney transplantation: our 22 years of experi-ence
  • F Lasaponara
  • M Pardiso
  • Milan
  • Mgl
Lasaponara F, Pardiso M, Milan MGL, et al: Erectile dysfunction after kidney transplantation: our 22 years of experi-ence. Transplant Proc 36:502, 2004 POSTTRANSPLANT SEXUAL FUNCTION
Tratamento psicoterápico da inibição do desejo sexual
  • Glina
Glina S, Puech-Leão P, Reis JMSM, et al: Tratamento psicoterápico da inibição do desejo sexual. Disfunção Sexual Masculina 3:329, 2002
Mechanisms of vasculogenic erectile dysfunction after kidney transplantation Tratamento psicoterápico da inibição do desejo sexual Função sexual de homens submetidos a transplante hepático
  • Abdel-Hamid Ia Glina
  • S Puech-Leão
  • P Reis
Abdel-Hamid IA: Mechanisms of vasculogenic erectile dysfunction after kidney transplantation. BJU Int 94:497, 2004 10. Glina S, Puech-Leão P, Reis JMSM, et al: Tratamento psicoterápico da inibição do desejo sexual. Disfunção Sexual Masculina 3:329, 2002 11. Coelho JC, Matias JE, Jorge FM, et al: Função sexual de homens submetidos a transplante hepático. Rev Assoc Med Bras 49:413, 2003 12. Lasaponara F, Pardiso M, Milan MGL, et al: Erectile dysfunction after kidney transplantation: our 22 years of experience. Transplant Proc 36:502, 2004
Effect of renal transplantation on sperm quality and sex hormone levels
  • Akbari