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Erectile Dysfunction

POST RALP
Sildenafil immediately after RALP may have some beneficial role to recovering erectile function post RALP. (9)

PROGNOSIS
3 to 14% of ED symptoms have remission over a 7 year period in one study. (10)

MEDICATION INDUCED
This meta-analysis and systematic review found a 4.6% rate of ED from alpha blockers, 6.5% from 5-ARI and higher rate with combination therapy. (12)

ED IN CKD/ESRD
If the ED is thought to be caused by β-blockers or centrally acting antihypertensives, these can be gradually changed to α-1adrenergic blockers or calcium channel blockers or angiotensin converting enzyme inhibitors. Sildenafil has been reported to be safe in ESRD patients, with some recommending that sildenafil should be used on days with no dialysis and that a smaller dose (25 mg) should be used initially to avoid hypotension. 

Tadalafil and vardenafil are more selective than sildenafil for PDE-6, and should not be associated with the related visual disturbances that occur in some patients using sildenafil. Vardenafil, has the highest 
in vitro potency of all available PDE-5 inhibitors, and tadalafil, has a prolonged half-life that may enable couples to have non-programmed sexual activity. Data on the use of these drugs in CRF patients are lacking. One clinical study showed the efficacy and safety of vardenafil in hemodiaysis patients[33].  (3)

Testosterone gel has been shown effective in the treatment of ED in hypogonadal hemodialysis patients has been showed in a cohort of 96 men with ESRD.(
4)  ESRD w/ HD causes coagulopathy and intracavernosal injections should be used with caution.  (5) Penile prostheses can be considered after 1st/2nd line therapies and should await renal transplantation, since many of men may improve their sexual function after transplantation. Research has shown penile prostheses can be successfully implanted without excessive risk of infection in patients with ESRD. (6)

TESTOSTERONE
Studies suggest hypogonadism treated with testosterone improves sexual function. (1)  Specifically a 2017 RCT showed patients w/ type II DM who had increased sexual desire at 6 weeks had improved erectile function at 30 weeks. (2)Testosterone gel has been shown effective in the treatment of ED in hypogonadal hemodialysis patients has been showed in a cohort of 96 men with ESRD. (4)

HYPERBARIC OXYGEN
Hyperbaric oxygen showed not difference in a prospective randomized study of 109 men. (7)

SHOCK WAVE
Low intensity shock wave treatment is effective in the short term for some patients, with only 1/2 of patients with efficiency 2 years after treatment; however, if no diabetes 76% had beneficial effect at 2 years. (8)  A phase II RCT found increased in IIEF-EF score of 2.7 (13) and meta-analysis found increase in 6.4 points. (14)

SEXUAL DISFUNCTION AFTER INGUINAL HERNIA
A meta-analysis in 2020 found new onset sexual dysfunction rate of 5.3% after inguinal hernia and new onset pain with sexual activity rate of 9.0% after inguinal hernia. (11)



  1. Haider, Karim Sultan, et al. "Long-term testosterone therapy improves urinary and sexual function, and quality of life in men with hypogonadism: results from a propensity matched subgroup of a controlled registry study." The Journal of urology 199.1 (2018): 257-265.
  2. ​Hackett, G., et al. "Testosterone replacement therapy: improved sexual desire and erectile function in men with type 2 diabetes following a 30‐week randomized placebo‐controlled study." Andrology 5.5 (2017): 905-913.
  3. El-Assmy, Ahmed. "Erectile dysfunction in hemodialysis: A systematic review." World journal of nephrology 1.6 (2012): 160.
  4. Cangüven, Ö., et al. "Efficacy of testosterone gel in the treatment of erectile dysfunction in hypogonadal hemodialysis patients: a pilot study." International journal of impotence research 22.2 (2010): 140.
  5.  Ayub W, Fletcher S. End-stage renal disease and erectile dysfunction. Is there any hope. Nephrol Dial Transplant. 2000;15:1525–1528. 
  6. Ahuja SK, Krane NK, Hellstrom WJ. Penile prostheses in the management of impotence in patients with end-stage renal disease. J La State Med Soc. 1998;150:32–34. 
  7. Chiles, Kelly A., et al. "A double-blind, randomized trial on the efficacy and safety of hyperbaric oxygenation therapy in the preservation of erectile function after radical prostatectomy." The Journal of urology 199.3 (2018): 805-811.
  8. Kitrey, Noam D., et al. "Low intensity shock wave treatment for erectile dysfunction—how long does the effect last?." The Journal of urology (2018).
  9. Jo, Jung Ki, et al. "Effect of starting penile rehabilitation with sildenafil immediately after robot-assisted laparoscopic radical prostatectomy on erectile function recovery: a prospective randomized trial." The Journal of urology 199.6 (2018): 1600-1606.
  10. Palmer, M. R., Holt, S. K., Sarma, A. V., Dunn, R. L., Hotaling, J. M., Cleary, P. A., … Jacobson, A. M. (2017). Longitudinal Patterns of Occurrence and Remission of Erectile Dysfunction in Men With Type 1 Diabetes. The Journal of Sexual Medicine, 14(10), 1187–1194.​
  11. Ssentongo, Anna E., et al. "Pain and Dysfunction with Sexual Activity after Inguinal Hernia Repair: Systematic Review and Meta-Analysis." Journal of the American College of Surgeons 230.2 (2020): 237-250.
  12. ​Favilla, Vincenzo, et al. "Impact of combination therapy 5-alpha reductase inhibitors (5-ARI) plus alpha-blockers (AB) on erectile dysfunction and decrease of libido in patients with LUTS/BPH: a systematic review with meta-analysis." The Aging Male 19.3 (2016): 175-181.
  13. Patel, Premal, et al. "Phase II Randomized, Clinical Trial Evaluating 2 Schedules of Low-Intensity Shockwave Therapy for the Treatment of Erectile Dysfunction." Sexual Medicine (2020).
  14. Clavijo, Raul I., et al. "Effects of low-intensity extracorporeal shockwave therapy on erectile dysfunction: a systematic review and meta-analysis." The journal of sexual medicine 14.1 (2017): 27-35.
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