Correcting impotence in the male dialysis patient: Experience with testosterone replacement and vacuum tumescence therapy

Lawrence, Ian; Price, David E.; Howlett, Trevor A.; Harris, Kevin; Feehally, J.; Walls, John

doi:10.1053/ajkd.1998.v31.pm9469503

Cited by 67 publications

(27 citation statements)

References 32 publications

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“…12 Our study restoring circulating plasma T to midnormal levels was reasonably successful. In the study by Lawrence et al 11 administering depot injections, sexual function was fully restored in only three men (11.1%), and two gradually lost the response over 18 months. A total of 19 patients (70.3%) had partial responses, varying from an increased sense of well-being alone to restored sexual function apart from an impairment of the duration of penile erection.…”

Section: Discussionmentioning

confidence: 93%

“…Subjects who scored o26 in this domain were considered to have ED. The score for each item ranges from 0 to 5 for questions 1-10, 0 meaning no sexual activity/no attempt to have sexual intercourse, and from 1 to 5 for questions [11][12][13][14][15]. The severity of ED was classified using five categories: no ED (EF score: 26-30), mild (EF score: [22][23][24][25], mild to moderate (EF score: 17-21), moderate (EF score: 11-16) and severe (EF score: 6-10).…”

Section: Methodsmentioning

confidence: 99%

“…7,11,12 Remarkably, in the study of Brockenbrough et al 7 T administration of 100 mg of topical 1% T-gel for 6 months did not increase serum T levels and there was no effect on sexual function scores. But another study has shown that T transdermally administered daily as gel or patch resulted in a significant increase in serum T levels.…”

Section: Introductionmentioning

confidence: 93%

“…13 Lawrence et al studied the effectiveness of T replacement with depot T injections in men with biochemically proven hypogonadism. 11 Only 3 of 27 patients benefited from T administration and the others had to use vacuum tumescence therapy to improve erectile function (EF).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of testosterone gel in the treatment of erectile dysfunction in hypogonadal hemodialysis patients: a pilot study

Cangüven¹,

Aykose²,

Albayrak³

et al. 2009

Int J Impot Res

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End-stage renal disease (ESRD) affects sexual function. The etiology of sexual dysfunction in ESRD is multifactorial and hypogonadism is not uncommon. In a cohort of 96 men with ESRD, scores on International Index of Erectile Function (IIEF) correlated with bioavailable testosterone (T; Po0.01). We further evaluated the effects of administration of T on ED in hypogonadal men on hemodialysis. Nine men with ED and hypogonadism (baseline bioavailable T o3.82 nmol l À1 ), received 5 g T-gel (1% (10 mg g À1 ) per day treatment for 6 months. The IIEF and frequency of sexual intercourse per week were used to assess treatment efficacy. T administration significantly increased serum T levels to the normal range, and was associated with statistically significant improvements of the scores of the IIEF domains (erectile function from 7.6 ± 8.0 to 12.8 ± 7.8; intercourse satisfaction from 3.4 ± 4.5 to 4.8 ± 3.1; orgasmic function from 4.8 ± 3.1 to 3.4±2.9; sexual desire from 3.4±2.9 to 4.4±0.6; overall sexual satisfaction from 2.6±1.3 to 3.8±1.0). But scores of the IIEF did not normalize. Frequency of weekly sexual intercourse increased from 0.4 ± 0.4 to 1.1 ± 0.8 (Po0.05) after 6 months. There were no adverse effects. We conclude that restoring T levels to normal in men with ESRD improved scores on the IIEF and frequency of weekly sexual intercourse.

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Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Efficacy of testosterone gel in the treatment of erectile dysfunction in hypogonadal hemodialysis patients: a pilot study

Cangüven¹,

Aykose²,

Albayrak³

et al. 2009

Int J Impot Res

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“…Toorians et al (7) attributed decreased sexual desire (libido) for men, like women, to be the main cause of sexual difficulties (7). Furthermore, the treatment of erectile dysfunction in men has proven to be challenging; problems include a lack of interest in treatment programs and a poor response to various therapeutic regimens, in large part because of lack of interest in targeted therapies (8,9).…”

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confidence: 99%

Sexual Inactivity among Hemodialysis Patients

Finkelstein

2014

Clinical Journal of the American Society of Nephrology

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An emphasis on patient-centered care is becoming one of the dominant themes of health care reform worldwide. This emphasis involves active participation by patients (and their family/caregivers) in determining the type and standard of care that is best suited to maximize the individuals' quality of life. In this model, the goal of the health care provider is to develop collaborative structures of care that engage patients in decisions and empower them to make informed choices about their care. This goal requires that health care providers listen carefully to patients and strive to understand the patients' perspective on their illness, symptoms, life concerns, and treatment. Too often, health care providers focus on objective, easily assessed outcomes and organize therapeutic regimens around these measures. However, what problems and issues do patients want addressed? What are their concerns?The work by Mor et al.(1) in this issue of CJASN examines sexual functioning in women on hemodialysis (median age564 years) using a reasonable modification of the well validated Female Sexual Function Index (FSFI). This study is important, because few previous studies have critically examined the problem of the perception of the sexual functioning of women with ESRD. Mor et al.(1) note a low level of sexual activity among these patients (on all assessments, 81% of women reported that they were not sexually active), which has been well documented in prior studies (2). Importantly, however, Mor et al.(1) also look at the reasons for sexual inactivity and patient satisfaction with their current level of sexual functioning. The main reasons cited by patients for lack of sexual activity in this study were lack of a partner (39%) and lack of interest (43%). Actual sexual difficulties were cited by only 2% of women.The recent meta-analysis by Strippoli et al.(2) suggests that 84% of women on dialysis have sexual dysfunction. Sexual dysfunction in this study was defined as a score on the FSFI of $18. This instrument assesses sexual dysfunction by evaluating six domains of sexual functioning in 4 weeks before completion of the questionnaire: (1) desire, (2) arousal, (3) lubrication, (4) orgasm, (5) global satisfaction, and (6) pain. However, what if the patient is not engaging in sexual activity? Does lack of sexual activity define sexual dysfunction? A variety of factors can contribute to lack of sexual activity. For example, age is an important determinant of sexual activity (3). Of general medical patients, 60% of women ages 65-74 years and 85% of women ages 75-85 years report not having sexual activity in the preceding 12 months (3). The presence of a potential sexual partner has also been noted to be strongly associated with sexual activity for women with ESRD in the meta-analysis by Strippoli et al. (2). Similarly, for men with ESRD, the absence of a sexual partner is also associated with sexual dysfunction (4).However, are women on dialysis dissatisfied with their level of sexual activity (5,6)? A previous study by Steele et al...

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