Renal Transplantation Improves Erectile Function in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis

Abstract

Erectile dysfunction has a lower prevalence in renal transplant recipients compared to dialysis patients. Despite this observation, the effect of renal transplantation on erectile function remains unknown. We aimed to assess the role of renal transplantation on erectile function and to determine potential factors improving or deteriorating erectile dysfunction. Materials and Methods: We conducted a systematic review and random effects meta-analysis of observational studies comparing erectile function preoperatively and postoperatively in renal transplant recipients (PROSPERO ID: CRD42020189580). Records reporting relevant outcomes were identified through search of PubMedÒ, EmbaseÒ, Cochrane Library and ScopusÒ databases from inception to September 2020. Judgment of the strength of evidence was performed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: We included 20 studies with 1,695 renal transplant recipients. At postoperative evaluation the number of patients with erectile dysfunction was reduced (RR 1.21, 95% CI 1.02e1.45, I 2 [88%). Renal transplant recipients reported an improvement in erectile function (RR 2.53, 95% CI 1.44e4.44, I 2 [90%) and the mean International Index of Erectile Function score increased by 3.04 points (95% CI 0.63e5.45, I 2 [96%) after renal transplantation. These effects were not demonstrated in the sensitivity analysis. In individuals reporting severe erectile dysfunction, no favorable effect of renal transplantation was observed (RR 1.51, 95% CI 0.85e2.68, I 2 [33%). For all outcomes the strength of evidence was considered low or very low due to methodological concerns and high heterogeneity among the included studies. Conclusions: Renal transplantation improves erectile function and the risk of erectile dysfunction reduces postoperatively compared to preoperatively. However, evidence on the matter is mostly based on low quality data. More studies with standardized outcomes are needed to validate and strengthen our findings.

A methodologic survey on use of the GRADE approach in evidence syntheses published in high-impact factor urology and nephrology journals

“…SRs analyzing evidence from only RCTs ( n = 20) [ 12 , 14 , 15 , 18 , 20 , 22 , 24 , 26 , 30 , 32 – 37 , 40 , 41 , 43 , 45 , 46 ], only NRSs ( n = 15) [ 19 , 21 , 23 , 31 , 39 , 42 , 44 , 47 – 54 ], or RCTs and NRSs ( n = 14) [ 7 – 11 , 13 , 16 , 17 , 25 , 27 – 29 , 38 , 55 ] were included into this methodological study. The main features of these 49 eligible SRs are summarized in Supplementary Table S 2 .…”

“…Twenty-one upgrades of the certainty of evidence were due to a large effect (14.3%), dose–response (47.6%), and plausible confounding (38.1%). The authors of those SRs considered that the all plausible residual confounding in the included studies would reduce the demonstrated effect [ 21 , 29 , 53 ]. Downgrading for RoB was more common in SRs of RCTs (53.8%) than SRs of NRSs (49.3%), whereas downgrading for publication bias was more common in SRs of NRSs (1.2%) than SRs of RCTs (0.1%).…”

Kidney transplantation improve semen quality in patients with dialysis: A systematic review and meta‐analysis

“…The hormonal changes indicated that the renal transplantation may potentially reverse the dysfunction in the pituitary‐Leydig cell axis in advanced uraemia. Former meta‐analyses conducted by other groups also found that kidney transplantation could restore the hormonal changes induced by dialysis (Kang et al., 2020; Pyrgidis et al., 2021).…”

“…With the popularity and maturity of transplantation technology, more and more patients with ESRD could choose renal transplantation for the substitution of dialysis. In the USA, nearly 22,000 ESRD patients live with a functioning kidney transplant (Pyrgidis et al., 2021). And approximately 100,000 Americans are still waiting for renal transplantation (Lundy & Vij, 2019).…”

“…Notably, many original studies and meta‐analysis have been conducted to compare the erectile function between dialysis patients and renal transplantation patients (Kang et al., 2020; Pyrgidis et al., 2021). They all concluded that renal transplantation could improve the erectile function, comparing to patients with dialysis.…”