Does radical nephrectomy increase the risk of erectile dysfunction compared with partial nephrectomy? A cohort analysis

Abstract

What ' s known on the subject? and What does the study add? Erectile dysfunction (ED) is a form of endothelial dysfunction that is prevalent in patients with chronic kidney disease (CKD). We hypothesized that partial nephrectomy (PN) would limit development of ED compared with radical nephrectomy (RN), primarily due to renal function preservation, and found that patients undergoing RN had signifi cantly higher de novo ED compared with a contemporary, well-matched cohort undergoing PN; in addition to RN, hypertension, CKD and diabetes mellitus were associated with developing ED. To our knowledge, this is the fi rst study demonstrating an increased risk of ED after RN compared with PN. OBJECTIVES• To evaluate prevalence and risk factors for development of erectile dysfunction (ED) in patients who underwent radical nephrectomy (RN) and partial nephrectomy (PN).• ED is a form of endothelial dysfunction that is prevalent in patients with chronic kidney disease (CKD). PN confers superior renal functional preservation compared with RN; however, the impact on ED is unclear. METHODS• This was a retrospective study of 432 patients (264 RN/168 PN, mean age 58 years, mean follow-up 5.8 years) who underwent surgery for renal tumours between January 1998 and December 2007.• The primary outcome was rate of de novo ED postoperatively. Secondary outcomes included development of CKD (estimated GFR < 60 mL/min/1.73 m 2 ) and response to phosphodiesterase-5 inhibitors.• Multivariate analysis was performed to determine risk factors for de novo ED postoperatively. RESULTS• RN and PN groups had similar demographics and comorbidities.• Tumour size (cm) was larger for RN (RN 7.0 vs PN 3.7, P < 0.001) and more preoperative ED existed in PN vs RN ( P = 0.042). No differences were observed for preoperative CKD, hyperlipidaemia and diabetes mellitus.• Postoperatively, higher rates of de novo ED (29.5% vs 9.5%, P < 0.001) and CKD (33.0% vs 9.8%, P < 0.001) developed in RN vs PN cohorts, respectively.• Of men with ED, 63% responded to phosphodiesterase inhibitors, without signifi cant difference between the two groups ( P = 0.896).• Multivariate analysis demonstrated de novo ED to be associated with RN (odds ratio [ OR ] 3.56, P < 0.001), hypertension (OR 2.32, P = 0.014), preoperative (OR 8.77, P < 0.001) and postoperative (OR 2.64, P = 0.001) CKD, and postoperative diabetes mellitus (OR 2.93, P < 0.001). CONCLUSIONS• Patients undergoing RN had signifi cantly higher de novo ED compared with a contemporary, well-matched cohort undergoing PN. In addition to RN, hypertension, CKD and diabetes mellitus were associated with developing ED.• Further investigation on effects of surgically induced nephron loss on ED is requisite. KEYWORDSrenal cell carcinoma , erectile dysfunction , nephrectomy , partial nephrectomy , chronic renal insuffi ciency Study Type -Therapy (prospective cohort) Level of Evidence 2b

Male Sexual Dysfunction and Chronic Kidney Disease

“…A study examining the risk of ED following radical versus partial nephrectomy found a significantly higher rate of de novo ED in those subjected to radical surgery (51). This suggests that a greater reduction in nephron mass resulted in a greater risk of ED development.…”

Initial evidence demonstrating the association between the vascular status in surgically resected renal parenchymal pathology and sexual function

“…To focus on the evaluation of erectile function, the severity of ED was graded as no (26-30), mild (22)(23)(24)(25), mild to moderate (17)(18)(19)(20)(21), moderate (11)(12)(13)(14)(15)(16) or severe (6-10) using the IIEF-erectile function domain data according to a previous study. 11 Five (7.7%), ten (15.4%), eleven (16.9%), nine (13.8%) and thirty (46.2%) patients were categorized as no, mild, mild to moderate, moderate and severe ED, respectively.…”

“…Despite the significant increase in CKD mortality due to medical causes, 6 surgically induced CKD did not necessarily correlate with increased mortality in a recent large study. 16 If the issue is limited to the relationship between surgical CKD and ED, then there are few studies available in which a comparative evaluation between RN and partial nephrectomy, 17 and ED prevalence in a donor nephrectomy cohort 18 are discussed. Because surgical CKD is a recent unique entity, its clinical manifestations are not entirely known.…”

Nephron-sparing surgery in bilateral Wilms' tumor: A report of two cases

“…Long-term studies with NSS in adults have suggested improved long-term renal function, cardiovascular health, decreased osteoporosis, and increased overall survival while maintaining equivalent oncological outcomes. [1617] More data in the pediatric population are needed to see if the results in adults can be replicated in this group as well. Vanden Berg et al .…”