Study On Male Sexual Function And Related Influence Factors Before And After Urethroplasty

Urethral stricture is a common disease which is difficult to cure and prone to relapse. Inrecent two decades, with the development of medicine, the success rate of treatment ofurethral stricture has markedly increased. Sexual dysfunction is one of the most concernedissues for patients whose urinary problems have been solved. In order to deeply investigatethe sexual function of male patients with urethral stricture and related influence factorsbefore and after urethroplasty, this study was performed, and divided into two parts:Objective: To investigate and evaluate the pre and postoperative sexual function of malepatients with anterior urethral stricture, and analyze its related influence factors.Materials and methods: Between March2010and November2011,61male patients withanterior urethral stricture were successfully treated with anterior urethroplasty in ShanghaiSixth People’s Hospital Affiliated to Shanghai Jiaotong University. The Brief Male SexualFunction Inventory (BMSFI) was used to subjectively evaluate sexual drive, erectilefunction and ejaculatory function before and after surgery respectively.Results: Of all the61patients, erectile function score after surgery was lower than thatbefore surgery (P=0.0033), and decrease in erectile function score was seen only inpatients with the postoperative period less than1year (P=0.0273); ejaculatory function score significantly increased after surgery (P=0.0261); and no statistical difference wasfound in scores of sexual drive or overall satisfaction before and after surgery. Erectilefunction score of patients with age≥40years decreased postoperatively (P=0.0339);ejaculatory function score of patients with age <40years increased postoperatively (P=0.0019). Erectile function score of patients with traumatic urethral stricture decreasedfollowing surgery (P=0.0313), but ejaculatory function score of them significantlyincreased after surgery (P=0.0313). Ejaculatory function scores of patients treated withend-to-end anastomotic urethroplasty and graft urethroplasty both increasedpostoperatively (P=0.0033, P=0.0192); and erectile function score decreasedpostoperatively in the former (P=0.0332); no significant changes in sexual function scoreswere seen in patients who underwent skin flap urethroplasty. Multivariate analysis showedthat correlation was seen only between stricture location and change in erectile function (P=0.0214).Conclusion: Anterior urethroplasty has little effect on sexual drive, long-term erectilefunction, or overall satisfaction, but can significantly improve ejaculatory function. Age,etiology and location of urethral stricture, and surgical method are all important influencefactors.Objective: To investigate and evaluate the pre and postoperative sexual function of malepatients with traumatic posterior urethral stricture, and analyze its related influence factors.Materials and methods: Between May2011and May2012,50male patients withposterior urethral stricture resulting from pelvic fracture urethral distraction defects(PFUDD) underwent end-to-end anastomotic urethroplasty in Shanghai Sixth People’sHospital Affiliated to Shanghai Jiaotong University. The International Index of ErectileFunction-5(IIEF-5) was used to subjectively evaluate erectile function before and after surgery respectively, and the pharmacopenile duplex ultrasonography (PPUD) was used toobjectively examined erectile function before surgery.Results: Erectile function declined in100%of the50patients after injury; pre andpostoperative erectile function did not differ significantly in50%of patients, andpostoperative improvement and decline in erectile function was noted respectively in12%and38%of patients. IIEF-5score declined significantly after injury (P <0.0001), but didnot have significant change postoperatively (P=0.0512). Preoperative PPUD showed60%,18%and22%of the patients had arterial, venous, and non-vascular erectile dysfunction(ED) respectively. IIEF-5score was higher in patients with non-vascular ED than in thosewith arterial ED or venous ED (P <0.0001, P <0.0001), and it declined significantly inpatients with non-vascular ED postoperatively (P=0.0002). In patients with arterial andvenous ED, IIEF-5scores did not differed before surgery, and neither of them changedsignificantly after surgery. Pre-and post-injury IIEF-5scores differed significantly in allthree age groups (P <0.0001, P=0.0001, P=0.0313), but pre and postoperative scores didnot. The mean length of urethral strictures was longer in patients with erectile functiondecreased postoperatively than in those with erectile function unchanged and increasedpostoperatively, and this difference was statistically significant (P=0.0230).Conclusion: Urethral trauma resulting from high-energy pelvic fracture seriously affectserectile function, leading predominantly to vascular ED. Subsequent end-to-endanastomotic urethroplasty for a posterior urethral stricture, however, has little effect onerectile function. Preoperative sexual function status and urethral stricture length influencepatients’ erectile function after surgery, whereas age is not specifically related topostoperative changes in erectile function.