Less is definitely more for men who undergo nephrectomy

By Sally Robertson, B.Sc.Aug 6 2012

Researchers have identified a link between complete kidney removal and erectile dysfunction (ED), a manifestation of endothelial dysfunction that often precedes cardiovascular (CV) disease.

However, the team found that men who undergo partial (PN) rather than radical nephrectomy (RN) are significantly less likely to develop de novo ED after surgery.

"Our report is the first to suggest that ED, seen as a harbinger for developing cardiovascular disease, can be a consequence of renal surgery, and that preserving functioning renal tissue by partial nephrectomy may have a protective role," lead author Ithaar Derweesh, from the University of California San Diego Medical Center in the USA, told MedWire News.

In a study comparing 264 men who had undergone RN and 168 who had undergone PN, the team found that ED prevalence was 48.1% in the former compared with 36.9% in the latter group. In addition, de novo ED, defined as the development of ED at least 6 months after surgery, was also significantly higher among the RN versus PN patients, at 29.5% versus 9.5%.

Furthermore, a significantly greater proportion of the RN than PN cohort developed a de novo estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73m², at 33.0% versus 9.8%.

"The proportion of de novo ED was strikingly similar to the proportion of de novo eGFR < 60 (CKD [chronic kidney disease] stage III) in RN and PN postoperatively," remark Derweesh et al in the British Journal of Urology International.

Further analysis revealed that de novo ED was significantly associated with RN, hypertension, preoperative CKD, postoperative CKD, and postoperative diabetes, at odds ratios of 3.56, 2.32, 8.77, 2.64, and 2.93, respectively.

The team says the findings support the hypothesis that PN and renal function preservation limit the risk of at least one endothelial disease, and could reduce the risk of other CV diseases, compared with RN.

However, "while emerging reports show an increasing utilization of partial nephrectomy, in Europe as well as the United States, evidence thus far still demonstrates gross underutilization of nephron sparing approaches, particularly for small renal masses," said Derweesh.

"Further investigation on the effects of nephron loss on ED and endothelial disease is requisite," concludes the team.

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