Erectile Impotence and Infertility in Men Undergoing Renal Replacement Therapy

The outlook for patients with end-stage renal disease has improved markedly over the last 30 years as a result of advances in renal replacement therapy. In 1978 data from the European Dialysis and Transplant Registry showed that the prognosis for patients starting dialysis was better than that following myocardial infarction or breast cancer (Wing et al. 1978) and the 10 year survival for adults starting dialysis in the early 1980s can be expected to exceed 65% (Brunner et al 1988). Whilst cardio- and cerebrovascular events caused by premature atherosclerosis are the major causes of death, there is a host of complications to which the end-stage renal disease patient is susceptible which will cause significant morbidity. Sexual dysfunction manifested by loss of libido, reduced fertility and in particular erectile impotence has emerged as a frequent problem in men undergoing renal replacement therapy and this chapter reviews its aetiology, pathophysiology and management.