Male Infertility in Renal Failure and Transplantation

Scott D. Lundy; Sarah C. Vij

Disclosures

Transl Androl Urol. 2019;8(2):173-181. 

In This Article

ED in Renal Failure and Transplant

ESRD and ED

While an in-depth discussion on this topic is outside the scope of this review, it is important to acknowledge that the dramatic effect of ESRD on ED is now well documented and related both to the underlying etiology of CKD (e.g., diabetes or hypertension) as well as direct effects of uremia, particularly on the nervous system. Psychogenic ED in the setting of high levels of anxiety and depression, decreased activity, and poor body image associated with patients initiating dialysis is likely also a key driver in this phenomenon.[27] Finally, polypharmacy with medications known to impair erections (beta blockers, diuretics, neuromodulators) likely contributes in many cases as well. When combined, these synergistic effects result in a >50% prevalence of ED in the ESRD population.[28] This suggests that, even in the absence of changes in hormones and semen quality, a significant proportion of men with ESRD may be unable to conceive due to ED alone.

ED and Renal Transplant

In parallel with the improvement in hormonal parameters, erectile function also appears to improve with transplantation in a subset of patients.[9] The degree of improvement, however, is widely variable in the literature depending on the cohort studied and analysis method, and the degree of reported improvement ranges from no change to improvement in 75% of patients. The most comprehensive study to date (including IIEF, Doppler ultrasound, cavernosometry, and Rigiscan endpoints) supports improvement in the majority (>50%) of patients.[29] In stark contrast, a large cohort from Europe was found to have worse—not better—ED via IIEF in young men undergoing transplantation.[30] Further work will be needed to better characterize this important aspect of men's reproductive health as it relates to renal dysfunction.

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