You are here

Kronik böbrek yetmezliği, diyaliz ve böbrek naklinin cinsel ve üreme işlevleri üzerindeki etkileri

The effects of chronic renal failure, dialysis and kidney transplantation on sexual and reproductive functions

Journal Name:

Publication Year:

Author Name
Abstract (2. Language): 
The uremic milieu plays an important role in the development of sexual dysfunction in chronic renal failure. High FSH and LH and low testosterone levels are reported in uremic men and testosterone level returns to normal after a successful kidney transplantation. Spermatogenic abnormalities and loss of libido and potency associated with a defect in testosterone biosynthesis have been reported in about half of hemodialysis patients. It is well established that libido and potency, which are of disorders of sexual dysfunction persisting during hemodialysis in men with uremia resolve after renal transplantation. In this article pathophysiology of sexual dysfunction is firstly reviewed, and later erectile dysfunction and its treatment are discussed.
Abstract (Original Language): 
Kronik böbrek yetmezliğinde cinsel işlev bozukluğunun ortaya çıkmasında üremik ortam önemli rol oynar. Üremik erkeklerde yüksek FSH, LH ve dü- şük testosteron seviyeleri bildirilmektedir ve başarılı böbrek nakli sonrası testosteron seviyesinin normal sınırlara geldiği anlaşılmıştır. Hemodiyaliz hastalarının yaklaşık yarısında, spermatogenik anormallikler ve testosteron biyosentezinde eksiklikle ilişkili libido ve potens kaybı meydana gelir. Üremik erkeklerde hemodiyalizin devamı boyunca sürekli olarak görülen cinsel işlev bozukluklarından libido ve potensin böbrek nakli sonrası geriye döndüğü ortaya konmuştur. Bu derlemede kronik böbrek yetmezliği hastalarında üreme işlevi yetersizliğinin patofizyolojisi öncelikle incelenmiş, sonra erektil işlev bozukluğu ve tedavisi tartışılmıştır.
229-236

REFERENCES

References: 

1. Procci WR, Goldstein DA, Adestein J, Massry SG.
Sexual dysfunction in the male patient with uremia: a
reappraisal. Kidney Int 1981; 19: 317-323.
2. Chopp RT, Mendez R. Sexual function and hormonal
abnormalities in uremic man on chronic dialysis
and after renal transplantation. Fertil Steril 1978; 29:
661-666.
3. Diemont WL, Vruggink PA, Meuleman EJ, Doesburg
WH, Lemmens WA, Berden JH. Sexual dysfunction
after renal replacement therapy. Am J Kidney Dis 2000;
35: 845-851.
4. Rosas SE, Joffe M, Franklin E, et al. Association of
decreased quality of life and erectile dysfunction in
hemodialysis patients. Kidney Int 2003; 64: 232-238.
5. Holdsworth SR, de Kretser DM, Atkins RC. A comparison
of hemodialysis and transplantation in reversing the
uremic disturbance of male reproductive function. Clin
Nephrol 1978; 10: 146-150.Cilt 52 • Sayı 3 Böbrek yetmezliğinde cinsel işlev • 235
6. Toorians AW, Janssen E, Laan E, et al. Chronic renal
failure and sexual functioning: clinical status versus
objectively assessed sexual response. Nephrol Dial
Transplant 1997; 12: 2654-2663.
7. Holdsworth S, Atkins R, de Kretser D. The pituitarytesticular axis in men with chronic renal failure. N Engl
J Med 1977; 296: 1245-1249.
8. Pezeskhi ML, Ghazizadeh S. Sexual and reproductive
function in end-stage renal disease and effect of kidney
transplantation. Asian J Androl 2008: 10; 441-446.
9. Hagen C, Olgaard K, McNeilly AS, Fisher R. Prolactin
and the pituitary-gonadal axis in male uraemic patients
on regular dialysis. Acta Endocrinol (Copenh) 1976; 82:
29-38.
10. Handelsman DJ, Spaliviero JA, Turtle JR. Hypothalamic
pituitary function in experimental uremic hypogonadism. Endocrinology 1985; 117: 1984-1995.
11. Handelsman DJ. Hypothalamic pituitary gonadal
dysfunction in renal failure, dialysis and renal
transplantation. Endocrinol Rev 1985; 6: 151-182.
12. Lim VS. Reproductive function in patients with renal
insufficiency. Am J Kid Dis 1987; 9: 363-367.
13. Peces R, Horcajada C, Lopez-Novoa JM, Frutos MA,
Casado S, Hernando L. Hyperprolactinemia in chronic
renal failure. impaired responsiveness to stimulation
and suppression. Normalization after transplantation.
Nephron 1981; 28: 11-16.
14. Akbari F, Alavi M, Esteghamati A, et al. Effect of renal
transplantation on sperm quality and sex hormone
levels. BJU Int 2003; 92: 281-283.
15. Rowe SJ, Montague DK, Steinmuller DR, Lakin MM,
Novick AC. Treatment of organic impotence with
penile prosthesis in renal transplant patients. Urology
1993; 41: 16-20.
16. NIH Consensus Conference. Impotence. NIH Consensus
Development Panel on Impotence. J Am Med Assoc
1993; 270: 83-90.
17. Feldman HA, Goldstein I, Hatzichristou DG, Krane
RJ, McKinlay JB. Impotence and its medical and
psychosocial correlates: results of the Massachusets
Male Aging Study. J Urol 1994; 151: 54-61.
18. Jackson G, Betteridge J, Dean J, et al. A systematic
approach to erectile dysfunction in the cardiovascular
patient: a consensus statement. Int J Clin Pract 1999;
53: 445-451.
19. Sherman FP. Impotence in patients with chronic renal
failure on dialysis: its frequency and etiology. Fertil
Steril 1975; 26: 221-223.
20. Rodger RS, Fletcher K, Dewar JH, et al. Prevalence and
pathogenesis of impotence in one hundred uremic
men. Uremia Invest 1984-1985; 8: 89-96.
21. Procci WR, Hoffman KI, Chatterjee SN. Sexual
functioning of renal transplant recipients. J Nerv Ment
Dis 1978; 166: 402-407.
22. Carson CC, Patel MP. The epidemiology, anatomy,
physiology, and treatment of erectile dysfunction in
chronic renal failure patients. Adv Ren Replace Ther
1999; 6: 296-309.
23. Schrier RW. Diseases of the Kidney and Urinary Tract.
7th ed. Philadelphia: Lippincott Williams & Wilkins,
2001.
24. Stewart RS. Psychiatric issues in renal dialysis and
transplantation. Hosp Commun Psychiatry 1983; 34:
623-628.
25. Kwan M, Greenleaf W, Mann J, Crapo L, Davidson J.
The nature of androgen action on male sexuality: a
combined laboratory- self-report study on hypogonadal
men. J Clin Endocrinol Metab 1983; 57: 557-562.
26. Delano B. Improvements in quality of life following
treatment with r-HuEPO in anemic hemodialysis
patients. Am J Kidney Dis 1989; 14: 14-18.
27. Haffner D, Nissel R, Wuhl E, et al. Metabolic effects of
long-term growth hormone treatment in prepubertal
children with chronic renal failure and after kidney
transplantation. The German Study Group for Growth
Hormone Treatment in Chronic Renal Failure. Pediatr
Res 1998; 43: 209-215.
28. Biller B, Molitch M, Vance ML, et al. Treatment of
prolactin-secreting macroadenomas with the onceweekly dopamine agonist cabergoline. J Clin Endocrinol
Metab 1996; 81: 2338-2343.
29. Meuleman E, Cuzin B, Opsomer RJ, et al. A doseescalation study to assess the efficacy and safety of
sildenafil citrate in men with erectile dysfunction. Br J
Urol Int 2001; 87: 75-81.
30. Christiansen E, Guirguis WR, Cox D, Osterloh IH.
Long-term efficacy and safety of oral Viagra (sildenafil
citrate) in men with erectile dysfunction and the
effect of randomised treatment withdrawal. Sildenafil
Multicentre Study Group. Int J Impot Res 2000; 12:
177-182.
31. Montorsi F, McDermott TE, Morgan R, et al. Efficacy
and safety of fixed-dose oral sildenafil in the treatment
of erectile dysfunction of various etiologies. Urology
1999; 53: 1011-1018.
32. Rosas SE, Wasserstein A, Kobrin S, Feldman HI.
Preliminary observations of sildenafil treatment for
erectile dysfunction in dialysis patients. Am J Kidney
Dis 2001; 37: 134-137.
33. Chen J, Mabjeesh NJ, Greenstein A, Nadu A, Matzkin
H. Clinical efficacy of sildenafil in patients on chronic
dialysis. J Urol 2001; 165: 819-821.
34. Grossman EB, Swan SK, Muirhead GJ, et al. The
pharmacokinetics and hemodynamics of sildenafil
citrate in male hemodialysis patients. Kidney Int 2004;
66: 367-374.
35. Ifudu O. Care of patients undergoing hemodialysis. N
Engl J Med 1998; 339: 1054-1062.
36. Palmer JM, Chatterjee SN. Urologic complications in
renal transplantation. Surg Clin North Am 1978; 58:
305-319.
37. Seibel I, Poli De Figueiredo CE, Telöken C, Moraes
JF. Efficacy of oral sildenafil in hemodialysis patients
with erectile dysfunction. J Am Soc Nephrol 2002; 13:
2770-2775.
38. Danovitch GM. Handbook of Kidney Transplantation.
4th ed. Philadelphia: Lippincott Williams & Wilkins,
2005.
39. De Celis R, Pedrón-Nuevo N. Male fertility of kidney
transplant patients with one to ten years of evolution
using a conventional immunosuppressive regimen.
Arch Androl 1999; 42: 9-20.
40. Lim VS, Fang VS. Gonadal dysfunction in uremic men.
A study of the hypothalamopituitary testicular axis
before and after renal transplantation. Medicine 1975;
58: 655-662.
41. Phadke AG, Mackinnon KL, Dossector JB. Male fertility
in uremia: restoration by renal allografts. Can Med
Assoc J 1970; 102: 607-608.236 • Eylül 2010 • Gülhane Tıp Derg Ateş
42. Rodriguez R, Burgos Revilla FJ, Gomez Dosantos V, et
al. Endocrine changes and sexual dysfunction in kidney
transplantation and hemodialysis: Comparative study.
Actas Urol Esp 1996; 20: 697-701.
43. Prem AR, Punekar SV, Kalpana M. Male reproductive
function in uremia efficacy of hemodialysis and renal
transplantation in India. Br J Urol 1996; 78: 635-638.
44. Morely JE, Distiller LA. Effect of renal transplantation
on pituitary gonadal function. Metabolism 1978; 27:
281-283.
45. Handelsman DJ, McDowell IF, Caterson ID, Tiller
DJ, Hall BM, Turtle JR. Testicular function after renal
transplantation: comparison of Cyclosporin A with
azathioprine and prednisolone combination regimens.
Clin Nephrol 1984; 22: 144-148.
46. Gates RD. Nonsurgical treatment of infertility: specific
therapy. In: Lipshultz LI, Howard SS (eds). Infertility in
the Male. 2nd ed. St. Louis: Mosby-Year Book, 1991:
371-394.
47. Seethalakshmi L, Flores C, Diamond DA, Menon
M. Reversal of the toxic effects of cyclosporine on
male reproduction and kidney function of rats by
simultaneous administration of hCG + FSH. J Urol
1990; 144: 1489-1492.
48. Seethalakshmi L, Diamond DA, Malhotra RK, Mazanitis
SG, Kumar S, Menon M. Cyclosporine induced
testicular dysfunction: a separation of the nephrotoxic
component and an assessment of a 60-day recovery
period. Transplant Proc 1988; 20: 1005-1010.
49. Seethalakshmi L, Flores C, Carboni AA, Bala R, Diamond
DA, Menon M. Cyclosporine: its effect on testicular
function and fertility in the prepubertal rat. J Androl
1990; 11: 17-24.
50. Eid MM, Abdel-Hamid IA, Sobh MA, el-Saied MA.
Assessment of sperm motion characteristics in infertile
renal transplant recipients using computerized analysis.
Int J Androl 1996; 19: 338-344.
51. Olshan AF, Mattison DR, Zwanenburg TS. International
Commission for Protection against Environmental
Mutagens and Carcinogens. Cyclosporine A: review
of genotoxicity and potential for adverse human
reproductive and developmental effects. Report of a
Working Group on the genotoxicity of cyclosporine A.
Mutat Res 1994; 317: 163-173.
52. Kaczmarek I, Groetzner J, Adamidis I, et al. Sirolimus
impairs gonadal function in heart transplant recipients.
Am J Transplant 2004; 4: 1084-1088.
53. Nevins T, Dunn DL. Use of ganciclovir for
cytomegalovirus infection. J Am Soc Nephrol 1992; 2:
S270-273.
54. Peskircioglu L, Tekin MI, Demirag A, Karakayali H,
Ozkardes H. Evaluation of erectile function in renal
transplant recipients. Transplant Proc 1998; 30:
747-749.
55. Malavaud B, Rostaing L, Rischmann P, Sarramon J-P,
Durand D. High prevalence of erectile dysfunction
after renal transplantation. Transplantation 2000; 69:
2121-2124.
56. Salvatierra O, Fortmann JL, Belzer FO. Sexual function
of males before and after renal transplantation. Urology
1975; 5: 64-66.
57. Nghiem DD, Corry RJ, Mendez GP, Lee HM. Pelvic
hemodynamics and male sexual impotence after renal
transplantation. Am Surg 1982; 10: 532–535.
58. Pach J, Waniek W, Hartmann HG. Changes in male
sexual function during hemodialysis and after renal
transplantation under psychiatric aspects. Med Klin
1977; 72: 216-220.
59. Tsujimura A, Matsumiya K, Tsuboniwa N, et al. Effect of
renal transplantation on sexual function. Arch Androl
2002; 48: 467-474.
60. Şahin AF, Cihan A, Akgül K ve ark. Erkek hastalarda
böbrek nakli sonrası cinsel işlevler. Türk Üroloji Dergisi
2009; 35: 23-27.
61. Matthew RW. Medical Management of Kidney
Transplantation. Philadelphia: Lippincott Williams &
Wilkins, 2005.
62. Juenemann KP, Lue TF, Luo JA, Benowitz NL, Abozeid
M, Tanagho EA. The effect of cigarette smoking on
penile erection. J Urol 1987; 138: 438-441.
63. Miller N, Gold MS. The human sexual response and
alcohol and drugs. J Subst Abuse Treat 1988; 5: 171-177.
64. Dillard FT, Miller BS, Sommer BG, Horchak AM, York
JP, Nesbitt JA. Erectile dysfunction posttransplant.
Transplant Proc 1989; 21: 3961-3962.
65. Reinberg Y, Bumgardner GL, Aliabadi H. Urological
aspects of renal transplantation. J Urol 1990; 143:
1087-1092.
66. Barroui B, Cuzin B, Malavaud B, et al. Early experience
with sildenafil for the treatment of erectile dysfunction
in renal transplant recipients. Nephrol Dial Transplant
2003; 18: 411-417.
67. Lue TF. Erectile dysfunction. N Engl J Med 2000; 342:
1802-1813.
68. Muller JE, Mittleman MA, Maclure M, Sherwood JB,
Tofler GH. Triggering myocardial infarction by sexual
activity: low absolute risk and prevention by regular
physical exertion. JAMA 1996; 275: 1405-1409.
69. Pietro Castr RM, Anglada Curado FJ, Reguiro Lopez
JC, et al. Treatment with sildenafil citrate in renal
transplant patients with erectile dysfunction. Br J Urol
Int 2001; 88: 241-243.
70. Rostaing L, Tran-Van T, Ader JL. Increased glomerular
filtration rate in kidney-transplant recipients who take
sildenafil. N Engl J Med 2000; 342: 1679-1680.
71. Zusman RM, Morales A, Glasser DB, Osterloh IH.
Overall cardiovascular profile of sildenafil citrate. Am J
Cardiol 1999; 83: 35C-44C.
72. Christ B, Brockmeier D, Hauck EW, Friemann S.
Interactions of sildenafil and tacrolimus in men with
erectile dysfunction after kidney transplantation.
Urology 2001; 58: 589-593.
73. de Mattos AM, Bennett WM, Barry JM, Norman DJ. HLA
identical sibling renal transplantation-a 21-yr singlecenter experience. Clin Transplant 1999; 13: 158-167.

Thank you for copying data from http://www.arastirmax.com