Critical Underdiagnosis and Undertreatment of Sexual Health Issues in Male Kidney Transplant Recipients

Abstract

ABSTRACT Introduction Patients with end stage renal disease (ESRD) often endure a worse quality of life (QOL) than the general population. As a result of improved outcomes with kidney transplants, it has become increasingly important to address QOL. Sexual function is one such QOL domain in which kidney transplant (KT) patients are particularly affected by. Objective This study aims to elucidate the underdiagnosis and undertreatment of sexual health issues in male KT recipients, as well as the treatment profile for erectile dysfunction (ED) in these patients. Methods With IRB approval we retrospectively reviewed the charts of men age 18 and older who received a KT between January 2016 and February 2020 at an academic institute. We sought to identify those with a diagnosis of ED, low or decreased libido, hypogonadism, ejaculatory dysfunction, Peyronie's disease (PD), or male factor subfertility. Next, for those with a diagnosis of ED, information regarding time of initial diagnosis of ED, time when treatment was started, treatment profile and adverse events were documented. Causes of ESRD were obtained, but not controlled for. Results A total of 35 men were diagnosed with some form of sexual dysfunction, which represents 4.2% of the 833 men aged 18+ years who received a KT during this time. Seventy-one percent of men had a diagnosis of ED, 17.1% had ED and hypogonadism, 2.9% had ED and low libido, 8.6% had hypogonadism alone, and there were no diagnosis of ejaculatory dysfunction, PD, or infertility. Seventy-five percent of men with a diagnosis of ED were treated with phosphodiesterase-5 inhibitors (PDE5i), 25% with intracavernosal injections (ICI), 3.1% with intraurethral (IU) suppositories, and 9.4% with a penile prosthesis (PP). No severe medical or surgical adverse events were noted. Of those with ED, 87.5% were diagnosed prior to their transplant surgery and only 62.5% received any treatment prior to it. Conclusions In this study we show that a small fraction of men who received a KT had a diagnosis of a sexual health issue. This is in spite of the known high prevalence of ED in ESRD patients that can be as high as 75%, with up to a 10-20% improvement of ED with transplant alone. Furthermore, we note that KT recipients with ED are treated similarly to the general population and have a similar side effect profile, however, a significant number of patients do not receive treatment until after their transplant. Disclosure No