Risk factor analysis for ejaculatory disorders following urethral reconstruction surgery

Introduction. Urethral stricture is a common urological condition that substantially impairs patients' quality of life. Historically, restoration of spontaneous voiding has been considered the primary success criterion for stricture management. However, contemporary urethroplasty decision-making rarely accounts for potential postoperative sexual dysfunctions in men, including ejaculatory and erectile disorders, penile curvature and shortening, reduced genital sensation, and impaired glans blood supply.

Objective. To identify risk factors for ejaculatory dysfunction following urethroplasty and quantify their impact.

Materials & methods. We evaluated 74 patients with urethral strictures treated surgically from 2015 to 2024. Ejaculatory function was assessed using the Male Sexual Health Questionnaire — Ejaculatory Dysfunction Short Form (MSHQ-EjD SF) preoperatively and at 12 months postoperatively.

Results. At 12 months, patients aged ≥ 60 years exhibited statistically significant declines in ejaculation achievement, force, and ejaculate volume. Similar deteriorations occurred in patients with hypertension and diabetes mellitus (across all three parameters) and coronary artery disease (ejaculation force and volume only). Conversely, patients undergoing urethroplasty without corpus spongiosum transection showed preserved ejaculation parameters.

Conclusion. Urethroplasty may induce de novo ejaculatory dysfunction. Principal risk factors include advanced age (≥ 60 years), comorbidities (hypertension, diabetes mellitus, coronary artery disease), and surgical transection of the corpus spongiosum.

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