Clinical Implications and Risk Factors for Erectile Dysfunction in Kidney Transplant: A Single-Center Assessment.

BACKGROUND: Erectile dysfunction (ED) affects the great majority of people undergoing dialysis and also the majority of patients undergoing kidney transplantation. In this study, we investigated the degree of erectile dysfunction (ED), as well as its prevalence, contributory variables, and overall impact after renal transplant. METHODS: Adult male kidney transplant patients were the subject of an observational, non-interventional study that was conducted at a single center. Age, time and type of dialysis before transplantation, comorbidities, factors associated with cardiovascular risk, data on sexual history, physical examination, and laboratory results were among the clinical data we examined. In addition to gathering clinical and demographic characteristics, the International Index of Erectile Function (IIEF) questionnaire was used to evaluate sexual function. RESULTS: A total of 170 renal transplanted patients between 20 and 70 years old (mean age: 45.40±11.5) were included in this study. All of the patients had immunosuppressive treatment with a calcineurin inhibitor (cyclosporine or tacrolimus) and had a normal glomerular filtration rate (GFR). The prevalence of sexual dysfunction increased with age (42.6% of patients under 40, 47.4% of patients in the 40-60 age group, and 78.9% of patients over 60). Mild, moderate, and severe ED was noted in 33.5%, 20.6%, and 10.6% of cases, respectively, and 51 (30%) patients reported having a normal sexual function. While calcium channel blockers (122 cases) were the most commonly used antihypertensive medication and chronic glomerulosclerosis (55.3%) was the most common cause of chronic kidney disease (CKD) before transplantation, none of these variables appear to have affected the severity of erectile dysfunction. The only medications associated with sexual dysfunction were alpha-blockers and aspirin (75 mg) (p=0.026 and p=0.013, respectively). CONCLUSIONS: Although kidney transplantation has positive impacts on the quality of life, erectile dysfunction is a frequent condition among patients with renal transplants, and it has an increased frequency with age. In our study, it has been observed that only a small percentage of the research group had a normal sexual function, although most of the patients were young, and that alpha-blockers and aspirin (75 mg) are associated with erectile dysfunction.

Non-Traditional Non-Immunological Risk Factors for Kidney Allograft Loss-Opinion.

Rates of late allograft loss have improved slowly in the last decades. Well described traditional risk factors that influence allograft survival include cardiovascular events, rejection, infections and post-transplant neoplasia. Here, we critically evaluate the influence of several non-immunological, non-traditional risk factors and describe their impact on allograft survival and cardiovascular health of kidney transplant recipients. We assessed the following risk factors: arterial stiffness, persistent arteriovenous access, mineral bone disease, immunosuppressive drugs residual levels variability, hypomagnesemia, glomerular pathological alterations not included in Banff criteria, persistent inflammation and metabolic acidosis.

The impact of renal transplantation on sexual function in males with end-stage kidney disease: a systematic review and meta-analysis.

INTRODUCTION: Patients with end-stage kidney disease (ESKD) on dialysis have a special profile, including constant uremic status and frequent comorbidities, such as diabetes mellitus, arterial hypertension and coronary artery disease, as well as complications related to dialysis. All listed factors can influence or be the cause of sexual dysfunction in both men and women. There is a high incidence (70%) and prevalence (82%) of erectile dysfunction in men with CKD. PURPOSE: In this meta-analysis, we aimed to evaluate the impact of renal transplantation in patients with end-stage chronic kidney disease and erectile dysfunction, using the same study population before and after transplantation. DATA SOURCES: we searched MEDLINE (PubMed), Embase, Scopus and Cochrane Library (Inception to August 2022) and clinicaltrials.gov (Inception to August 2022) without language restrictions. STUDY SELECTION: eligible studies evaluated the same patients with end-stage kidney disease before and after renal transplantation using IEEF questionnaire. DATA EXTRACTION: reviewers working independently and in duplicate extracted data and assessed the risk of bias. DATA SYNTHESIS: the final analysis included 28 cohort studies, comprising 2252 participants. RESULTS: Our results showed improvement in erectile function after renal transplantation. Our study shows a 13% improvement in erectile dysfunction after renal transplantation. CONCLUSIONS: The results of this meta-analysis would suggest improvement in erectile dysfunction after renal transplantation.

Treating a thrombotic giant dissecting renal artery aneurysm through ex-vivo vascular reconstructive surgery followed by kidney reimplantation.

Renal artery aneurysms, although rare, may give rise to complications both per se (due to the risk of thrombosis and subsequent wall rupture) and by impairment of the renal function (due to extrinsic compression and high blood pressure). We describe a paucisymptomatic young patient with acute thrombosis of a massive dissecting renal artery aneurysm, for which the successful treatment was performed through ex-vivo vascular surgery followed by autotransplantation of the reconstructed kidney. The aneurysm was described through abdominal echography, computed tomography angiography, and transfemoral transcatheter arterial angiography. It originated from an atypical branch emerging at 90 degrees from the left renal artery. After a short branching off, it degenerated into a dissected aneurysmal sac as large as half a kidney (outer diameter of 60 mm), compressing the lower pole of the left kidney and delaying the lower half nephrogram. Ex-vivo surgical exclusion of the aneurysm was successfully performed. The kidney was reimplanted in the left iliac fossa (termino-lateral anastomosis between the renal artery and external left iliac artery, termino-terminal ureteric anastomosis) with excellent postoperative outcomes. For most asymptomatic aneurysms, expectant treatment is a reasonable approach. However, interventional or surgical repair is indicated in certain circumstances depending on the size of the aneurysm and its natural history, rupture risk, and interventional/surgical risks. The renovascular hypertension, dissecting and thrombotic events, its giant size, the young fertile age, and the presence of the flank pain were all indicative of the need for aneurysm exclusion in our case.

Comparison Between Alprostadil and Iloprost in Intravenous Treatment of Patients With Chronic Peripheral Arterial Disease.

INTRODUCTION: chronic peripheral arterial disease (PAD) seems to be a "rediscovered" pathology nowadays, brought into spotlight by its strong correlation with other signifi cant cardiovascular disorders. OBJECTIVES: to sustain a real benefi t from treatment with i.v. prostaglandins (PG) in PAD patients and to directly compare the currently used PG: alprostadil and iloprost. METHOD: open, non-randomized cohort study, with placebo group ("classical therapy") reviewing 615 PAD patients with therapeutic approach during 2003-2012 period, divided in 3 subgroups: "classical" therapy; "classical" therapy + iloprost; "classical" therapy + alprostadil; patients with Burger's disease were excluded; multiple factor analysis with statistical results inserted. RESULTS: clear domination of male gender patients, with older female gender patients (p.0.001); smoking like major risk factor in male and in all patients (p< 0.0001); 124 patients underwent angiography . CONCLUSION: a real improvement in the clinical status of patients receiving i.v. prostaglandin therapy with no diff erences between genders, diabetic and non-diabetic patients; alprostadil seems better than iloprost.

Severe thoracic impalement injury: Survival in a case with delayed surgical definitive care.

Impalement injuries are rare and among the most spectacular and dramatic traumatic lesions. The survival of a patient with a thoracic impalement injury is an extremely rare event. The objective of this study was to present the case of a 24-year-old male patient with a severe thoracic impalement injury successfully treated despite his late arrival in our hospital. A log in 12 cm diameter penetrated his right thorax producing injuries of the right main bronchus, right pulmonary lobe, right subclavian artery as well as extensive parietal lesions. Definitive surgical repair of these lesions was performed more than seven hours after trauma. The management principles contributing to the successful outcome that we would like to emphasize are: rapid transportation and reaction of the trauma team, minimal manipulation of the impaling object, removal of the log as one piece under direct vision in the operating room, ventilatory support, extensive debridement, and lavage associated with appropriate antibiotherapy.