الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Introduction: The effect of renal transplantation on erectile function was studied since 1970s, however its specific impact on erectile function has been difficult to quantitate. Objectives: Determination of the prognostic factors affecting erectile function among male renal transplant recipients and to clarify the effect of renal transplantation on penile hemodynamics both in a retrospective and prospective ways. Patients and methods: In the retrospective part we evaluated 500 renal transplant recipients. All of them were interviewed, during interview a complete medical and sexual history was taken to detect any possible risk factors for ED. The hospital transplant files were reviewed to identify the type of arterial anastomosis done to revascularize the graft and the type of immunosuppressive regimen. All patients underwent routine laboratory evaluation and in a selected group, sex hormones assay and penile Doppler ultrasound were carried out. In the prospective part we evaluated 50 patients on hemodialysis (with no vascular risk factors for ED) who were transplanted between January 2002 and December 2003. All the 50 patients were interviewed before and 6 months after transplantation, during interview a complete medical and sexual history was taken. In all patients penile CDU and hormonal assay were carried out. Results: Using the univariate analysis 12 factors had a significant impact on erectile function, namely age, duration of pretransplant uremia, graft duration , history of DM, ischaemic heart disease, peripheral neuropathy, smoking, the use of CsA based immunosuppressive regimens, fasting blood sugar, hemoglobin level, graft function and serum free testosterone. On multivariate analysis, only 5 factors maintained independent and significant association with ED, namely age, hemoglobin level, DM, duration of pretransplant dialysis, and peripheral neuropathy sustained their significance. Our prospective study showed that after unilateral interruption of internal iliac artery, there is significant reduction in blood flow in the cavernosal arteries on both sides, however none of the patients developed penile arterial insufficiency. Conclusions: In spite of successful renal transplantation, prevalence of ED remains high (34.4%). The pathogenesis of erectile dysfunction in renal transplant patients is multifactorial. Age, duration of pretransplant uremia, anemia, and presence of diabetes mellitus and/or peripheral neuropathy were shown to be the main variables associated with ED in RTR. Also from the vascular evaluation of our patients using the CDU, we concluded that penile vascular insufficiency is less common in renal transplant recipients than previously reported. The pathogenesis of penile arterial occlusive disease in impotent RTR is mainly due to associated vascular risk factors. Early transplantation may delay or prevent the development of penile vasculopathy. Unilateral interruption of the hypogastric artery significantly decreases arterial penile blood flow; however an adequate blood supply is compensated by the other internal iliac artery in all cases. from laboratory results, we conclude that successful renal transplantation corrects the hyperprolactinaemia and the hypogonadism induced by uremia.