Sexual and reproductive function in men treated with hemodialysis and renal transplantation

Disturbances in male sexual and reproductive function often occur in patients with chronic renal failure. Sherman found that 50 per cent of the men with uremia and on hemodialysis (average age 42 years) were impotent, whereas Kinsey and associates reported that the incidence of impotence in nonuremic 42-year-old men is <5 percent. Similarly, alterations in libido, spermatogenesis, testosterone levels and gonadotropin production are known to occur in uremic patients. Whether these alterations are specific and potentially reversible causes of uremic sexual dysfunction has received little investigative attention until recently. Renewed clinical interest in these problems coupled with advances and refinements in laboratory techniques have now enabled more precise quantification of these factors and has provided important new information in this area. Furthermore, renal transplantation has afforded the opportunity to evaluate which elements may be restored by normalization of renal function and has allowed comparison with hemodialysis. The factors that are involved in erectile and reproductive function, the specific impairments of these factors associated with end stage renal disease, and the diagnosis and management of these problems are reviewed herein.