Impact of kidney transplantation on erectile function and reproductive health in men with chronic kidney disease

Objective : to evaluate the impact of kidney transplantation (KT) on erectile function and reproductive health in men with chronic kidney disease (CKD). Materials and methods . A prospective study was conducted involving 276 male patients (mean age 44.3 ± 5.8 years) with CKD who underwent KT from a living related donor. Erectile function was assessed using the International Index of Erectile Function (IIEF-5). Penile hemodynamics were evaluated by Doppler ultrasonography of the penile arteries, while hormonal status was determined by measuring serum testosterone, luteinizing hormone, and follicle-stimulating hormone (FSH) levels. Reproductive function was assessed by semen analysis and testicular volume measurements at five time points: baseline, at high azotemia, and at 3, 6, and 12 months post-transplantation. Management of post-transplant erectile dysfunction included phosphodiesterase type 5 inhibitors (IIEF-5, 5 mg daily for 3 months, followed by 20 mg on demand), pelvic fl oor muscle exercises, vacuum therapy, and physiotherapy. Results . After 12 months of follow-up, erectile function was fully restored in 65.6% of patients. The proportion of moderate-to-mild erectile dysfunction decreased to 9.4%, while mild dysfunction persisted in 25% of patients, primarily due to residual vascular, hormonal, and psychoemotional factors. The mean IIEF-5 score increased signifi cantly from 13.2 ± 0.1 to 21.2 ± 0.2 (p < 0.001). The average peak systolic velocity in the right cavernous artery rose from 5.6 ± 0.1 cm/s to 7.2 ± 0.1 cm/s (p < 0.001). Serum testosterone levels increased from 4.6 ± 0.1 ng/ml to 5.6 ± 0.2 ng/ml (p < 0.001), and the proportion of patients with normospermia grew from 37.3% to 61.2% (p < 0.001). Erectile dysfunction persisted in 34.4% of patients despite therapy. Conclusion . The findings demonstrate a significant restoration of erectile function and fertility in most patients following KT and supported by comprehensive management of residual vascular, hormonal, and psychoemotional disorders.