Erectile Impotence and Infertility in Men Undergoing Renal Replacement Therapy

  • R. S. C. Rodger


The outlook for patients with end-stage renal disease has improved markedly over the last 30 years as a result of advances in renal replacement therapy. In 1978 data from the European Dialysis and Transplant Registry showed that the prognosis for patients starting dialysis was better than that following myocardial infarction or breast cancer (Wing et al. 1978) and the 10 year survival for adults starting dialysis in the early 1980s can be expected to exceed 65% (Brunner et al 1988). Whilst cardio- and cerebrovascular events caused by premature atherosclerosis are the major causes of death, there is a host of complications to which the end-stage renal disease patient is susceptible which will cause significant morbidity. Sexual dysfunction manifested by loss of libido, reduced fertility and in particular erectile impotence has emerged as a frequent problem in men undergoing renal replacement therapy and this chapter reviews its aetiology, pathophysiology and management.


Peritoneal Dialysis Renal Replacement Therapy Sexual Function Sexual Dysfunction Erectile Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abram HS, Hunter LR, Sheridan WF, Epstein CM (1975) Sexual function in patients with chronic renal failure. J Nerv Mental Dis 160:220–226CrossRefGoogle Scholar
  2. Antoniou LD, Sudhaker T, Shalhoub RJ, Smith JC (1977) Reversal of uraemic impotence by zinc. Lancet ii:895–898CrossRefGoogle Scholar
  3. Barton CH, Mirahmadi MK, Vaziri NB (1982) Effects of long-term testosterone administration on pituitary testicular in end-stage renal failure. Nephron 31:61–64PubMedCrossRefGoogle Scholar
  4. Blumberg A, Wildbolz A, Descoeudres C, Hennes, Dambacher MA, Fisher JA, Weidman P (1980) Influence of 1.25 dihydroxycholecalciferol on sexual dysfunction and related endocrine parameters in patients on maintenance haemodialysis. Clin Nephrol 13:208–214PubMedGoogle Scholar
  5. Bommer J, Tschope W, Ritz E, Andrassy K (1976) Sexual behaviour of hemodialysed patients. Clin Nephrol 6:315–318PubMedGoogle Scholar
  6. Bommer J, Del Pozo F, Ritz E, Bommer G (1979) Improved sexual function in male haemodialysis patients on bromocryptine. Lancet ii:496–497CrossRefGoogle Scholar
  7. Bommer J, Alexion C, Muller-Buhl W, Eifert J, Ritz E (1987) Recombinant human erythropoietin therapy in hemodialysis patients: dose determination and clinical experience. Nephrol Dial Transplant 2:238–242PubMedGoogle Scholar
  8. Brannen GE, Peters TG, Hambidge KM, Kumpe DA, Kempczinski RF, Schrofer GP, Weil R (1980) Impotence after kidney transplantation. Urology 15:138–146PubMedCrossRefGoogle Scholar
  9. Brook AC, Johnston DG, Ward MK, Watson MJ, Cook DB, Kerr DN (1989) Absence of a therapeutic effect of zinc in the sexual dysfunction of haemodialysis patients. Lancet ii:618–619Google Scholar
  10. Brunner FP, Fassbinder W, Broyer M et al. (1988) Survival on renal replacement therapy: data from the EDTA Registry. Nephrol Dial Transplant 3:109–122PubMedGoogle Scholar
  11. Campese VM, Procci WR, Levitan D, Romoff MS, Goldstein DA, Massry SG (1982) Autonomic nervous system dysfunction and impotence in uraemia. Am J Nephrol 2:140–143PubMedCrossRefGoogle Scholar
  12. Canadian Erythropoietin Study Group (1990) Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis. Br Med J 300:573–578CrossRefGoogle Scholar
  13. Condon CJ, Freeman RM (1970) Zinc metabolism in renal failure. Ann Intern Med 73:531–536PubMedGoogle Scholar
  14. Dillard FT, Miller BS, Sommer BG, Horchak AM, York JP, Nesbitt JA (1989) Erectile dysfunction post transplant. Transplant Proc 21:3961–3962PubMedGoogle Scholar
  15. Distiller LA, Morley JE, Sagel J, Pokroy M, Rabkin R (1975) Pituitary gland function in chronic renal failure: the effect of LHRH and the influence of dialysis. Metabolism 24:711–720PubMedCrossRefGoogle Scholar
  16. Gomez F, De La Cueva R, Wauters JP, Lemarchand-Berauld (1980) Endocrine abnormalities in patients undergoing long-term haemodialysis. Am J Med 68:522–530PubMedCrossRefGoogle Scholar
  17. Handelsman DJ, Ralec VL, Tiller DJ, Hovarth JS, Turtle JR (1981) Testicular function after renal transplantation. Clin Endocrinol 14:527–538CrossRefGoogle Scholar
  18. Handelsman DJ, McDowell IFW, Caterson ID, Tiller DJ, Hall BM, Turtle JR (1984). Testicular function after renal transplantation: comparison of cyclosporin A with azathioprine and prednisolone combination regimes. Clin Nephrol 22:144–148PubMedGoogle Scholar
  19. Handelsman DJ, Spaliviero JA, Turtle JR (1986) Bioactive luteinising hormone in plasma of uraemic men and men with primary testicular damage. Clin Endocrinol 24:259–266CrossRefGoogle Scholar
  20. Holdsworth S, Atkins RC, De Kretser DM (1977) The pituitary-testicular axis in men with chronic renal failure. N Engl J Med 296:1245–1249PubMedCrossRefGoogle Scholar
  21. Holdsworth SR, De Kretser DM, Atkins RC (1978) A comparison of hemodialysis and transplantation in reversing the uremic disturbance of male reproductive function. Clin Nephrol 10:146–150PubMedGoogle Scholar
  22. Ikram H, Lynn KL, Bailey RR, Little PJ (1983) Cardiovascular changes in chronic haemodialysis patients. Kidney Int 24:371–376PubMedCrossRefGoogle Scholar
  23. Imagawa A, Kavanishi Y, Numata A (1990) Is erythropoietin effective for impotence in dialysis patients? Nephron 54:95–96.PubMedCrossRefGoogle Scholar
  24. Kabalin JN, Kessler R (1989) Successful implantation of penile prosthesis in organ transplant patients. Urology 33:282–284PubMedCrossRefGoogle Scholar
  25. Karacan I, Dervent A, Cunningham G (1978) Assessment of nocturnal penile tumescence as an objective method for evaluating sexual function in ESRD patients. Dialysis Transplant 7:872–875Google Scholar
  26. Levy NB (1973) Sexual adjustment of maintenances haemodialysis and renal transplantation. Trans Am Soc Artif Intern Organs 19:138–143PubMedGoogle Scholar
  27. Lim VS, Fang VS (1976) Restoration of plasma testosterone levels in uraemic men with clomiphene citrate. J Clin Endocrinol Metab 43:1370–1377PubMedCrossRefGoogle Scholar
  28. Lim VS, Fang VS (1975) Gonadal dysfunction in uraemic men: a study of the hypothalamic-pituitary-testicular axis before and after renal transplantation. Am J Med 58:655–662PubMedCrossRefGoogle Scholar
  29. Mahajan SK, Prasad AS, Rabbani P, Briggs WA, McDonald FD (1979). Zinc metabolism in uremia. J Lab Clin Med 94:693–698PubMedGoogle Scholar
  30. Mahajan SK, Abbasi AA, Prasad AS, Rabbani P, Briggs WA, McDonald FD (1982) Effect of oral zinc therapy on gonadal function in haemodialysis patients. Ann Intern Med 97:357–361PubMedGoogle Scholar
  31. Massry SG, Goldstein DA, Procci WR, Kletzky OA (1977) Impotence in patients with uraemia: a possible role for parathyroid hormone. Nephron 19:305–310PubMedCrossRefGoogle Scholar
  32. Mastrogiacomo I, Bonanni G, Gasparotto, Colonna A, Motta RG (1989) Semen analysis in hemo-dialysed and renal transplant patients. In: Seriom (ed) Proceedings of the 4th International Society of Andrology: miniposter 130. Serono Symposia review. Ares-Serono, RomeGoogle Scholar
  33. Mastrogiacomo I, Feghali V, De Besi L, Seratini E, Gasparotto L (1982) Prolactin, gonadotropins, testosterone and estrogens in uremic men undergoing periodic hemodialysis. Arch Androl 9:279–282PubMedCrossRefGoogle Scholar
  34. Muir JW, Besser GM, Edwards CRW et al. (1983) Bromocryptine improves reduced libido and potency in men receiving maintenance haemodialysis. Clin Nephrol, 20:308–314PubMedGoogle Scholar
  35. Peces R, Horcajada C, Lopez-Novoa JM, Frutos MA, Casado S, Hernando L (1987) Hyperprolac-tinaemia in chronic renal failure impaired responsiveness to stimulation and suppression. Nephron 28:11–16CrossRefGoogle Scholar
  36. Phadke AG, MacKinnon KJ, Dossetor JB (1970) Male fertility in uraemia: restoration by renal allografts. Can Med Assoc J 102:607–608PubMedGoogle Scholar
  37. Prasad AS, Miale A, Farid Z, Sandstead HH, Schulert AR (1963) Zinc metabolism in patients with the syndrome of iron deficiency anaemia, hepatosplenomegaly dwarfism and hypergonadism. J Clin Lab Med 61:537–549Google Scholar
  38. Procci WR, Goldstein DA, Adelstein J, Massry SG (1981) Sexual dysfunction in the male patient with uraemia — a reappraisal. Kidney Int 19:317–323PubMedCrossRefGoogle Scholar
  39. Randerson DH, Farrell PC (1981). Subjective assessment of CAPD patient. In Gahl GM et al. (eds) Advances in peritoneal dialysis. Excerpta Medica, Amsterdam pp 233–239Google Scholar
  40. Reid IR, Ibbertson HK, France JT, Pybus J (1985) Plasma testosterone concentrations in asthmatic men treated with glucocorticoids. Br Med J 291:574CrossRefGoogle Scholar
  41. Rizzoni G, Ehrich JHH, Broyer M et al. (1992) Successful pregnancies in women on renal replacement therapy. Nephrol Dial Transplant 7:279–287PubMedGoogle Scholar
  42. Rodger RS, Fletcher K, Dewar JH, Genner D, McHugh M, Wilkinson R, Ward MK, Kerr DN (1985a) Prevalence and pathogenesis of impotence in one hundred uraemic men. Uraemia Invest 8:89–96Google Scholar
  43. Rodger RS, Morrison L, Dewar JH, Wilkinson R, Ward MK, Kerr DNS (1985b) Loss of pulsatile luteinising hormone in men with chronic renal failure. Br Med J 291:1598–1600CrossRefGoogle Scholar
  44. Rodger RS, Fletcher K, Genner D, Dewar J, Ward MK, Kerr DNS (1986) Sexual dysfunction in patients treated by CAPD. In: Mehrer J, Winchester J (eds) Frontiers in peritoneal dialysis. Field Rich, New York, pp 512–515Google Scholar
  45. Rodger RS, Sheldon WL, Watson ML, Dewar JH, Wilkinson R, Ward MK, Kerr DN (1989) Zinc deficiency and hyperprolactinaemia are not reversible causes of sexual dysfunction in uraemia. Nephrol Dial Transplant 4:888–892PubMedGoogle Scholar
  46. Salvatierra O, Fortuna JL, Beizer FO (1975) Sexual function in males before and after renal transplantation. Urology 5:64–66PubMedCrossRefGoogle Scholar
  47. Sawin CT, Longhope CL, Schmidt GW, Ryan RJ (1973) Blood levels of gonadotrophins and gonadal hormones in gynaecomastia associated with chronic haemodialysis. J Clin Endocrinol Metab 36:988–990PubMedCrossRefGoogle Scholar
  48. Schaefer RM, Kokot F, Wernze H, Geiger H, Heidland A (1989) Improved sexual function in haemodialysis patients on recombinant erythropoietin. Clin Nephrol 31:1–5PubMedGoogle Scholar
  49. Schalch DS, Gonzalez-Barcena D, Kastin AJ, Landa L, Lee LA, Zamora MT, Schally AV (1975) Plasma gonadotrophins after administration of LHRH in patients with renal or hepatic failure. J Clin Endocrinol Metab 41:921–925PubMedCrossRefGoogle Scholar
  50. Schmitz O, Moller J (1983) Impaired prolactin response to arginine infusion and insulin hypoglycaemia in chronic renal failure. Acta Endocrinol 102:486–491PubMedGoogle Scholar
  51. Semple CG, Beastall GH, Henderson IS, Thomson JA, Kennedy AC (1982) The pituitary-testicular axis of uraemic subjects on haemodialysis and CAPD. Acta Endocrinol 101:464–467PubMedGoogle Scholar
  52. Sherman FB (1975) Impotence in patients with chronic renal failure: frequency and etiology. Fertil Steril 26:221–223PubMedGoogle Scholar
  53. Sidi AM, Peng W, Sansean C, Lange PH (1987) Penile prosthesis surgery with treatment of impotence in the immunosuppressed patient. J Urol 137:681–682PubMedGoogle Scholar
  54. Stieff CG, Gall H, Scherb W, Bahren W (1988) Midterm results of autoinjection therapy for erectile dysfunction. Urology 31:483–485CrossRefGoogle Scholar
  55. Talbot JA, Rodger RSC, Robertson WR (1990) Pulsatile bioactive luteinising hormone secretion in men with chronic renal failure and following renal transplantation. Nephron 56:66–72PubMedCrossRefGoogle Scholar
  56. Tharandt L, Graben N, Schafer R et al. (1980). Effects of prolactin suppression on hypogonadism in patients on maintenance haemodialysis. Proc Eur Dial Transplant Assoc 17:323–327PubMedGoogle Scholar
  57. Thomson NM, Stevens BJ, Humphrey TJ, Atkins RC (1983) Comparison of trace elements in peritoneal dialysis haemodialysis and uraemia. Kidney Int 23:9–14PubMedCrossRefGoogle Scholar
  58. Van Kammen E, Thijssen JHH, Schwarz F (1978) Sex hormones in male patients with chronic renal failure. Clin Endocrinol 8:7–14CrossRefGoogle Scholar
  59. Wheatley T, Clark PMS, Raggatt RR (1987) Pulsatility of luteinising hormone in man with chronic renal failure: Abnormal rather than absent. Br Med J 294:482CrossRefGoogle Scholar
  60. Winer RL, Rajudin MM, Skowsky WR, Parker LN (1982) Preservation of normal adrenal androgen secretion in end-stage renal disease. Metabolism 31:269–273PubMedCrossRefGoogle Scholar
  61. Wing AJ, Brunner FP, Brynger H et al. (1978) Combined report on regular dialysis and transplantation in Europe. Proc Euro Dial Transplant Assoc 15:3–76Google Scholar
  62. Winnearls CG, Oliver DO, Pippard MJ, Reid C, Downing MR, Cotes PM (1986) Effect of human erythropoietin derived from recombinant DNA on the anaemia of patients maintained by chronic haemodialysis. Lancet ii:1175–1177CrossRefGoogle Scholar
  63. Zetin M, Frost NR, Brunsfield D, Stone RA (1987) Amitriptyline stimulates weight gain in haemodialysis patients. Clin Nephrol 18:79–82Google Scholar
  64. Zetin M, Stone RA (1980) Effects of zinc on chronic haemodialysis. Clin Nephrol 13:20–25PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1994

Authors and Affiliations

  • R. S. C. Rodger

There are no affiliations available

Personalised recommendations