Erectile Dysfunction After Urethroplasty: Is the Risk Overstated?

Three-Piece Inflatable Penile Prosthesis Implantation for the Treatment of Severe Erectile Dysfunction Following a Complex Pelvic Fracture: A Case Report

Pelvic fracture is one of the common causes of erectile dysfunction (ED). The pathophysiology of ED following pelvic injury is quite complicated and comprises vascular, neurogenic, corporal, as well as psychogenic causes. Penile prosthesis implantation is the third-line treatment of ED due to any reason including pelvic trauma that poorly responds to other standard treatments. In this study, we reported a case of a 33-year-old man with severe erectile dysfunction and urethral stricture following a complex pelvic fracture due to a traffic accident who was successfully implanted with a three-piece inflatable penile prosthesis at People's Hospital 115. At the sixth month of follow-up, this device has been working effectively, the patient had the ability to attain full erection for sexual intercourse. Both the patient and the partner are satisfied with their sexual lives. ED is a long-term consequence of pelvic fracture. The high proportion of young patients with a demand for erection rehabilitation and complex pathophysiology make the treatments even more challenging. Penile implant surgery is a potential treatment for refractory ED patients suffering from pelvic trauma.

Erectile and Ejaculatory Dysfunction After Urethroplasty

PURPOSE OF THE REVIEW

The goal of this paper was to evaluate the impact on erectile and ejaculatory function after anterior and posterior urethroplasty.

RECENT FINDINGS

With a rise in the use of urethroplasty, its impact on sexual function has come into question. For anterior urethroplasties, some degree of erectile dysfunction is common, but this tends to be transient, with most patients having a resolution of any de novo dysfunction by 12 months. Patients with posterior urethral strictures have a very high rate of erectile dysfunction prior to surgery and may show improvement after urethroplasty. Ejaculatory function tends to improve in patients due to alleviation of obstruction while some patients notice degradation in force of ejaculation. While urethroplasty has a minimal permanent effect on sexual function for most patients, there are some patients who notice improvement and others worsening. Patients should be counseled on these risks prior to urethroplasty.

Patient-reported outcomes after buccal mucosal graft urethroplasty for bulbar urethral strictures: results of a prospective single-centre cohort study

OBJECTIVES

To describe patient-reported outcome measures (PROMs) after buccal mucosa graft (BMG) urethroplasty.

MATERIALS AND METHODS

We prospectively collected PROMs in patients who underwent BMG urethroplasty for bulbar urethral strictures between October 2009 and February 2017. Preoperatively and at the first, second and third postoperative follow-up visits, patients completed five PROM questionnaires: the International Prostate Symptom Score (IPSS); the IPSS Quality of Life questionnaire; the Urogenital Distress Inventory Short-Form questionnaire (UDI-6); the International Index of Erectile Function (IIEF)-5 questionnaire, combined with IIEF-Q9 and IIEF-Q10 for assessing ejaculatory and orgasmic functions; and the International Consultation on Incontinence Questionnaire Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS-QOL) questionnaire. In addition to using these questionnaires, we evaluated maximum urinary flow rate (Q_max ), post-void residual urine volume and total voided urine volume at each follow-up visit. Buccal pain and discomfort were assessed using a visual analogue scale (VAS). Comparison of questionnaire scores was performed using a paired Wilcoxon rank-sum test. Treatment failure was defined as any need for urinary diversion or urethral instrumentation after surgery.

RESULTS

A total of 97 patients met the inclusion criteria. The first postoperative follow-up visit was at a median of 2.1 months (n = 97/97), and the second and third visits were after a median of 7.8 (n = 82/97) and 17.0 months (n = 70/97), respectively. Significant improvements compared to baseline were observed in IPSS, and IPSS-QOL, UDI-6 and ICIQ-LUTS-QOL scores at the first follow-up, and remained improved during the follow-up period (P ≤ 0.001). Patients with mild to no baseline erectile dysfunction experienced a significant decline in erectile function at the first follow-up (median [interquartile range {IQR}] preoperative IIEF-5 score 23.0 [21.0-25.0] vs median [IQR] IIEF-5 score at first follow-up 19.5 [16.0-23.8]; P ≤ 0.001). This decline fully recovered during further follow-up (median [IQR] IIEF-5 score at third follow-up 24.0 [20.5-25.0]; P = 0.86). No significant changes in median orgasmic and ejaculatory function were noted. The first postoperative median (IQR) VAS score was 3.0 (2.0-4.45), and a significant improvement in local pain and discomfort was observed during the follow-up (median [IQR] VAS at third follow-up: 0.0 [0.0-1.0]; P ≤ 0.001). Nine patients (9/97; 9.3%) had treatment failure. Stratifying recurrence based on a difference of <10 mL/s vs ≥10 mL/s between preoperative and postoperative Q_max could not demonstrate a significant difference (P = 0.06).

CONCLUSION

Significant improvements in voiding symptoms and quality of life after surgery were reported. Patients with good baseline erections recovered erectile function during follow-up, although a significant decrease in erectile function was observed at the first follow-up. This study highlights the importance of PROMs in urethral reconstructive surgery, emphasizing that success should not be defined only by stricture-free survival.