Estudo prospectivo para avaliação da função erétil em pacientes renais crônicos pré e pós-transplante renal
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Data
2023-08-28
Autores
Vasco, Matheus Brandão [UNIFESP]
Orientadores
Aguiar, Wilson Ferreira [UNIFESP]
Tipo
Tese de doutorado
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Resumo
INTRODUÇÃO: A disfunção erétil é uma disfunção sexual que apresenta alta prevalência mundial. Entre os fatores de risco para a disfunção erétil está a doença renal crônica (DRC). Estima-se que entre 47-82% dos pacientes em diálise apresentam disfunção erétil. Embora, acredita-se que o transplante renal possa reestabelecer a função sexual desses pacientes, a disfunção erétil permanece prevalente no transplantado renal, acometendo até 55% deles. Assim, a literatura é conflitante em relação ao real benefício do transplante renal e a melhora da disfunção erétil. OBJETIVO: Primário: avaliar se o transplante renal melhora a função erétil de pacientes renais crônicos. MÉTODOS: Trata-se de estudo prospectivo, descritivo-analítico e longitudinal. Para tanto, foram selecionados aleatoriamente, entre junho de 2019 e julho de 2022, pacientes do sexo masculino, com idade entre 18-60 anos, previamente estabelecidos para a realização do transplante renal vivo. Foram coletados dados demográficos e comorbidades, exames laboratoriais, análise do estado androgênico, aplicação do questionário Índice Internacional de Função Erétil (IIEF) para avaliar a função erétil e a realização da ultrassonografia Doppler do pênis com indução farmacológica pré-transplante e 12 meses pós-transplante. RESULTADOS: Foram elegíveis 37 pacientes pré-transplante e 30 realizaram a avaliação pré e pós-transplante. O escore do domínio da ereção do IIEF, o resultado da ultrassonografia Doppler do pênis com indução farmacológica e a análise combinada entre o resultado da ultrassonografia Doppler do pênis com indução farmacológica e do escore do domínio da ereção do IIEF pré e pós-transplante não apresentaram diferença significativa (p-valor = 0,101; p-valor = 0,604 e p-valor = 0,374, respectivamente). Na análise pareada das questões do IIEF pré e pós-transplante, identificamos melhora do desejo sexual, maior capacidade de penetrar a parceira, maior capacidade de manter a ereção após ter penetrado a parceira e maior número de relações sexuais no pós-transplante (p = 0,025; p = 0,04; p = 0,041 e p= 0,036). CONCLUSÃO: O transplante renal não melhora a função erétil global do paciente com DRC. Contudo, foi observado que há melhora do desejo sexual, maior capacidade de penetrar a parceira, maior capacidade de manter a ereção após ter penetrado a parceira e maior número de relações sexuais no pós-transplante.
INTRODUCTION: Erectile dysfunction, a sexual dysfunction, has a high worldwide prevalence. Chronic kidney disease (CKD) is know as one of the risk factors for erectile dysfunction. It is estimated that between 47-82% of dialysis patients have erectile dysfunction. Althought, it is believed that kidney transplantation might be able to restore sexual function, erectile dysfunction remains prevalent in kidney transplant recipients, affecting up to 55% of cases. Thus, the literature is conflicting regarding the real benefit of kidney transplantation and the improvement of erectile dysfunction. OBJECTIVE: Primary: to evaluate whether kidney transplantation improves erectile function in chronic renal patients. METHODS: In the current prospective, descriptive-analytical and longitudinal study, male patients, aged 18-60 years, previously established for live kidney transplantation, were randomly selected between June 2019 and July 2022. Demographic data and comorbidities, laboratory tests, analysis of androgenic status, application the International Index of Erectile Function (IIEF) questionnaire to assess erectile function and Doppler ultrasonography of the penis with pharmacological induction before transplantation and 12 months after transplantation were collected. RESULTS: Thirty-seven pre-transplant patients were eligible and 30 underwent pre and post-transplant evaluation. The IIEF erection domain score, the penile Doppler ultrasound result with pharmacological induction and the combined analysis between the penis Doppler ultrasound result with pharmacological induction and the IIEF erection domain score before and after transplantation showed no significant difference (p-value = 0.101; p-value = 0.604 and p-value = 0.374, respectively. ). In the paired analysis of the pre and post-transplant IIEF questions, improved sexual desire, greater ability to penetrate the partner, greater ability to maintain erection after penetrating the partner, and a greater number of post-transplant sexual intercourse were identified (p-value = 0.025; p-value = 0.04; p-value = 0.041 and p-value = 0.036). CONCLUSION: Renal transplantation does not improve the overall erectile function in CKD patients. However, heigher sexual desire, penetration ability, ability to maintain erection after having penetrated the partner and number of sexual intercourse after transplantation were reported.
INTRODUCTION: Erectile dysfunction, a sexual dysfunction, has a high worldwide prevalence. Chronic kidney disease (CKD) is know as one of the risk factors for erectile dysfunction. It is estimated that between 47-82% of dialysis patients have erectile dysfunction. Althought, it is believed that kidney transplantation might be able to restore sexual function, erectile dysfunction remains prevalent in kidney transplant recipients, affecting up to 55% of cases. Thus, the literature is conflicting regarding the real benefit of kidney transplantation and the improvement of erectile dysfunction. OBJECTIVE: Primary: to evaluate whether kidney transplantation improves erectile function in chronic renal patients. METHODS: In the current prospective, descriptive-analytical and longitudinal study, male patients, aged 18-60 years, previously established for live kidney transplantation, were randomly selected between June 2019 and July 2022. Demographic data and comorbidities, laboratory tests, analysis of androgenic status, application the International Index of Erectile Function (IIEF) questionnaire to assess erectile function and Doppler ultrasonography of the penis with pharmacological induction before transplantation and 12 months after transplantation were collected. RESULTS: Thirty-seven pre-transplant patients were eligible and 30 underwent pre and post-transplant evaluation. The IIEF erection domain score, the penile Doppler ultrasound result with pharmacological induction and the combined analysis between the penis Doppler ultrasound result with pharmacological induction and the IIEF erection domain score before and after transplantation showed no significant difference (p-value = 0.101; p-value = 0.604 and p-value = 0.374, respectively. ). In the paired analysis of the pre and post-transplant IIEF questions, improved sexual desire, greater ability to penetrate the partner, greater ability to maintain erection after penetrating the partner, and a greater number of post-transplant sexual intercourse were identified (p-value = 0.025; p-value = 0.04; p-value = 0.041 and p-value = 0.036). CONCLUSION: Renal transplantation does not improve the overall erectile function in CKD patients. However, heigher sexual desire, penetration ability, ability to maintain erection after having penetrated the partner and number of sexual intercourse after transplantation were reported.