Sexual Function In Urethral Stricture After Urethroplasty: A Systematic Review

Objective:Urethral stricture is one of the common urogenital diseases.With the development of society,in particular,the process of industrialization,increased traffic accidents and increased urinary tract operations,the incidence of urethral stricture is significantly increased.The final outcome of urethral stricture is the lower urinary tract symptoms and affect their quality of life.At present,most of the researchers have focused on the causes of the disease,the effect of different surgical methods,postoperative recurrence rate.Sexual function is an important outcome measure after the repair of urethral stricture,but the existing research is more dispersed and the results are not consistent.The purpose of this paper is to summary the information of the preoperative and postoperative sexual function(erectile function,ejaculatory function,sexual desire and sexual sensation etc.)in the literature,and to evaluate the changes of sexual function.To summarize the related factors that affect the outcome of patients with urethral stricture after reconstruction,and to improve the diagnosis and treatment of the disease.Methods:According to the approach of systematic review,we searched EMBASE and PUBMED,all literature retrievals were updated until February,2017.According to the literature screening qualifications:(1)The types of literature,mainly for the analysis of clinical researches,case series(more than 5 cases)and the case report with valuable discussions(less than 5 cases);(2)Patients have suffered from urethral stricture with various etiology in adult patients(over 16 years),including anterior,posterior,multi-site and complex urethral stricture;(3)The surgical methods include urethral dilatation and direct vision internal urethrotomy,end-end anastomosis with scar resection and urethroplasty with various grafts;(4)The content related to sexual function in patients with preoperative and postoperative urethral stricture(erectile function,ejaculation function,sexual desireand and the sensation of ejaculation etc.).Studies were included in according with the pre-defined standards of the systematic review,and the related dates were extracted with self-designed data sheets(the first author and study year,research literature type,general characteristics,quality of research,treatment,follow-up and outcome),to establish a database in EXCEL form of literature research,the quality of the literature? follow-up and outcome were analyzed.Results:A total of 39 studies were included in the review,including a total of 4559 patients with urethral stricture.Most of the studies were retrospective case analysis,a small number of prospective case analysis.The research reports are not standardized,and the quality is low.Most research projects come from developed countries.The results showed that:(1)Urethral stricture was common in pelvic fracture after urethral injury or iatrogenic injury.(2)In the 16 study,the location and length of urethral stricture were determined by objective diagnostic methods such as antegrade-retrograde urography.(3)The incidence of ED after anterior urethral and posterior urethral surgery was 4% and 21.3%,respectively.The improvement of ejaculatory function was significantly better than that of posterior urethra.Posterior long urethral stricture after operation of EF decreased,but no significant changes in the anterior urethra.(4)End to end anastomosis and graft replacement as the most commonly used in the treatment of,the incidence of postoperative ED was 20%,13.4%.(5)The study of 4 cases of endoscopic direct vision surgery confirmed the therapeutic effect.(6)Preoperative complications and sexual function,surgical experience and the quality of surgical repair were not sufficient to evaluate the impact of the patient's postoperative sexual function due to the lack of detailed data and data.(7)Most of the postoperative outcomes were evaluated by IIEF and SHIM.The number of 16 studies were followed up for more than 12 months,and the study was conducted in a way that was followed up every three months for 23.3% of the study.Conclusions:The sexual function of patients with urethral reconstruction was influenced by many factors,and sexual dysfunction may be associated with the location of urethral stricture and the surgical methods.However,but the exact weight of specific factors and whether other factors need further discussion.The correlation between injury factors and postoperative sexual dysfunction was not evaluated.The standardization of surgical reports is recommended.