IMPOTENCE AFTER RENAL TRANSPLANTATION

Abstract

REPLY TO "IMPOTENCE AFTER RENAL TRANSPLANTATION" Dr. Nghiem does not appear to understand the purpose of my article. I am fully aware of the incidence and of the many causes of impotence, which he describes so clearly. I do not claim that division of both internal arteries always causes impotence, although I do believe that it is a major risk factor. I further believe that is not necessary to divide both arteries for transplantation purposes because there are other perfectly adequate ways to revascularize transplanted organs. The article is not about my prejudices, but about what can be regarded as acceptable surgical practice. A court in the United Kingdom recently ruled that to divide both internal iliac arteries was acceptable because there was nothing in the literature to say that it was not. It is not true to say that "the hypogastric artery is almost never used for the transplantation procedure." It is still used quite frequently in live donor transplants, as Dr. Nghiem says, and by some surgeons in cadaveric transplantation. It was therefore my objective to find out if transplant surgeons in the United Kingdom believed that dividing both internal iliac arteries was a risk factor in impotence and whether it is an acceptable thing to do. The "simplistic questionnaire" establishes quite clearly that British transplant surgeons do think that division of both arteries is a risk and that it is not acceptable practice. One hypogastric artery can have its uses in transplantation but not two. Publication of the views currently held by British transplant surgeons should prevent recipients of kidneys being subjected to an unnecessary risk of impotence. If I achieve that objective I am content, and leave Dr. Nghiem to his studies of penile tumescence to evaluate scientifically the extent of the "risk." R.M.R. Taylor Royal Victoria Infirmary; Newcastle NE1 4LP, England