Sexual and reproductive function in men treated with hemodialysis and renal transplantation

The epidemiology, anatomy, physiology, and treatment of erectile dysfunction in chronic renal failure patients

Erectile dysfunction (ED) is an associated morbidity for men with chronic renal failure. An understanding of the epidemiology, anatomy, physiology, and treatment options for ED can greatly improve the quality of life for men with chronic renal failure. There are psychological and physiological causes for erectile dysfunction. Once the key features leading to the patient's loss of potency have been identified, appropriate treatment plans can be instituted, often with successful outcomes. The purpose of this article is to assist the nephrology interdisciplinary team in the management of ED by reviewing possible causes, available studies, and treatment options for their patients.

Impotence and the use of the internal iliac artery in renal transplantation: a survey of surgeons' attitudes in the United Kingdom and Ireland

BACKGROUND

In 1996, a court in the United Kingdom ruled against a plaintiff who claimed that: (1) division of both internal iliac arteries at separate renal transplant operations had made him impotent and (2) the risk of his becoming impotent was sufficiently high that he should have been warned. The court ruled that there was not enough evidence in the medical literature to allow his claim to succeed.

METHODS

A survey of the views of transplant surgeons in the United Kingdom and Ireland on attitudes toward using the internal iliac artery for transplantation was conducted.

RESULTS

A 100% response rate was received. In a potent male patient, 11% of surgeons would never use the first internal iliac artery and 52% would use it infrequently. If one internal iliac artery had already been used, 61% would never use a second and 34% would use it infrequently. Eighty-nine percent believed the risk of impotence when the second internal iliac artery was used was 25% or higher, and 91% thought the risk should be explained to the patient.

CONCLUSION

A very strong opinion exists among transplant surgeons in the United Kingdom and Ireland that the second internal iliac artery should not be used to revascularize a kidney transplant when the first has already been divided. The risk of impotence, if the second internal iliac artery is used, is greater than 25% and should be explained to the patient. This represents a very clear statement of currently accepted practice.

Effect of erythropoietin on sexual potency in chronic haemodialysis patients. A preliminary study

Six male dialysis patients were submitted to a Doppler study of the deep penile arteries and intracavernosal injection of 30 mg papaverine under basal conditions before and after erythropoietin therapy. Penile tumescence was recorded after 15 min by measuring the length and the circumference of the penis as well as the erectile angle between the penis and the legs with the patient in standing position. Haematocrit was raised by erythropoietin therapy from 19.3 +/- 4.5 to 31.2 +/- 5.5 within 3 months. Five patients completed the study. We encountered a significant improvement in the frequency of sexual intercourse per month from 1.3 +/- 0.5 to 2.3 +/- 0.8 (p = 0.014). Furthermore, an increase was observed in the penile brachial index (from 0.87 +/- 0.1 to 0.91 +/- 0.1) and in the papaverin induced increase in penile length (4.6 +/- 1.4 cm versus 5.2 +/- 1.1 cm), penile circumference (2.7 +/- 0.14 cm versus 2.7 +/- 0.27 cm) as well as in the erectile angle (61.7 +/- 37.1 versus 80 +/- 23.5 degrees). These changes were not statistically significant. There was a significant correlation between the increase in the erectile angle and the increase in frequency of intercourse (p = 0.04). In conclusion, erythropoietin treatment could improve the sexual potency in uraemic patients under chronic haemodialysis therapy.