CORRECTING IMPOTENCE IN THE MALE DIALYSIS PATIENT - EXPERIENCE WITH TESTOSTERONE REPLACEMENT AND VACUUM TUMESCENCE THERAPY

Sexual dysfunction remains a common and often distressing problem in t he male dialysis population. Traditionally its management has consiste d of correction of anemia, optimization of dialysis, removal of implic ated medication, and finally depot injections of a testosterone eater. At a dedicated renal impotence clinic, we studied the effectiveness o f testosterone replacement in men with biochemically proven hypogonadi sm and then vacuum tumescence therapy in those with continued erectile dysfunction. Depot testosterone was given to 27 patients (aged 52.4 /- 2.5 years; duration of dialysis, 2.00 +/- 0.40 years; and duration of sexual dysfunction, 2.92 +/- 0.49 years): sexual function was fully restored in only three (11.1%), and two gradually lost the response o ver 18 months. Nineteen patients (70.3%) had partial responses, varyin g from an increased sense of well-being alone to restored sexual funct ion apart from an impairment of the duration of penile erection. Five patients (18.5%) had no response, and testosterone was contraindicated in another four. Four of the treated patients (14.8%) reported fluid retention. Vacuum tumescence devices were then offered to 32 patients who remained impotent but declined by six. Twenty-six patients (aged 4 9.6 +/- 2.2 years; duration of dialysis, 2.50 +/- 0.58 years; and dura tion of sexual dysfunction, 3.26 +/- 0.56 years) used the devices, wit h 19 (73.1%) having full correction of their erectile dysfunction; six also continued with depot testosterone to maintain their libido. Peni le discomfort was described by five patients (19.2%) whose potency was not restored. A further five predialysis patients have used the devic es, and all had correction of their erectile dysfunction. The correcti on of biochemical hypogonadism in the male dialysis population with te stosterone rarely restores sexual function to normal, whereas vacuum t umescence therapy corrects penile erection dysfunction in most patient s. (C) 1998 by the National Kidney Foundation, Inc.