Reproductive function in patients following urethral stricture surgery

Introduction. The principal aim of surgery for urethral stricture is to restore satisfactory voiding. Given the refinement and standardisation of contemporary reconstructive techniques, excellent functional urinary outcomes are now routinely achievable. Nevertheless, men of reproductive and middle age are often equally concerned about preserving fertility. Currently, however, the literature provides very limited information on reproductive outcomes in men following urethroplasty.

Objective. To characterise the pattern and prevalence of reproductive disorders in men who have undergone surgical treatment for urethral stricture.

Materials & methods. In this prospective comparative cohort study, 54 men were enrolled: 30 patients with anterior urethral stricture who underwent urethroplasty and 24 men who had circumcision and served as a comparison group. In addition to standard preoperative assessment, all participants underwent semen analysis, measurement of serum hormones (total testosterone, LH, FSH), scrotal ultrasonography, and transrectal ultrasound of the prostate and seminal vesicles. These investigations were performed preoperatively and then repeated at 3, 6 and 12 months after surgery.

Results. Comparison of baseline characteristics between groups showed statistically significant differences in semen analysis parameters and ultrasound findings, but not in hormonal profile, with FSH, LH and total testosterone levels remaining comparable. At three months after urethroplasty there was an increase in the prevalence of signs of male accessory gland inflammation (from 40.0% to 63.3%), leukocytospermia (from 20.0% to 46.7%) and abnormal semen viscosity (from 33.3% to 53.3%). In addition, the proportion of positive semen cultures rose from 33.3% to 53.3% in the urethral reconstruction group.

Conclusion. Statistically significant postoperative changes included higher rates of abnormal semen viscosity, leukocytospermia and altered ejaculate pH. Furthermore, men after urethroplasty showed an increased frequency of male accessory gland inflammation.

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