| Background Urethral stricture in the cause of complex,surgery is difficult,and high recurrence rate has become a big difficulty,urology academic in patients with traumatic urethral stenosis exists not only dysuria,urinary tract infections,relevant pathological physiological factors of Erectile Dysfunction,Erectile Dysfunction,ED)for the treatment of the patient's life also have a negative impact.ED is one of the common complications in patients with traumatic posterior urethral stricture,and some patients with traumatic anterior urethral stricture often have some degree of ED or ejaculatory dysfunction.ED according to the different risk factors can be divided into psychological,physical,and mixed ED,but ED,as a result of trauma are often caused by a variety of combination,traumatic urethral stricture or atresia patients often accompanied by pudendal nerve vascular injury,micturition not free,long-term indwelling urinary bladder fistula,poor quality of life of patients with erectile function and sexual life hard to avoid adverse impact.Generally,the evaluation of erectile function mainly includes subjective score and objective monitoring,and it is of practical guiding significance to clearly diagnose the nature and cause of ED for later treatment.In order to further explore the subjective questionnaire scores and objective detection in patients with traumatic urethral injury correlation ED diagnostic value and the connections and differences,further improve the accuracy of ED in the diagnosis of traumatic urethral injury patients,the study proposed by the center about 50 cases of patients with traumatic urethral injury subjective questionnaire(IIEF score 5)investigation and objective detection(erectile function testing the NPT,night penile vascular ultrasound monitoring),through the contrast research both diagnostic value in patients with traumatic urethral injury ED,connection and differences,It provides some guidance for the diagnosis and treatment of traumatic urethral injury associated ED.Objective To explore the diagnostic value of subjective score and objective monitoring in erectile dysfunction(ED)in patients with traumatic urethral injury.Methods Fifty-five patients with traumatic urethral injury admitted to the department of urology of the sixth people's hospital affiliated to Shanghai jiaotong university from February 2017 to February 2019 were selected.Inclusion criteria: age range 18-50 years old;Have regular sex life before injury;No previous cardiovascular and cerebrovascular diseases such as heart disease and hypertension,no chronic diseases such as liver and kidney insufficiency,no central and peripheral neuropathy,no endocrine disorders and disorders of blood glucose and lipid metabolism.No pde-5 inhibitor was taken before thetest;No complications such as urethrorectal fistula,penile scrotum,perineal tear and testicular injury were found.Blood testosterone,follicle stimulating hormone,luteinizing hormone,prolactin and estradiol were measured by venous blood.According to the inclusion criteria,suitable patients were selected for this study.According to the stricture site of traumatic urethral injury,patients were divided into two groups: group A patients with anterior urethral stricture(including bulbous urethra and distal urethra),and group B patients with posterior urethral stricture(prostate and membranous urethra).Detailed record the patient medical history information,including patient age,injuries,trauma,time factor,urethral injury,the basic information such as history of urinary tract surgery to repair,and adopt the subjective rating score(IIEF-5)and the evaluation of the objective detection(NPT,PPDU)in patients with injury of the erectile function before and after,the NPT 2 nights for testing monitoring records,preferential selection results as an input,finally combining with the testing results of the NPT,in patients with diagnosis of organic ED drug blood flow to the penis for ultrasound(PPDU)monitoring,observation records and penile erectile function related arteriovenous blood flow.SPSS 23.0 software was used for statistical analysis,and independent sample t test was used for inter-group mean comparison,while one-way analysis of variance(ANOVA)was used for multi-group comparison,P < 0.05 was considered statistically significant.Finally,all the results were combined for correlation comparative analysis,and the diagnostic value,advantages and disadvantages,correlation and significance of subjective scoring and objective monitoring of two different diagnostic tools in traumatic urethral stricture ED were evaluated.Results A total of 55 cases of traumatic urethral injury were actually included in this study,including 20 cases in group A(anterior urethral stricture)and 35 cases in group B(posterior urethral stricture).The average age ranged from 20 to 48 years old;The time after injury ranged from march to 20 months,with an average time of 7.35 months.There were 33 cases of pelvic fracture and 22 cases of riding injury.The previous history of urethral repair surgery was 0~2 times,with an average of 0.6 times.The mean length of urethral stricture was 3.05 cm in group A and 3.80 cm in group B,respectively(p<0.05).The iief-5 score before injury was 22.55 1.86 in group A and 23.05 1.62 in group B(p>0.05).The iief-5 score after injury was 13.83 2.52 in group A and 9.85 0.78 in group B(p<0.05).NPT detection nighttime penile erection times were 2.80 1.16 times in group A,respectively.In group B,0.85 0.73 times(p<0.05),33 cases were diagnosed with organic ED(60%)by NPT test,including 5 cases(25%)in group A and 28 cases(80%)in group B.Further PPDU examination revealed that 27 cases(81.8%)were vascular ED,including4 cases in group A(all venous ED),23 cases in group B(arterial ED ED),6 cases in group B(venous ED ED),10 cases in group c(venous ED),and 7 cases in combination of arterial and venous ED.According to NPT results,there were 33 cases in organic ED group.Non-organic ED group: 22 cases.The results showed that the age between the two groups was 32.86 7.45 years.32.25 7.68 years old(p>0.05).The time interval between the two groups was 8.58 3.55 months.There was no statistically significant difference in the length of urethral injury between the two groups(3.58 0.46 vs 2.83 0.34cm)(p<0.05),and urethral injury site(OR=3.75)and urethral stricture OR atresia length(OR=1.88)were also closely related to the occurrence of urethral injuration-related erectile dysfunction.Conclusion The incidence of organic ED in patients with traumatic urethral injury is60%,of which vascular ED accounts for the vast majority,about 81.8%.The diagnosticevaluation of traumatic urethral injury related ED is highly accurate through the subjective evaluation based on iief-5 score and the objective detection based on NPT and PPDU.Subjective score can roughly evaluate the situation of ED,but cannot distinguish the specific nature of ED,while objective diagnostic indicators can further clarify the degree and nature of ED,providing a basis for further treatment. |
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