Vasculogenic erectile dysfunction in renal transplant recipients--assessment of potential risk factors.

Objectives: This study was performed to determine the effects of renal transplantation on penile haemodynamics using pharmaco-stimulation and colour Duplex ultrasonographic examination and then to determine the possible vascular risk factors for impotence in these patients.

Material And Methods: A total of 100 renal transplant recipients (RTRs; 80 impotent, 20 potent) and 20 potent uraemic patients on haemodialysis waiting for transplantation (control group) were included in the study. The patients were evaluated by means of detailed medical and sexual histories, clinical examination and laboratory investigations. The severity of erectile dysfunction was assessed using the International Index of Erectile Function questionnaire. Pharmacodynamic penile Duplex ultrasonography was carried out for all patients.

Results: The following factors were more commonly associated with impotent compared to potent RTRs: older age, diabetes mellitus, a longer pre-transplant duration of uraemia, impaired graft function and the use of cyclosporin A-based immunosuppressive therapy. Arterial occlusive disease was identified among 11 RTRs (11%), all of whom were impotent. Impotent RTRs had a significantly lower penile blood flow compared to potent RTRs or controls. Age, duration of pre-transplant uraemia and cyclosporin A level had a negative impact on penile haemodynamic parameters.

Conclusions: Penile vascular insufficiency is less common in RTRs than previously reported. The pathogenesis of penile arterial occlusive disease in impotent RTRs is mainly due to associated vascular risk factors. After unilateral interruption of the internal iliac artery, an adequate penile blood supply is maintained in the majority of cases. Early transplantation may delay or prevent the development of penile vasculopathy.