Erectile function in patients after urethral plastic surgery

Introduction. At present, the progress in reconstructive urology demonstrates high efficiency rates in treating urethral strictures (US), ensuring satisfactory urination parameters. Meanwhile, there is a need to maintain a high quality of life associated with male sexual function.

Objective. To evaluate the erectile function in males suffering from US considering the presence of risk factors for erectile dysfunction (ED), characteristics of US and surgical techniques employed.

Materials & methods. The study involved 153 sexually active patients with US who underwent surgical treatment. The assessment of erectile function was carried out using the IIEF-5 questionnaire, while considering the presence of risk factors for ED in patients (age, smoking, coronary heart disease, arterial hypertension, type 2 diabetes mellitus), stricture parameters (primary/recurrent, length) and surgical technique (transecting and non-transecting techniques). Evaluation time points: baseline (before surgery), 3, 6, and 12 months after urethroplasty.

Results. The mean age of the patients was 53.0 years, and their baseline erectile function scores were 19.0 points. Regardless of the parameters under study, a decline in erectile function was observed in all study groups by the 3-month follow-up, which regressed over the one-year follow-up period. The duration of recovery and severity of erectile dysfunction were associated with age, smoking, the presence of coronary heart disease and arterial hypertension, US length, and recurrent nature of strictures. No significant differences were found in erectile function indicators after surgery, depending on the grade of transection of the spongy body. According to multivariate analysis, predictors of ED development after surgery include age (adjusted odds ratio [AOR] 1.082; 95% confidence interval [CI] 1.038–1.127; p < 0.001), arterial hypertension (AOR 4.608; 95% CI 1.089–19.511; p = 0.038), and baseline erectile function status (AOR 0.046; 95% CI 0.013–0.160; p < 0.001).

 Conclusion. ED following surgical treatment of urethral strictures is predominantly transient, with regression observed by the 12-month follow-up period. The recovery of erectile function is adversely affected by advanced age, smoking, cardiovascular diseases, the length and recurrent nature of US.

1. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the 'Cologne Male Survey'. Int J Impot Res. 2000;12(6):305-11. DOI: 10.1038/sj.ijir.3900622

2. Pushkar D.Yu., Kamalov A.A., Al–Shukri S.H., Yerkovich A.A., Kogan M.I., Pavlov V.N., Zhuravlev V.N., Bernikov A.N. Epidemiological study of the prevalence of erectile dysfunction in the Russian Federation. Russian Medical Journal. 2012;(3):112-115. (In Russian). eLIBRARY ID: 17826950; EDN: PACUHF

3. Rosen RC. Psychogenic erectile dysfunction. Classification and management. Urol Clin North Am. 2001;28(2):269-78. DOI: 10.1016/s0094-0143(05)70137-3

4. Laumann EO, West S, Glasser D, Carson C, Rosen R, Kang JH. Prevalence and correlates of erectile dysfunction by race and ethnicity among men aged 40 or older in the United States: from the male attitudes regarding sexual health survey. J Sex Med. 2007;4(1):57-65. DOI: 10.1111/j.1743-6109.2006.00340.x

5. Mulhall JP, Luo X, Zou KH, Stecher V, Galaznik A. Relationship between age and erectile dysfunction diagnosis or treatment using real-world observational data in the USA. Int J Clin Pract. 2016;70(12):1012-1018. DOI: 10.1111/ijcp.12908

6. Kogan M.I., Glukhov V.P., Ilyash A.V., Bugaenko V.A., Mitusov V.V., Sizyakin D.V. Multi-stage operations for anterior urethral strictures: evaluation of sexual function. Experimental and Clinical Urology. 2022;15(4):96- 101. (In Russian). DOI: 10.29188/2222-8543-2022-15-4-96-101

7. Mundy AR. Results and complications of urethroplasty and its future. Br J Urol. 1993;71(3):322-5. DOI: 10.1111/j.1464-410x.1993.tb15951.x

8. Anger JT, Sherman ND, Webster GD. The effect of bulbar urethroplasty on erectile function. J Urol. 2007;178(3 Pt 1):1009-11; discussion 1011. DOI: 10.1016/j.juro.2007.05.053

9. Jordan GH, Eltahawy EA, Virasoro R. The technique of vessel sparing excision and primary anastomosis for proximal bulbous urethral reconstruction. J Urol. 2007;177(5):1799-802. DOI: 10.1016/j.juro.2007.01.036

10. Andrich DE, Mundy AR. Non-transecting anastomotic bulbar urethroplasty: a preliminary report. BJU Int. 2012;109(7):1090-4. DOI: 10.1111/j.1464-410X.2011.10508.x

11. Kotov S.V. Non-transecting anastomotic urethroplasty is a new type of urethroplasty for short bulbar urethral stricture. Experimental and Clinical Urology. 2015;(3):68-71. (In Russian). eLIBRARY ID: 25622728; EDN: VOSGLJ

12. Chapman DW, Cotter K, Johnsen NV, Patel S, Kinnaird A, Erickson BA, Voelzke B, Buckley J, Rourke K. Nontransecting Techniques Reduce Sexual Dysfunction after Anastomotic Bulbar Urethroplasty: Results of a Multi-Institutional Comparative Analysis. J Urol. 2019;201(2):364-370. DOI: 10.1016/j.juro.2018.09.051

13. Xie H, Xu YM, Xu XL, Sa YL, Wu DL, Zhang XC. Evaluation of erectile function after urethral reconstruction: a prospective study. Asian J Androl. 2009;11(2):209-14. DOI: 10.1038/aja.2008.1

14. Erickson BA, Wysock JS, McVary KT, Gonzalez CM. Erectile function, sexual drive, and ejaculatory function after reconstructive surgery for anterior urethral stricture disease. BJU Int. 2007;99(3):607-11. DOI: 10.1111/j.1464-410X.2006.06669.x

15. Urkmez A, Yuksel OH, Ozsoy E, Topaktas R, Sahin A, Koca O, Ozturk MI. The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study. Int Braz J Urol. 2019;45(1):118-126. DOI: 10.1590/S1677-5538.IBJU.2018.0276

16. Bhowmik P, Sharma G, Sharma PK, Patawari PK, Dey S, Mandal S. Prospective study of de novosexual dysfunction after anterior urethroplasty: Causative factors, incidence, and recovery of function - A singlecenter experience. Urol Ann. 2022;14(1):60-66. DOI: 10.4103/ua.ua_24_21.