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

You have accessJournal of UrologyReview Article1 Apr 2021Renal Transplantation Improves Erectile Function in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis Nikolaos Pyrgidis, Ioannis Mykoniatis, Sokolakis, Ioanna Minopoulou, Meletios P. Nigdelis, Petros Sountoulides, Paolo Verze, Georgios Hatzichristodoulou, Dimitrios Hatzichristou PyrgidisNikolaos Pyrgidis *Correspondence: Alois 16, Pilaia, Thessaloniki, Greece telephone: 0030 6982 14 2006; E-mail Address: [email protected] First Department Urology, G. Gennimatas Hospital, Aristotle University More articles by this author , MykoniatisIoannis Mykoniatis SokolakisIoannis Sokolakis ‘Martha-Maria’ Hospital Nuremberg, Germany MinopoulouIoanna Minopoulou School Medicine, Faculty Health Sciences, NigdelisMeletios Nigdelis SountoulidesPetros Sountoulides VerzePaolo Verze Surgery, Dentistry “Scuola Medica Salernitana”, Urology Unit—University Salerno, Italy HatzichristodoulouGeorgios Hatzichristodoulou HatzichristouDimitrios View All Author Informationhttps://doi.org/10.1097/JU.0000000000001577AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract Purpose: dysfunction has a lower prevalence renal transplant recipients compared dialysis patients. Despite observation, the effect transplantation on erectile function remains unknown. We aimed assess role determine potential factors improving or deteriorating dysfunction. Materials Methods: conducted systematic review random effects meta-analysis observational studies comparing preoperatively postoperatively (PROSPERO ID: CRD42020189580). Records reporting relevant outcomes were identified through search PubMed®, Embase®, Cochrane Library Scopus® databases from inception September 2020. Judgment strength evidence was performed Grading Recommendations Assessment, Development Evaluation (GRADE) approach. Results: included 20 1,695 recipients. At postoperative evaluation number patients reduced (RR 1.21, 95% CI 1.02–1.45, I2=88%). reported an improvement 2.53, 1.44–4.44, I2=90%) mean International Index score increased 3.04 points (95% 0.63–5.45, I2=96%) after transplantation. These not demonstrated sensitivity analysis. In individuals severe dysfunction, no favorable observed 1.51, 0.85–2.68, I2=33%). For all considered low very due methodological concerns high heterogeneity among studies. Conclusions: improves risk reduces preoperatively. However, matter is mostly based quality data. standardized are needed validate strengthen our findings. Abbreviations Acronyms ED EF HD hemodialysis IIEF MMF mycophenolate mofetil PDE5i phosphodiesterase type 5 inhibitors RR ratio RT RTR recipient optimal replacement therapy end-stage disease.1 The increasing worldwide more than 90,000 RTs every year.2 United States alone, about 220,000 live functioning kidney transplant.3 Among RTRs, estimated 59%4 major burden that affects life may lead anxiety, depression loss self-esteem.5 patients, even higher exceed 75%.4,6 RTRs been attributed recovery function, restoration important metabolic endocrine parameters such as urea testosterone levels well general life.7 On contrary, various immunosuppressant medications, multiple perioperative complications deteriorate RTRs.8 Still, be explained fact undergoing generally younger, better physical mental health state they present fewer comorbidities patients.9 Epidemiological data non-systematic, qualitative reviews do comprehensively address render controversial.10,11 Within framework, we systematically synthesized available generated meta-analysis, aiming Methods Search Strategy predefined documented aims methods protocol registered at PROSPERO (ID: study compliance Preferred Reporting Items for Meta-Analyses statement (supplementary 1, https://www.jurology.com).12 Two authors (NP, IM) searched PubMed, Embase, Scopus 2020 exploring EF. targeted grey literature, including conference abstracts published nephrology, urology, sexual medicine journals websites providing information dissertations. EudraCT Clinicaltrials.gov also perused additional ongoing trials. reference lists eligible studies, guidelines hand-searched identify further Our detailed strategy presented supplementary 2 (https://www.jurology.com). Selection Criteria prospective retrospective cohort assessing self-reported validated tools pretransplantation posttransplantation state. single-arm, multi-arm comparative without language restrictions older 18 years age. contrast, excluded only evaluating nonvalidated dichotomous (yes/no) way. Similarly, did encompass cross-sectional measuring postoperatively. Narrative reviews, editorials letters editor excluded. When records overlapping populations identified, most recent included. Data Extraction Quality Assessment independently screened eligibility. Any disagreements resolved consensus. extracted Microsoft® Excel® spreadsheet. From each study, retrieved patient characteristics, details outcomes. Established methods, recommended Collaboration, applied calculate full-text articles, summary tables figures.13 standard deviation change baseline domain Function-15 IIEF-5 reported, it obtained error, confidence interval p value provided study. none latter SD correlation coefficient other trials.13 trials timepoints postoperatively, proximate assessment retrieved. Between reviewers, pilot test extraction process guarantee coherence. case unavailability, directly contacted information.14 evaluated modified version Newcastle-Ottawa Scale Based Scale, judged upon 8 items, grouped into 3 categories include selection participants, comparability results 3, https://www.jurology.com).15 investigators (IS, MPN) assessed any discrepancies Accordingly, bias across (publication bias) via visual funnel plot asymmetry Egger’s statistical test.16 Evidence, Synthesis Statistical Analysis determined overall applying approach.17 Three IM, IS) bias, inconsistency, indirectness, imprecision publication inverse variance, following outcomes: 1) experiencing some level versus postoperatively; 2) improved deteriorated assessment, 3) IIEF-15 RTRs. particular, absolute presenting before binary way, deterioration preoperative evaluation. Therefore, 1 ratios. hand, regarding outcome single-arm raw differences estimate IIEF-5. Regarding RRs, denominator total consisted same ratio. Further synthesis can found 4, analysis good subgroup vs Moreover, I2. measures, values 0.05 statistically significant. analyses using R software (version 3.6.3). Results Study yielded 2,051 resulting 85 screening titles abstracts. Ultimately, quantitative EF.18–37 illustrated figure Figure 1. Flow diagram Employing 7 good, moderate 12 poor quality. mainly nonrepresentative sample size, variety measure patient-reported diversity followup 6 Characteristics age 41.8±10.5 meta-analysis. Dialysis duration 26.2 months (range 4 93.8). data, end-to-end anastomosis graft internal iliac artery end-to-side external selected cases. Common concomitant hypertension 80% cases, smoking 32%, diabetes 24% previous 3.1%. levels, significantly increased, remained stable decreased RT. Eight 10 its abridged (IIEF-5). questionnaire developed employed. Overall, participants time 71.7±52.4 months, while another report exact timepoint characteristics 2. Table Reference Country Population Tool No. Participants Living Donor Immunosuppresants Previous Type Transplant Anastomosis Ahmad 200918 Pakistan Adult males 30 NA Bujdak 200319 Slovakia 58 El-Bahnasawy 200420 Egypt 400 Cyclosporine treatment 215 End-to-end artery: 369; End-to-side 21; common Gontero 201221 22 Tacrolimus, prednisolone, MMF: 17; prednisolone: 2; sirolimus: Cyclosporine, 1; Sirolimus, Prednisolone, Guo 201022 China Married receiving living-donor (including Hepatitis B virus+patients) 87 Corticosteroids, tacrolimus + Internal 84; External Jabali 202023 Kurdistan 59 tacrolimus: 32; 26; Everolimus, Jürgensen 200824 simultaneous pancreas 101 Mirone 200925 78 0 Azathioprine: 8; 18; Ly antigen: 3; Methylprednisolone: 30; Prednisone: 31; Everolimus: 5; Rapamycin: Sirolimus: Tacrolimus: 10; Cyclosporin: 57 variously combined Nanjappa 201226 India 127 Nassir 200927 Saudi Arabia partners peritoneal 16 Park 2013 28 Korea 25 Pe?kircio?lu 199829 Turkey Questionnaire et al. 65 Pourmand 2007 Iran 64 Prednisone, cyclosporine 45; 11; Qiao 200931 deceased-donor 48 Russo 200432 113 Shamsa 200533 Males 15 azathioprine, prednisolone Soliman 201734 C virus+adult Teng 201135 24 Cyclosporine: 7; MMF, prednisone: 17 Tian 200736 212 Tsujimura 2002 37 Japan 121 93 85; Azathioprine, 23; 13 NA, available. Baseline Age±SD Mos. RT±SD Smoking Hypertension Diabetes Testosterone prior (ng/dl) RT, ng/dl 39±7.4 mos postop 633 46.4±10 37±10 17.2±16.9 66.2±55.6 86 300 53 2012 21 50.6±12.1 75±35.5 19 410±182 419±129 11.1±5.5 83 49.4±7.1 5.3±7.2 45.5±8.7 53.9±4 69 805±170 943±216 49.2±11.4 201328 53.5±12.3 22±18.8 124±69.2 516±243 42.5±9.3 72±41.5 200730 42.3±10.4 16.8±18.7 35.2±8.2 18.1±9.6 41.8±31.9 31 43.5±10.2 43.6±34.1 53.6±49.2 35.3±12 51.7±93.8 11 387 40.8±7.1 12.8±20.5 307±94 654±314 200237 44.7±0.8 42.3±4 107.9±6 391±17 Comparative 921 studies.18,21–23,25–29,31–33,35,36 Before 589 (64%) degree ED, 492 (53.4%) associated I2=88%; fig. 2). quality, significant difference 1.13, 0.88–1.44, I2=92%; 7.1, https://www.jurology.com). 331 I2=33%; 8, inspection indicate (p=0.16; 9, Forest IV, variance. Improved Deteriorated Postoperative 1,322 EF.18–20,24,25,27–30,32,33,35–37 evaluation, 515 (39%) EF, whereas 211 (16%) deterioration. likelihood 1.44 4.44, I2=90%; 3). Additionally, 596 (45%) maintained assessment. analysis, No 4.89, 0.15–154.68, 7.2, 3. Mean Change Score Seven which score.21,25–27,30,34,35 Five 361 their I2=96%; 4). Furthermore, (mean 1.72, 0.89–4.33, I2=97%; 7.3, 4. MD, difference; Evidence Although significance deemed certainty low. design records, downgraded Even though there influence affect confounders. grading summarized Discussion This suggests leads ED. and, accordingly, increased. robustness findings should stressed when undertaking Interestingly, almost IIEF-5, highlighting constitutes gold tool evaluate disease. underlying mechanisms disease complex, both organic psychogenic factors.38 Concomitant cardiovascular comorbidities, hypothalamic-pituitary-gonadal axis, neurovascular endothelial alterations, disorders, long-term psychosocial EF.39 reverts many these clearance hormonal secretion, terminating dependence life.40 factors, agents, emerge.41 seems RT.42 unclear whether clinically important. vascular penile abnormalities, does exert reverse initial cause ED.10 Phosphodiesterase modality persistent de novo safe effective clinical profile.43 Of interest, improve but concentrations agents tacrolimus.44,45 Other modalities intracavernosal injections, topical intraurethral alprostadil, vacuum devices, replacement, low-intensity extracorporeal shockwave implants prove beneficial nonresponders contraindications PDE5i.46–49 Last least, psychosexual alone combination therapeutic approach predominant ED.50 Strengths Limitations necessary, life-saving procedure permit randomized between scarce, context, first holistic approach, meta-analytical techniques. provide evidence, raise awareness benefit Indeed, displayed raised concerns. attempt overcome biases, paucity us conduct metaregression analyses. underpowered. existing graded Another limitation taken consideration Assessing short falsely estimates malfunction alterations patients’ body image. long confounding factors. Future Perspectives field research where controlled possible, large, high-quality IIEF. adjust confounders, timepoints, preferred surgical procedure, different immunosuppression regimens complications. current treatments options future successful unsuccessful RTs. They presence causes Ideally, carefully designed, long-term, multicenter could aforementioned predialysis during elucidate pathophysiology chronic It necessary. meta-analyses summarizing literature recommendations formulate Well-conducted molecular animal help understand aspects reproductive male female worldwide. Conclusion note, Understanding leading highly prevalent warrants attention life. To date, References : review: Am J Transpl 2011; 11: 2093. Google Scholar Global Observatory Donation Transplantation: observatory donation Transplantation. Available at: http://www.transplant-observatory.org/. Accessed October 30, US system 2019 annual report: epidemiology States. Kidney Dis 2020; 75: A6. 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Efficacy safety vardenafil 38: 1379. 45. sildenafil citrate allograft randomized, double-blind, placebo-controlled, crossover trial. 128. 46. self-injection prostaglandin e1. 159: 1927. 47. transplantation: experience. 36: 502. 48. Low-intensity prospective, double blinded, sham-controlled Doppler ultrasonography. 31: 195. 49. Correcting impotence patient: experience tumescence 313. 50. An integrated orodispersible tablet cognitive behavioral dysfunction: Andrology 2015; 3: 909. participated drafting, writing, editing manuscript. gave final approval agree accountable work ensuring integrity accuracy. © 2021 American Urological Association Education Research, Inc.FiguresReferencesRelatedDetails Volume 205Issue 4April 2021Page: 1009-1017Supplementary Advertisement Copyright Permissions© Inc.Keywordskidney failureerectile dysfunctionmeta-analysiskidney transplantationchronicMetricsAuthor Information Expand Loading ...