Evaluation Of The Factors Influencing Erectile Dysfunction After Renal Transplantation

Objectives: To investigate the prevalence, main manifestation and related factors of sexual dysfunction in male patients with chronic renal insufficiency (CRI) and evaluate the efficacy and safety of sildenafil citrate in treating male kidney transplant recipients with erectile dysfunction.Methods: Fifty males aged 20-60 years, who had received kidney transplantations at least half a year before and whose serum creatinine was under133 umol/L, were selected randomly in the study. Structured questionnaires were administrated by trained interviewers. The International Index of Erectile Dysfunction (IIEF-5) was employed to evaluate erectile dysfunction (ED) before and after kidney transplantation, and levels of sex hormones were determined. Logistic regression was used to examine and test the association between sexual dysfunction and other medical conditions.Results: The prevalence of sexual dysfunction was wider in patients with CRI than in those without. The main manifestations in male patients were decreased libido, erectile dysfunction and premature ejaculation. The prevalence of ED was 82% before kidney transplantation and it decreased to 52% in patients with normal renal function after transplantation (P<0.01). A multivariable showed that the prevalence and severity of sexual dysfunction were related to age, vocation, education, duration of haemodialysis, HB, style of anastomosis, numbers of transplantation, depression and CsA treatment. Whereas, diabetes,β-blocker, anemia, creatinine clearance (Ccr), parathyroid hormone (PTH), albumin(Alb), Angiotesin-converting-enzyme inhibitor(ACEI) /angiotention receptor antagonist(ARB) were not associated with sexual dysfunction. Logistic regression analysis showed age, duration of haemodialysis, HB, style of anastomosis, number of transplantation, depression, CsA treatment were independent risk factors for ED in patients with kidney transplantation. IIEF-5 was higher in patients with hemodialysis less than 6 months than in those with hemodialysis between 6 and 12 months, and more than 12 months before transplantation (P<0.05). IIEF-5 were increased unrelated to age of recipients after transplantation (P<0.05). Oestradiol (P<0.05) and prolactin (P<0.01) levels were decreased significantly, and testosterone levels were increased after transplantation (P<0.05). Patients with ED received oral sildenafil citrate for 6 months. At the end of the treatment, each index in IIEF-5 increased significantly. There were no interactions between sildenafil and cyclosporine, and there was no significant adverse effect of sildenafil on the function of the graft.Conclusions: The main manifestations of sexual dysfunction in male patients with CRI are decreased libido, erectile dysfunction and premature ejaculation. The replacement therapy, especially transplantation, can decrease the prevalence and severity of sexual dysfunction. The genesis of sexual dysfunction is multifactorial, including age, physiological factors, psychological factors and medical conditions. Sildenafil is an effective and safe agent for the treatment of ED in kidney transplant recipients.