Abstract
The outlook for patients with end-stage renal disease has improved markedly over the last 30 years as a result of advances in renal replacement therapy. In 1978 data from the European Dialysis and Transplant Registry showed that the prognosis for patients starting dialysis was better than that following myocardial infarction or breast cancer (Wing et al. 1978) and the 10 year survival for adults starting dialysis in the early 1980s can be expected to exceed 65% (Brunner et al 1988). Whilst cardio- and cerebrovascular events caused by premature atherosclerosis are the major causes of death, there is a host of complications to which the end-stage renal disease patient is susceptible which will cause significant morbidity. Sexual dysfunction manifested by loss of libido, reduced fertility and in particular erectile impotence has emerged as a frequent problem in men undergoing renal replacement therapy and this chapter reviews its aetiology, pathophysiology and management.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Abram HS, Hunter LR, Sheridan WF, Epstein CM (1975) Sexual function in patients with chronic renal failure. J Nerv Mental Dis 160:220–226
Antoniou LD, Sudhaker T, Shalhoub RJ, Smith JC (1977) Reversal of uraemic impotence by zinc. Lancet ii:895–898
Barton CH, Mirahmadi MK, Vaziri NB (1982) Effects of long-term testosterone administration on pituitary testicular in end-stage renal failure. Nephron 31:61–64
Blumberg A, Wildbolz A, Descoeudres C, Hennes, Dambacher MA, Fisher JA, Weidman P (1980) Influence of 1.25 dihydroxycholecalciferol on sexual dysfunction and related endocrine parameters in patients on maintenance haemodialysis. Clin Nephrol 13:208–214
Bommer J, Tschope W, Ritz E, Andrassy K (1976) Sexual behaviour of hemodialysed patients. Clin Nephrol 6:315–318
Bommer J, Del Pozo F, Ritz E, Bommer G (1979) Improved sexual function in male haemodialysis patients on bromocryptine. Lancet ii:496–497
Bommer J, Alexion C, Muller-Buhl W, Eifert J, Ritz E (1987) Recombinant human erythropoietin therapy in hemodialysis patients: dose determination and clinical experience. Nephrol Dial Transplant 2:238–242
Brannen GE, Peters TG, Hambidge KM, Kumpe DA, Kempczinski RF, Schrofer GP, Weil R (1980) Impotence after kidney transplantation. Urology 15:138–146
Brook AC, Johnston DG, Ward MK, Watson MJ, Cook DB, Kerr DN (1989) Absence of a therapeutic effect of zinc in the sexual dysfunction of haemodialysis patients. Lancet ii:618–619
Brunner FP, Fassbinder W, Broyer M et al. (1988) Survival on renal replacement therapy: data from the EDTA Registry. Nephrol Dial Transplant 3:109–122
Campese VM, Procci WR, Levitan D, Romoff MS, Goldstein DA, Massry SG (1982) Autonomic nervous system dysfunction and impotence in uraemia. Am J Nephrol 2:140–143
Canadian Erythropoietin Study Group (1990) Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis. Br Med J 300:573–578
Condon CJ, Freeman RM (1970) Zinc metabolism in renal failure. Ann Intern Med 73:531–536
Dillard FT, Miller BS, Sommer BG, Horchak AM, York JP, Nesbitt JA (1989) Erectile dysfunction post transplant. Transplant Proc 21:3961–3962
Distiller LA, Morley JE, Sagel J, Pokroy M, Rabkin R (1975) Pituitary gland function in chronic renal failure: the effect of LHRH and the influence of dialysis. Metabolism 24:711–720
Gomez F, De La Cueva R, Wauters JP, Lemarchand-Berauld (1980) Endocrine abnormalities in patients undergoing long-term haemodialysis. Am J Med 68:522–530
Handelsman DJ, Ralec VL, Tiller DJ, Hovarth JS, Turtle JR (1981) Testicular function after renal transplantation. Clin Endocrinol 14:527–538
Handelsman DJ, McDowell IFW, Caterson ID, Tiller DJ, Hall BM, Turtle JR (1984). Testicular function after renal transplantation: comparison of cyclosporin A with azathioprine and prednisolone combination regimes. Clin Nephrol 22:144–148
Handelsman DJ, Spaliviero JA, Turtle JR (1986) Bioactive luteinising hormone in plasma of uraemic men and men with primary testicular damage. Clin Endocrinol 24:259–266
Holdsworth S, Atkins RC, De Kretser DM (1977) The pituitary-testicular axis in men with chronic renal failure. N Engl J Med 296:1245–1249
Holdsworth SR, De Kretser DM, Atkins RC (1978) A comparison of hemodialysis and transplantation in reversing the uremic disturbance of male reproductive function. Clin Nephrol 10:146–150
Ikram H, Lynn KL, Bailey RR, Little PJ (1983) Cardiovascular changes in chronic haemodialysis patients. Kidney Int 24:371–376
Imagawa A, Kavanishi Y, Numata A (1990) Is erythropoietin effective for impotence in dialysis patients? Nephron 54:95–96.
Kabalin JN, Kessler R (1989) Successful implantation of penile prosthesis in organ transplant patients. Urology 33:282–284
Karacan I, Dervent A, Cunningham G (1978) Assessment of nocturnal penile tumescence as an objective method for evaluating sexual function in ESRD patients. Dialysis Transplant 7:872–875
Levy NB (1973) Sexual adjustment of maintenances haemodialysis and renal transplantation. Trans Am Soc Artif Intern Organs 19:138–143
Lim VS, Fang VS (1976) Restoration of plasma testosterone levels in uraemic men with clomiphene citrate. J Clin Endocrinol Metab 43:1370–1377
Lim VS, Fang VS (1975) Gonadal dysfunction in uraemic men: a study of the hypothalamic-pituitary-testicular axis before and after renal transplantation. Am J Med 58:655–662
Mahajan SK, Prasad AS, Rabbani P, Briggs WA, McDonald FD (1979). Zinc metabolism in uremia. J Lab Clin Med 94:693–698
Mahajan SK, Abbasi AA, Prasad AS, Rabbani P, Briggs WA, McDonald FD (1982) Effect of oral zinc therapy on gonadal function in haemodialysis patients. Ann Intern Med 97:357–361
Massry SG, Goldstein DA, Procci WR, Kletzky OA (1977) Impotence in patients with uraemia: a possible role for parathyroid hormone. Nephron 19:305–310
Mastrogiacomo I, Bonanni G, Gasparotto, Colonna A, Motta RG (1989) Semen analysis in hemo-dialysed and renal transplant patients. In: Seriom (ed) Proceedings of the 4th International Society of Andrology: miniposter 130. Serono Symposia review. Ares-Serono, Rome
Mastrogiacomo I, Feghali V, De Besi L, Seratini E, Gasparotto L (1982) Prolactin, gonadotropins, testosterone and estrogens in uremic men undergoing periodic hemodialysis. Arch Androl 9:279–282
Muir JW, Besser GM, Edwards CRW et al. (1983) Bromocryptine improves reduced libido and potency in men receiving maintenance haemodialysis. Clin Nephrol, 20:308–314
Peces R, Horcajada C, Lopez-Novoa JM, Frutos MA, Casado S, Hernando L (1987) Hyperprolac-tinaemia in chronic renal failure impaired responsiveness to stimulation and suppression. Nephron 28:11–16
Phadke AG, MacKinnon KJ, Dossetor JB (1970) Male fertility in uraemia: restoration by renal allografts. Can Med Assoc J 102:607–608
Prasad AS, Miale A, Farid Z, Sandstead HH, Schulert AR (1963) Zinc metabolism in patients with the syndrome of iron deficiency anaemia, hepatosplenomegaly dwarfism and hypergonadism. J Clin Lab Med 61:537–549
Procci WR, Goldstein DA, Adelstein J, Massry SG (1981) Sexual dysfunction in the male patient with uraemia — a reappraisal. Kidney Int 19:317–323
Randerson DH, Farrell PC (1981). Subjective assessment of CAPD patient. In Gahl GM et al. (eds) Advances in peritoneal dialysis. Excerpta Medica, Amsterdam pp 233–239
Reid IR, Ibbertson HK, France JT, Pybus J (1985) Plasma testosterone concentrations in asthmatic men treated with glucocorticoids. Br Med J 291:574
Rizzoni G, Ehrich JHH, Broyer M et al. (1992) Successful pregnancies in women on renal replacement therapy. Nephrol Dial Transplant 7:279–287
Rodger RS, Fletcher K, Dewar JH, Genner D, McHugh M, Wilkinson R, Ward MK, Kerr DN (1985a) Prevalence and pathogenesis of impotence in one hundred uraemic men. Uraemia Invest 8:89–96
Rodger RS, Morrison L, Dewar JH, Wilkinson R, Ward MK, Kerr DNS (1985b) Loss of pulsatile luteinising hormone in men with chronic renal failure. Br Med J 291:1598–1600
Rodger RS, Fletcher K, Genner D, Dewar J, Ward MK, Kerr DNS (1986) Sexual dysfunction in patients treated by CAPD. In: Mehrer J, Winchester J (eds) Frontiers in peritoneal dialysis. Field Rich, New York, pp 512–515
Rodger RS, Sheldon WL, Watson ML, Dewar JH, Wilkinson R, Ward MK, Kerr DN (1989) Zinc deficiency and hyperprolactinaemia are not reversible causes of sexual dysfunction in uraemia. Nephrol Dial Transplant 4:888–892
Salvatierra O, Fortuna JL, Beizer FO (1975) Sexual function in males before and after renal transplantation. Urology 5:64–66
Sawin CT, Longhope CL, Schmidt GW, Ryan RJ (1973) Blood levels of gonadotrophins and gonadal hormones in gynaecomastia associated with chronic haemodialysis. J Clin Endocrinol Metab 36:988–990
Schaefer RM, Kokot F, Wernze H, Geiger H, Heidland A (1989) Improved sexual function in haemodialysis patients on recombinant erythropoietin. Clin Nephrol 31:1–5
Schalch DS, Gonzalez-Barcena D, Kastin AJ, Landa L, Lee LA, Zamora MT, Schally AV (1975) Plasma gonadotrophins after administration of LHRH in patients with renal or hepatic failure. J Clin Endocrinol Metab 41:921–925
Schmitz O, Moller J (1983) Impaired prolactin response to arginine infusion and insulin hypoglycaemia in chronic renal failure. Acta Endocrinol 102:486–491
Semple CG, Beastall GH, Henderson IS, Thomson JA, Kennedy AC (1982) The pituitary-testicular axis of uraemic subjects on haemodialysis and CAPD. Acta Endocrinol 101:464–467
Sherman FB (1975) Impotence in patients with chronic renal failure: frequency and etiology. Fertil Steril 26:221–223
Sidi AM, Peng W, Sansean C, Lange PH (1987) Penile prosthesis surgery with treatment of impotence in the immunosuppressed patient. J Urol 137:681–682
Stieff CG, Gall H, Scherb W, Bahren W (1988) Midterm results of autoinjection therapy for erectile dysfunction. Urology 31:483–485
Talbot JA, Rodger RSC, Robertson WR (1990) Pulsatile bioactive luteinising hormone secretion in men with chronic renal failure and following renal transplantation. Nephron 56:66–72
Tharandt L, Graben N, Schafer R et al. (1980). Effects of prolactin suppression on hypogonadism in patients on maintenance haemodialysis. Proc Eur Dial Transplant Assoc 17:323–327
Thomson NM, Stevens BJ, Humphrey TJ, Atkins RC (1983) Comparison of trace elements in peritoneal dialysis haemodialysis and uraemia. Kidney Int 23:9–14
Van Kammen E, Thijssen JHH, Schwarz F (1978) Sex hormones in male patients with chronic renal failure. Clin Endocrinol 8:7–14
Wheatley T, Clark PMS, Raggatt RR (1987) Pulsatility of luteinising hormone in man with chronic renal failure: Abnormal rather than absent. Br Med J 294:482
Winer RL, Rajudin MM, Skowsky WR, Parker LN (1982) Preservation of normal adrenal androgen secretion in end-stage renal disease. Metabolism 31:269–273
Wing AJ, Brunner FP, Brynger H et al. (1978) Combined report on regular dialysis and transplantation in Europe. Proc Euro Dial Transplant Assoc 15:3–76
Winnearls CG, Oliver DO, Pippard MJ, Reid C, Downing MR, Cotes PM (1986) Effect of human erythropoietin derived from recombinant DNA on the anaemia of patients maintained by chronic haemodialysis. Lancet ii:1175–1177
Zetin M, Frost NR, Brunsfield D, Stone RA (1987) Amitriptyline stimulates weight gain in haemodialysis patients. Clin Nephrol 18:79–82
Zetin M, Stone RA (1980) Effects of zinc on chronic haemodialysis. Clin Nephrol 13:20–25
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1994 Springer-Verlag London Limited
About this chapter
Cite this chapter
Rodger, R.S.C. (1994). Erectile Impotence and Infertility in Men Undergoing Renal Replacement Therapy. In: Hargreave, T.B. (eds) Male Infertility. Springer, London. https://doi.org/10.1007/978-1-4471-1029-3_11
Download citation
DOI: https://doi.org/10.1007/978-1-4471-1029-3_11
Publisher Name: Springer, London
Print ISBN: 978-3-540-76216-4
Online ISBN: 978-1-4471-1029-3
eBook Packages: Springer Book Archive