Does kidney transplantation onto the external iliac artery affect the haemodynamic parameters of the cavernosal arteries?

Gontero, Paolo; Oderda, Marco; Filippini, Claudia; Fontana, Francesco; Lazzarich, Elisa; Stratta, Piero; Turello, E; Tizzani, A; Frea, Bruno

doi:10.1038/aja.2011.115

Cited by 10 publications

(7 citation statements)

References 23 publications

(39 reference statements)

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“…End-to-end arterial anastomosis with the internal iliac artery has previously been shown to reduce cavernosal arterial fl ow 15 , but recently similar eff ect was also found for end-to-side external iliac artery anastomosis 16 . Vitamin D defi ciency in CKD population has been extensively studied but never linked to ED.…”

Section: Table 2 Comparison Of Non-ed (Ed 0) Versus Patients With Anmentioning

confidence: 89%

Vitamin D Status in Renal Transplant recipients is not Associated with Erectile Dysfunction

Sudarević

Begić

Šimunović

et al. 2017

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SUMMARY -Erectile dysfunction (ED) is a highly prevalent disorder among renal transplant recipients. Vitamin D defi ciency (VDD) has been associated with several ED risk factors but only recently directly linked to ED. We conducted a study to investigate whether vitamin D serum levels were associated with the presence and severity of ED in 40 male patients that underwent deceased donor kidney transplantation (TX) from 2001 to 2013. Blood samples were collected on two seasonally distinct occasions and 25(OH)D concentration was assessed by radioimmunoassay. A 5-item version of the International Index of Erectile Function (IIEF-5) was used for ED evaluation and group stratifi cation. We found comparable rates of ED (75%) and VDD (42.5%-62.5%) as in previously published studies. Serum levels of 25(OH)D did not diff er between patients with and those without ED on both measurements (p=0.656 and p=0.914, respectively), or when comparing diff erent ED severity groups. Duration of renal replacement therapy before TX and graft duration until analysis were longer in patients with ED (p=0.022 and p=0.05, respectively), but with the results being nonsignifi cant on logistic regression. In conclusion, we found no association of 25(OH)D concentration with the presence and severity of ED in renal transplant recipients. So far, there are no similar published data.

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Section: Table 2 Comparison Of Non-ed (Ed 0) Versus Patients With Anmentioning

confidence: 89%

Vitamin D Status in Renal Transplant recipients is not Associated with Erectile Dysfunction

Sudarević

Begić

Šimunović

et al. 2017

acc

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“…Surgical procedures during transplantation, such as the interruption of iliac artery distal ends, may sometimes cause insufficiency of penile blood flow, leading to ED [ 17 , 20 ]. The type of arterial anastomosis differently influences the prevalence of ED in KTRs because of the impact on cavernosal artery hemodynamics [ 21 ]. Evidence reports an increased ED in KTRs revascularized through end-to-end anastomosis to the internal iliac artery compared to end-to-side anastomosis to the external iliac artery, suggesting a negative role of the unilateral ligation of the internal iliac artery in erectile function following kidney transplantation [ 21 ].…”

Section: Factors Influencing Ed After Kidney Transplantationmentioning

confidence: 99%

“…The type of arterial anastomosis differently influences the prevalence of ED in KTRs because of the impact on cavernosal artery hemodynamics [ 21 ]. Evidence reports an increased ED in KTRs revascularized through end-to-end anastomosis to the internal iliac artery compared to end-to-side anastomosis to the external iliac artery, suggesting a negative role of the unilateral ligation of the internal iliac artery in erectile function following kidney transplantation [ 21 ]. Indeed, when the kidney graft is anastomosed end-to-end to the internal iliac artery, the blood inflow from the internal pudendal artery is diverted [ 21 ].…”

Section: Factors Influencing Ed After Kidney Transplantationmentioning

confidence: 99%

“…Evidence reports an increased ED in KTRs revascularized through end-to-end anastomosis to the internal iliac artery compared to end-to-side anastomosis to the external iliac artery, suggesting a negative role of the unilateral ligation of the internal iliac artery in erectile function following kidney transplantation [ 21 ]. Indeed, when the kidney graft is anastomosed end-to-end to the internal iliac artery, the blood inflow from the internal pudendal artery is diverted [ 21 ]. However, the prevalence of ED is still high even in KTRs revascularized through anastomosis at the external iliac artery [ 21 ], which shows a slight reduction in penile arterial inflow [ 21 ].…”

Section: Factors Influencing Ed After Kidney Transplantationmentioning

confidence: 99%

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Erectile Dysfunction after Kidney Transplantation

Perri

Izzo

Lofaro

et al. 2020

JCM

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Patients with kidney transplantation often have a worse quality of life than the general population. One of the reasons for this, in male patients, is the high prevalence of erectile dysfunction. This is mainly due to the presence of comorbidities, surgery for kidney transplantation, adverse drug effects, psychological changes related to chronic disease, as well as hyperprolactinemia and hypogonadism. Whenever these endocrine dysfunctions occur after kidney transplantation, they must be corrected with appropriate treatment, i.e., testosterone replacement therapy. Administration of the phosphodiesterase-5 inhibitor (PDE5i) sildenafil at the recommended posology does not significantly alter the pharmacokinetics of the calcineurin inhibitors cyclosporin A or tacrolimus and does not impair kidney allograft function. Tacrolimus increases the peak concentration and prolongs the half-life of PDE5i in kidney transplant patients and, therefore, daily administration cannot be recommended due to the significant drop in blood pressure. Intracavernous injection or topical application of alprostadil can be a second-line option for the treatment of erectile dysfunction after kidney transplantation, which does not alter cyclosporine concentrations and does not deteriorate kidney function. Finally, penile prostheses can be successfully implanted following pelvic organ transplantation after eliminating the risk of infection associated with surgery.

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“…Indeed, hormonal abnormalities (decrease of free and total testosterone levels, hyperprolactinemia, decline of erythropoietin levels), neuropathy associated with uremia, endothelial dysfunction, psychological factors and drugs (first of all diuretics) occur in these patients [43]. Furthermore, other factors playing a role in the pathogenesis of ED might be present in transplanted patients, such as a decrease of the cavernous blood flow following the end-to-end arterial anastomosis with the internal iliac artery [44] or the end-to-side external iliac artery anastomosis [45]. Considering this multi-factoriality, vitamin D deficiency can only have a minor influence on ED in these patients.…”

Section: Discussionmentioning

confidence: 99%

Is There an Association Between Vitamin D Deficiency and Erectile Dysfunction? A Systematic Review and Meta-Analysis

et al. 2020

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Erectile dysfunction (ED) is found very frequently in the male population, in particular in its arteriogenic form, which also represents an important predictor of cardiovascular diseases (CVDs). Some evidence suggests that vitamin D could play a role in cardiovascular risk prevention thanks to its ability to reduce endothelial damage, oxidative stress, the production of inflammatory cytokines, and dyslipidemia. Since ED and CVDs have pathogenic mechanisms in common, numerous studies have evaluated a possible association between vitamin D deficiency (blood concentrations of 25-hydroxyvitamin D < 20 ng/mL) and ED, but with conflicting results. This meta-analysis was therefore performed to clarify the discrepancy of the data so far published. To achieve this, articles have been searched extensively in the Pubmed, MEDLINE, Cochrane, Academic One Files, Google Scholar, and Scopus databases from the first day they were created until January 2020. The search strategy included pertinent Medical Subjects Headings (MeSH) terms. Of the 431 items retrieved, only eight observational studies were included, resulting in a total sample size of 4055 patients. It was found that 25-hydroxyvitaminD (25(OH)D) levels did not show any significant difference between patients with and without ED. However, when patients with vitamin D deficiency only were taken into account, the international index of erectile function (IIEF) score for erectile dysfunction was significantly worse than in controls. This association remained significant even when eugonadal-only patients were considered. Finally, we found that eugonadal patients with severe ED have lower 25(OH)D3 levels than patients with mild ED. In conclusion, this meta-analysis suggests an association between vitamin D deficiency and the presence of severe forms of ED, independent of testicular function.

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Does kidney transplantation onto the external iliac artery affect the haemodynamic parameters of the cavernosal arteries?

Cited by 10 publications

References 23 publications

Vitamin D Status in Renal Transplant recipients is not Associated with Erectile Dysfunction

Vitamin D Status in Renal Transplant recipients is not Associated with Erectile Dysfunction

Erectile Dysfunction after Kidney Transplantation

Is There an Association Between Vitamin D Deficiency and Erectile Dysfunction? A Systematic Review and Meta-Analysis

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