World J Mens Health.  2017 Aug;35(2):94-99. 10.5534/wjmh.2017.35.2.94.

Incidence of De Novo Erectile Dysfunction after Urethroplasty: A Prospective Observational Study

• Sachin D
• ChikkaMoga Siddaiah M
• Vilvapathy Senguttuvan K
• Chandrashekar Sidaramappa R
• Ramaiah K

• KMID: 2388444
• DOI: http://doi.org/10.5534/wjmh.2017.35.2.94

Abstract

PURPOSE
De novo erectile dysfunction (ED) is a known complication after urethroplasty. Incidence and natural history of de novo ED after urethroplasty is underreported. We assessed the incidence of de novo ED after urethroplasty.
MATERIALS AND METHODS
Consecutive consenting urethroplasty (n=48) patients aged 21 to 50 years from February 2014 to July 2016 with normal preoperative erectile function as determined by an International Index of Erectile Function-5 (IIEF-5) score ≥22 were included and interviewed at 3, 6, and 12 months.
RESULTS
In patients with anterior stricture (n=40), substitution urethroplasty (SU) was performed in 22 patients (55.0%) and end-to-end anastomotic urethroplasty (EEAU) in 18 patients (45.0%). Their mean IIEF-5 score was 24.15±0.8 preoperatively, 20.10±4.2 at 3 months (p<0.001), 22.70±2.3 at 6 months (p=0.0012), and 23.70±1.7 at 12 months (p=0.03), showing a recovery of erectile function with time. All 8 patients with pelvic fracture urethral injury (PFUI) underwent progressive perineal urethroplasty. Their mean IIEF score was 24.0±1.2 preoperatively, 18.8±5.4 at 3 months (p=0.002), 20.9±3.5 at 6 months (p=0.37), and 22.0±1.5 at 12 months (p=0.427). The incidence of ED was similar at 1 year postoperatively between patients with anterior stricture and PFUI and between patients who underwent EEAU or SU for anterior stricture.
CONCLUSIONS
Incidence of ED at 1 year after PFUI is similar to that after surgery for anterior stricture in patients with normal preoperative erectile function. Among the cases of anterior stricture, recovery was better with SU at 3 months and was similar between SU and EEAU at 1 year.

Keyword

Erectile dysfunction; Urethral stricture

MeSH Terms

Constriction, Pathologic
Erectile Dysfunction*
Humans
Incidence*
Male
Natural History
Observational Study*
Prospective Studies*
Urethral Stricture

Figure

• 

  Fig. 1 Severity of erectile dysfunction (ED). Anterior urethral stricture (A), substitution urethroplasty for anterior urethral stricture (B), end-to-end anastomotic urethroplasty for anterior urethral stricture (C), pelvic fracture urethral injury (D).

Reference

1. Greenwell TJ, Castle C, Andrich DE, MacDonald JT, Nicol DL, Mundy AR. Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective. J Urol. 2004; 172:275–277. PMID: 15201793.

2. Blaschko SD, Sanford MT, Cinman NM, McAninch JW, Breyer BN. De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis. BJU Int. 2013; 112:655–663. PMID: 23924424.

3. Rourke K, Haines T. Patient age rather than urethral transaction influences erectile function after urethroplasty: a prospective analysis [Internet]. J Urol. 2015; 193(4 Suppl):e319. cited 2017 Mar 17. Available from: https://www.researchgate.net/profile/Stella_Ivaz/publication/276480700_Open_surgical_reconstruction_for_recalcitrant_bladder_neck_contractures_functional_outcome_after_implantation_of_an_artificial_urinary_sphincter/links/55d9e7a208ae9d659491e827.pdf.

4. Mundy AR. Results and complications of urethroplasty and its future. Br J Urol. 1993; 71:322–325. PMID: 8477319.

5. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997; 49:822–830. PMID: 9187685.

6. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999; 11:319–326. PMID: 10637462.

7. Erickson BA, Granieri MA, Meeks JJ, Cashy JP, Gonzalez CM. Prospective analysis of erectile dysfunction after anterior urethroplasty: incidence and recovery of function. J Urol. 2010; 183:657–661. PMID: 20018319.

8. Kessler TM, Fisch M, Heitz M, Olianas R, Schreiter F. Patient satisfaction with the outcome of surgery for urethral stricture. J Urol. 2002; 167:2507–2511. PMID: 11992068.

9. Coursey JW, Morey AF, McAninch JW, Summerton DJ, Secrest C, White P, et al. Erectile function after anterior urethroplasty. J Urol. 2001; 166:2273–2276. PMID: 11696750.

10. Barbagli G, De Stefani S, Annino F, De Carne C, Bianchi G. Muscle- and nerve-sparing bulbar urethroplasty: a new technique. Eur Urol. 2008; 54:335–343. PMID: 18384930.

11. Jordan GH, Eltahawy EA, Virasoro R. The technique of vessel sparing excision and primary anastomosis for proximal bulbous urethral reconstruction. J Urol. 2007; 177:1799–1802. PMID: 17437823.

12. Andrich DE, Mundy AR. Non-transecting anastomotic bulbar urethroplasty: a preliminary report. BJU Int. 2012; 109:1090–1094. PMID: 21933325.

13. Rosen RC, Cappelleri JC, Gendrano N 3rd. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res. 2002; 14:226–244. PMID: 12152111.