Impotence and Chronic Renal Failure: A Study of the Hemodynamic Pathophysiology

Kaufman, Joel M.; Hatzichristou, Dimitrios; Mulhall, John P.; Fitch, William P.; Goldstein, Irwin

doi:10.1016/s0022-5347(17)35030-9

Cited by 92 publications

(56 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11 In this study group, 99% of the diabetic patients displayed ED complaints. Only 8% of the patients whose CRF etiology was diabetic nephropathy did not have sexual impotence complaints; on the other hand, 80% of patients with diabetes already had such afflictions before starting dialytic treatment.…”

Section: Discussionmentioning

confidence: 64%

Erectile dysfunction: prevalence and associated variables in patients with chronic renal failure

2002

View full text Add to dashboard Cite

Patients with chronic renal failure (CRF) experience a significant decrease in quality of life, due both to the limitations imposed by the disease as well as the demands of the treatment that they receive. Some side effects of both illness and treatment contribute to increase the morbidity of these patients. Among them, erectile dysfunction (ED) is notable. One hundred and nineteen patients received clinical and laboratory evaluation. The following clinical data were observed: age, education, income, race, period of dialysis, period of complaints of ED, etiology of ED, use of erythropoietin, presence of arterial hypertension and=or diabetes mellitus, use of antihypertensive drugs, use of cigarettes, and psycho-emotional state of the patients. Assessment of complaints of ED was achieved using the International Index of Erectile Function (IIEF). The following laboratory data were analyzed: hemoglobin, hematocrit, free testosterone, gonadotrophin levels (FSH and LH), HDL-cholesterol, total cholesterol, prolactin, and parathyroid hormone. Statistical analysis of the means of continuous variables was performed through use of the Student's t-test. Analysis of significance of category variables was performed using the w 2 test. Descriptive analysis was obtained through use of the clinical and socio-demographic data. A multivariate model was created and the odds ratio calculated. The average age of the patients was 47.3 AE 15.9 y. The mean duration of erectile dysfunction complaints was 4 y. The average duration of dialysis was 66.2 AE 58.9 months. Prevalence of erectile dysfunction in this population was 57.9%. The main known etiology of chronic renal failure was glomerulonephritis. The main variables associated with erectile dysfunction were age, psycho-emotional state, and levels of HDL-cholesterol. This study showed a high prevalence of erectile dysfunction in the group of patients examined. Factors such as age, anxiety and depressive complaints, and dyslipidemy seem to play an important role in the origin of erectile dysfunction in such patients.

show abstract

Section: Discussionmentioning

confidence: 64%

Erectile dysfunction: prevalence and associated variables in patients with chronic renal failure

2002

View full text Add to dashboard Cite

show abstract

“…The causes for this high prevalence of ED in kidney transplant patients are probably related with the more frequent presence in patients with endstage renal disease of a variety of associated risk factors such as: increasing age, diabetes mellitus; 16 peripheral neuropathy, autonomic insufficiency, peripheral vascular disease, pharmacologic therapy, psychologic and physical stresses; 7 anxiety, changes in self-image, medication side effects and interference with penis vascularity and sinusoidal response to neurotransmitters; 10 hypothalamic-pituitary-gonadal axis alterations, anemia, secondary hyperparathyroidism, derangements in arterial supply or venous outflow, and the abnormal structure of cavernous body smooth muscle cells. 17 In a study 18 cavernous artery occlusive disease was found in 78% of the studied patients, and all patients who underwent arteriography had diffuse atherosclerotic disease of the distal penile arteries. Patients who received a renal transplant early had vasculogenic impotence only in the case of rejection of the renal transplant, suggesting that early renal transplantation may delay or prevent the development of the penile vasculopathy.…”

Section: Discussionmentioning

confidence: 90%

Factors associated with erectile dysfunction in male kidney transplant recipients

et al. 2003

View full text Add to dashboard Cite

A transversal study was carried out in order to evaluate the prevalence of erectile dysfunction (ED) in adult kidney transplant patients of our region (N ¼ 243), and to investigate the sociodemographic, analytic, and clinical factors associated with it. To evaluate ED, the Spanish five items version of the International Index of Erectile Function (IIEF-5) was employed. Sociodemographic, analytic, and clinical data, including 12 cardiovascular risk factors, were also collected. A total of 199 patients (82%) were included. The median age was 52 y (43-62 y); 106 patients (54.9%) presented with ED. Variables associated with ED were: higher age; longer time on dialysis prior to transplantation; higher comorbidity; presence of diabetes mellitus; had undergone prostatic surgery or peripheric artheriopathy; lower diastolic pressure; and some anti hypertensive drugs. Logistic Regression Model performed step by step showed (R 2 ¼ 0.52) that factors independently associated with ED were: age, time on dialysis previous to transplant, and peripheric artheriopathy.

show abstract

“…Two studies diagnosed corporeal veno-occlusive dysfunction in 31% and 80% of RTR. 4,5 A recent study detected arterial insufficiency in nine out of 11 patients. 6 These studies are either old 3 or have been conducted on a limited number of patients and frequently lack a control group.…”

Section: Introductionmentioning

confidence: 98%

Role of penile vascular insufficiency in erectile dysfunction in renal transplant recipients

et al. 2002

View full text Add to dashboard Cite

The objectives of this study were to define the role and haemodynamic features of penile vascular insufficiency in impotent renal transplant recipients (RTR) as well as to establish the possible vascular risk factors for impotence in these patients. A total of 54 RTR (35 impotent and 19 potent) and 21 potent healthy subjects were included in this study. All patients were assessed clinically and by measurement of serum creatinine, serum bilirubin, cyclosporine blood levels, haemoglobin and total serum cholesterol. All subjects were subjected to intracavernous injection of 20 mg prostaglandin E 1 followed by colour Duplex sonographic examination. Our results showed that impotent RTR were significantly more likely than potent RTR to have hypertension, diabetes and hypercholesterolaemia (P < 0.05). Arterial occlusive disease was identified in 42.9% of impotent RTR. Findings suggestive of veno-occlusive dysfuntion were found in 68.6% and 26.3% of impotent and potent RTR, respectively (P ¼ 0.003). Unilateral ligation of the internal iliac artery has a negative role on haemodynamic parameters compared to unilateral end-to-side anastomosis to external iliac artery in impotent RTR (P < 0.05). Impotent RTR receiving more than one antihypertensive drug showed significant decrease in basal peak systolic velocity (PSV), dynamic PSV, erectile angle and cavernosal artery diameter compared to those receiving one drug (P < 0.05). In conclusion, penile vascular insufficiency appears to play a substantial role in the pathogenesis of impotence in transplant patients. Anastomosis of the graft to external iliac artery could preserve the potency to some degree. Antihypertensives should be reduced as much as possible to avoid their negative effects on erectile function.

show abstract

Impotence and Chronic Renal Failure: A Study of the Hemodynamic Pathophysiology

Cited by 92 publications

References 28 publications

Erectile dysfunction: prevalence and associated variables in patients with chronic renal failure

Erectile dysfunction: prevalence and associated variables in patients with chronic renal failure

Factors associated with erectile dysfunction in male kidney transplant recipients

Role of penile vascular insufficiency in erectile dysfunction in renal transplant recipients

Contact Info

Product

Resources

About