Mansi M K, Alkhudair W K, Huraib S
Section of Urology and Kidney Transplantation, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.
J Urol. 1998 Jun;159(6):1927-30. doi: 10.1016/S0022-5347(01)63198-7.
We evaluate the results of treatment of erectile dysfunction in kidney transplant patients with intracavernosal self-injection of vasoactive drugs.
We evaluated and treated 26 male kidney transplant patients for erectile dysfunction. All patients had stable kidney function 6 to 75 months (mean 26.6 +/- 9) after transplantation. Each patient received an intracavernosal injection of 20 microg. prostaglandin E1 (PGE1), and after 20 to 30 minutes the response was assessed. Nonresponders received 40 microg. PGE1 at another visit, and those who showed no response were reinjected with 40 microg. PGE1 plus 30 mg. papaverine hydrochloride. A total of 21 patients were enrolled in a self-injection program and have been followed between 3 and 21 months (mean 11.6 +/- 2.7).
Hormonal alterations were seen in 7 patients with serum testosterone as low as 16.6 ng./ml. (normal 33 to 100), and testosterone injections gave only marginal response in 2. Intracavernosal injection of 20 microg. PGE1 provided good response in 15 patients (57.7%), while 40 microg. PGE1 alone or in combination with 30 mg. papaverine resulted in good response in another 6 and 2 patients, respectively. Among the 21 patients who were enrolled in the self-injection program 19 (90.5%) reported complete satisfaction with no adverse local or systemic complications except for local pain at the injection site in 4. There has been no change in serum creatinine, cyclosporine level or doses of immunosuppression medications during the observation period.
Intracavernosal self-injection of PGE1 is well accepted and tolerated by kidney transplant patients. It poses no apparent risks to the transplanted kidney and could be a good modality to treat erectile dysfunction in kidney transplant recipients.
我们评估了采用血管活性药物海绵体内自我注射治疗肾移植患者勃起功能障碍的效果。
我们评估并治疗了26例男性肾移植勃起功能障碍患者。所有患者在移植后6至75个月（平均26.6±9个月）肾功能稳定。每位患者接受20微克前列腺素E1（PGE1）海绵体内注射，20至30分钟后评估反应。无反应者在另一次就诊时接受40微克PGE1注射，仍无反应者再次注射40微克PGE1加30毫克盐酸罂粟碱。共有21例患者纳入自我注射方案，并随访了3至21个月（平均11.6±2.7个月）。
7例患者出现激素改变，血清睾酮低至16.6纳克/毫升（正常为33至100），其中2例睾酮注射仅有轻微反应。20微克PGE1海绵体内注射使15例患者（57.7%）有良好反应，而单独40微克PGE1或与30毫克罂粟碱联合使用分别使另外6例和2例患者有良好反应。在纳入自我注射方案的21例患者中，19例（90.5%）报告完全满意，除4例注射部位局部疼痛外无局部或全身不良并发症。观察期间血清肌酐、环孢素水平或免疫抑制药物剂量无变化。
肾移植患者对PGE1海绵体内自我注射接受度高且耐受性良好。它对移植肾无明显风险，可能是治疗肾移植受者勃起功能障碍的良好方式。
