Male Sexual Dysfunction after Anterior Urethroplasty: Results from a Tertiary Center

Abstract

Background: It has been proved that urethral stricture disease (USD) affects patient’s quality of life (QoL) significantly. Various treatment approaches for management of USD exist, however open urethroplasty is considered as the mainstay technique being an efficient and durable method for managing USD. The aim of this work was to evaluate sexual dysfunction in patients subjected to surgical repair of anterior urethral stricture. Methods: This prospective cohort study was conducted on 85 cases with clinical criteria of urethral stricture disease undergoing anterior urethral reconstructive surgery in the period from May 2020 to May 2022 at Tanta University Hospitals. Patients suffering pelvic fracture urethral injury (PFUI) or posterior urethral stenosis were excluded. Retrograde urethrography and uroflometry were performed. In addition, a detailed sexual history and a validated sexual health inventory for men (SHIM) questionnaire was filled by the patients before as well as following surgery. Results: 74 patients (87.1%) reported no change in their sexual symptoms, while the patient (1.2%) who had a preoperative penile curvature showed an improvement of his curvature post-operatively. Nine patients (10.6%) developed de novo ED, while 2 patients reported having a shortening of penis (2.4%). Meanwhile, less frequent sexual problems were encountered such as cold glans, a reduced sensation of ejaculation and failure of emission in 3.5% of patients collectively. All the patients with ejaculatory dysfunction showed an improvement except the patient who presented with failure of emission. Four patients (5.3%) showed an improvement of their transient postoperative ED while 4 patients had persistent ED. There were two more patients, one developed penile curvature and the other complained of prostatitis symptoms associated with haematospermia. Conclusions: The present study demonstrated that anterior urethroplasty may be associated with transient ED in nearly 6.25 % of patients. Recovery of erectile function was depicted in approximately half of cases within 6-9 months of surgery. There was no difference in the incidence of denovo ED in patients undergoing anastomotic repair and in patients undergoing augmentation urethroplasty. Urethral lumen restoration may be associated with improvement of pre ejaculatory dysfunction.