Abstract：
BACKGROUND: Erectile dysfunction (ED) and kidney dysfunction share common risk factors linked to conditions involving endothelial impairment, such as coronary artery disease, dyslipidemia, diabetes mellitus, hypertension, smoking, and obesity. Men with chronic kidney disease experience a high incidence and prevalence of ED. While a functional renal graft can alleviate the issue for some patients, a significant portion of recipients still experience ED (20%-50%).
OBJECTIVE: This narrative review describes the variety of current treatments modalities on ED in kidney transplant recipients (KTRs) and their clinical outcomes.
METHODS: MEDLINE, Web of Science, PubMed, and Google Scholar were used to find eligible articles pertaining to the treatment options of ED in KTRs. A total of 64 articles were evaluated.
RESULTS: In KTRs, ED stems from a multifaceted etiology: anxiety, drug side effects, interference with penile vascularity, or the response of cavernosal muscle to neurotransmitters, along with changes in the endocrine milieu. A diverse range of treatments to restore erectile function has proven to be safe and effective for KTRs. Options include drug therapy, surgical interventions, intracavernosal injection therapies, vacuum erection devices, and extracorporeal shockwave therapy.
CONCLUSIONS: The initial treatment approach may involve the use of a phosphodiesterase type 5 inhibitors at a low dosage, especially if testosterone-circulating levels align with the diagnosis of hypogonadism. The consideration of a combination therapy involving testosterone and phosphodiesterase type 5 inhibitors should be contemplated due to the associated beneficial effects. Extracorporeal shockwave therapy has shown positive short-term clinical and physiological effects on erectile function in patients who did not respond to first-line treatments, resulting in spontaneous erections sufficient for sexual penetration in 50% of cases. Penile implants should be considered as third-line options based on specific patient needs and compliance with clinical conditions.
OBJECTIVE: This narrative review describes the variety of current treatments modalities on ED in kidney transplant recipients (KTRs) and their clinical outcomes.
METHODS: MEDLINE, Web of Science, PubMed, and Google Scholar were used to find eligible articles pertaining to the treatment options of ED in KTRs. A total of 64 articles were evaluated.
RESULTS: In KTRs, ED stems from a multifaceted etiology: anxiety, drug side effects, interference with penile vascularity, or the response of cavernosal muscle to neurotransmitters, along with changes in the endocrine milieu. A diverse range of treatments to restore erectile function has proven to be safe and effective for KTRs. Options include drug therapy, surgical interventions, intracavernosal injection therapies, vacuum erection devices, and extracorporeal shockwave therapy.
CONCLUSIONS: The initial treatment approach may involve the use of a phosphodiesterase type 5 inhibitors at a low dosage, especially if testosterone-circulating levels align with the diagnosis of hypogonadism. The consideration of a combination therapy involving testosterone and phosphodiesterase type 5 inhibitors should be contemplated due to the associated beneficial effects. Extracorporeal shockwave therapy has shown positive short-term clinical and physiological effects on erectile function in patients who did not respond to first-line treatments, resulting in spontaneous erections sufficient for sexual penetration in 50% of cases. Penile implants should be considered as third-line options based on specific patient needs and compliance with clinical conditions.
摘要：
背景：勃起功能障碍（ED）和肾功能障碍具有与涉及内皮损伤的疾病相关的共同危险因素，比如冠状动脉疾病，血脂异常,糖尿病,高血压,吸烟,和肥胖。患有慢性肾脏病的男性ED的发病率和患病率很高。虽然功能性肾移植可以缓解一些患者的问题，很大一部分接受者仍然经历ED(20%-50%)。
目的：这篇叙述性综述描述了目前肾移植受者（KTRs）中ED的各种治疗方式及其临床结果。
方法：MEDLINE，WebofScience,PubMed,和谷歌学者被用来寻找与KTRs中ED的治疗选择有关的合格文章。共评价64篇。
结果：在KTR中，ED源于多方面的病因：焦虑，药物副作用,干扰阴茎血管，或者海绵体肌肉对神经递质的反应，随着内分泌环境的变化。恢复勃起功能的多种治疗方法已被证明对KTRs是安全有效的。选择包括药物治疗，手术干预，海绵体内注射疗法，真空安装装置,和体外冲击波疗法.
结论：初始治疗方法可能涉及使用低剂量的5型磷酸二酯酶抑制剂，特别是如果睾酮循环水平与性腺机能减退的诊断一致。由于相关的有益作用,应当考虑涉及睾酮和5型磷酸二酯酶抑制剂的联合治疗。体外冲击波疗法对一线治疗无反应的患者的勃起功能显示出积极的短期临床和生理作用，导致自发勃起足以在50％的情况下进行性渗透。阴茎植入物应根据患者的具体需求和对临床条件的依从性被视为第三线选择。
目的：这篇叙述性综述描述了目前肾移植受者（KTRs）中ED的各种治疗方式及其临床结果。
方法：MEDLINE，WebofScience,PubMed,和谷歌学者被用来寻找与KTRs中ED的治疗选择有关的合格文章。共评价64篇。
结果：在KTR中，ED源于多方面的病因：焦虑，药物副作用,干扰阴茎血管，或者海绵体肌肉对神经递质的反应，随着内分泌环境的变化。恢复勃起功能的多种治疗方法已被证明对KTRs是安全有效的。选择包括药物治疗，手术干预，海绵体内注射疗法，真空安装装置,和体外冲击波疗法.
结论：初始治疗方法可能涉及使用低剂量的5型磷酸二酯酶抑制剂，特别是如果睾酮循环水平与性腺机能减退的诊断一致。由于相关的有益作用,应当考虑涉及睾酮和5型磷酸二酯酶抑制剂的联合治疗。体外冲击波疗法对一线治疗无反应的患者的勃起功能显示出积极的短期临床和生理作用，导致自发勃起足以在50％的情况下进行性渗透。阴茎植入物应根据患者的具体需求和对临床条件的依从性被视为第三线选择。
