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Uğur R, Şimşek A. The best method for erection function in urethroplasty; is excision and primary anastomosis or buccal mucosal graft urethroplasty? Actas Urol Esp 2024; 48:170-176. [PMID: 37981167 DOI: 10.1016/j.acuroe.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION The aim of this study is to evaluate and compare erection function (EF) after Excision and Primary Anastomosis Urethroplasty (EPAU) and Buccal Mucosal Graft Urethroplasty (BMGU) in bulbar urethral stricture. METHODS Patients who underwent urethroplasty were identified retrospectively. The criteria for inclusion in the study were determined as being over 18 years old and under 70 years old, being sexually active. Exclusion criteria are; preoperative severe erectile dysfunction, stricture outside the bulbar urethra, psychosocial incompatibility, urethral stricture related to pelvic fracture, follow-up time less than a year. As the primary endpoint, the International Index of Erectile Function-5 (IIEF-5) was determined as a comparison of EF in the preoperative and third, sixth and twelfth months after surgery. The secondary endpoint was the evaluation of the effects of demographic data, stricture and treatment characteristics on EF. RESULTS Fifty patients were identified considering the inclusion/exclusion criteria. It was observed that there were 30 patients who underwent EPAU and 20 patients who underwent BMGU. At the third month after surgery, EF showed a statistically significant decrease in the EPAU group. In both patient groups, it was observed that the early negative effects after the operation in EF started to improve in the sixth month and returned to the baseline level by the first year. CONCLUSION EPAU and BMGU techniques have a similar effect on EF in the medium and long term. Both methods can be used safely and effectively in the appropriate patient group.
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Affiliation(s)
- R Uğur
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey.
| | - A Şimşek
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey
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Nourian Kafshgari H, Farhadi D, Kohandel Gargari M, Pourasghary S, Tahmasbi F, Soleimanzadeh F. Effects of continuous use of Tadalafil on male sexual function after posterior urethroplasty: A clinical trial. Urologia 2023; 90:735-740. [PMID: 37306088 DOI: 10.1177/03915603231179533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Posterior urethral injuries in men commonly occur following pelvic and perineal trauma. Erectile dysfunction (ED), whether brought on by the severity of the initial trauma or the surgery itself, is one of the complications in these patients. MATERIALS AND METHODS In this study, we divided candidates of posterior urethroplasty due to traumatic urethral injury into intervention and placebo groups; the former received continuous treatment with tadalafil (10 mg daily), and the latter received a placebo. Other services were provided equally to both groups. Before and after the intervention, both groups completed the International Index of Erectile Function version 5 (IIEF-5) questionnaire, and the findings were analyzed. RESULTS Forty patients were studied in groups of 20 with a mean age of 43.87 ± 15.70 years. The patient's most common cause of urethral injury was a pelvic fracture. Before the intervention, the mean scores of IIEF for patients in the intervention group and placebo group were 14.85 ± 7.39 and 14.77 ± 6.48, respectively with no statistical significance (p = 0.962) and patients of the groups were similar in terms of the severity of ED. The mean IIEF score in the intervention group was 20.12 ± 4.94 and in the placebo group, it was 18.05 ± 4.88 at the three-month follow-up, with no statistically significant difference (p = 0.063). In both the intervention and placebo groups, the IIEF score was significantly increased by 5.27 ± 4.04 (p < 0.001) and 3.27 ± 2.97 (p < 0.001), respectively. The rate of IIEF increase in the intervention group was higher than in the placebo group during the follow-up at 3-month follow-up with statistical significance. (p = 0.022). CONCLUSION The findings of this study suggest that tadalafil, in a 3-month treatment course, may improve erectile function in individuals with mild-to-moderate ED, significantly more than placebo. However, more studies, specifically with longer duration of follow-up and larger populations, are necessary for generalizing the current findings.
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Affiliation(s)
| | - Danial Farhadi
- Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morad Kohandel Gargari
- Imam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sajjad Pourasghary
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Fateme Tahmasbi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzin Soleimanzadeh
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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Muacevic A, Adler JR. Three-Piece Inflatable Penile Prosthesis Implantation for the Treatment of Severe Erectile Dysfunction Following a Complex Pelvic Fracture: A Case Report. Cureus 2022; 14:e30151. [PMID: 36238423 PMCID: PMC9550429 DOI: 10.7759/cureus.30151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
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.
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Kaneko T, Yanagida K, Matsui K, Kimura M, Kawai T, Yamada Y, Ishii K, Kurozumi T, Suzuki T, Watanabe Y, Kawano H, Sakamoto T, Nakagawa T. Incidence of genitourinary injuries in pelvic fractures: A 12-year single-center retrospective study. Neurourol Urodyn 2022; 41:1025-1030. [PMID: 35325489 DOI: 10.1002/nau.24919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to determine the epidemiology of genitourinary injuries in pelvic fractures and elucidate the clinical outcomes of patients with pelvic fractures with and without genitourinary injuries at a tertiary trauma center in Japan. METHODS Patients with pelvic fractures in our tertiary trauma center between May 2009 and April 2021 were retrospectively assessed. The patients' demographics, mechanism of injury, and hospital course details were collected. The outcomes of patients with pelvic fractures with and without genitourinary injuries were compared. RESULTS Of 402 patients with pelvic fractures, 18 (4.5%) had genitourinary injuries. Falls were the most common mechanisms of injury for all pelvic fractures The incidence of bladder, kidney, urethral, and testis injuries were 2.0%, 1.2%, 1.2%, and 0.5%, respectively. Patients with genitourinary injuries were significantly younger (median age, 26 vs. 51 years; p < 0.001), had a higher rate of intensive care unit admission (94% vs. 58%; p = 0.002), remained hospitalized longer (median duration, 82 vs. 45 days; p < 0.001), and had a longer intensive care unit stay (median duration, 6 vs. 2 days; p < 0.001) when compared to patients without genitourinary injuries. Genitourinary injuries were not associated with in-hospital mortality. CONCLUSIONS The incidence of genitourinary injuries with pelvic fractures was 4.5%. The presence of genitourinary injuries was associated with a higher rate of intensive care unit admission, longer hospital stay, and longer intensive care unit stay, but it was not associated with in-hospital mortality.
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Affiliation(s)
- Tomoyuki Kaneko
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuki Yanagida
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Matsui
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masaki Kimura
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukio Yamada
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Keisuke Ishii
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Taketo Kurozumi
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Suzuki
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinobu Watanabe
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
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Gou C, Liu T, Chen Z, Zhou Z, Song T, Mao K, Chen C, Chen B. Effects of unilateral/bilateral amputation of the ischiocavernosus muscle in male rats on erectile function and conception. Basic Clin Androl 2022; 32:1. [PMID: 34983365 PMCID: PMC8729152 DOI: 10.1186/s12610-021-00151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
Background The ischiocavernosus muscle (ICM) encompasses a pair of short pinnate muscles attached to the pelvic ring. The ICM begins at the ischial tuberosity and ends at the crus of the penis while covering the surface of the crus. According to the traditional view, the contraction of the ICM plays an auxiliary role in penile erection. However, we have previously shown that the ICM plays an important role in penile erection through an indirect method of diagnosing erectile dysfunction (ED) caused by ICM injury by observing the infertility of paired female rats. Since intracavernosal pressure (ICP) is the current gold standard for diagnosing ED, this study aimed to amputate unilaterally/bilaterally the ICM to establish an ED model by detecting the ICP, recording the infertility of matching female rats, and comparing the two methods. Results Forty sexually mature adult male rats were selected and randomly divided into the following groups: the control group (n = 10), sham operation group (n = 10), unilateral ischiocavernosus muscle (Uni-ICM) amputation group (n = 10), and bilateral ischiocavernosus muscle (Bi-ICM) amputation group (n = 10). Eighty female reproductive rats were randomly assigned to the above groups at a ratio of 2:1. We evaluated the time to conception for the paired female rats and the effects of unilateral/bilateral severing of the ICM on erectile function. The results showed that the baseline and maximum intracavernosal pressure (ICP) in the control group, sham operation group, Uni-ICM amputation group, and Bi-ICM amputation group were 17.44±2.50 mmHg and 93.51±10.78 mmHg, 17.81±2.81 mmHg and 95.07±10.40 mmHg, 16.73±2.11 mmHg and 83.49±12.38 mmHg, and 14.78±2.78 mmHg and 33.57±6.72 mmHg, respectively, immediately postsurgery. The max ICP in the Bi-ICM amputation group was lower than that in the remaining three groups (all P<0.05). The pregnancy rates were 100, 100, 90, and 0% in the control group, sham operation group, Uni-ICM amputation group, and the Bi-ICM amputation group, respectively. The pregnancy rate in the Bi-ICM amputation group was significantly lower than that in the remaining groups (all P<0.05). The time to conception was approximately 7–10 days later in the Uni-ICM amputation group than in the control and sham groups (all P<0.05). Conclusions Male rats undergoing Bi-ICM amputation may develop permanent ED, which affects their fertility. In contrast, rats undergoing Uni-ICM amputation may experience transient ED.
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Affiliation(s)
- Chengren Gou
- Department of Urology, the Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Tong Liu
- Department of Urology, the Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.,Department of Pediatric Surgery, the First Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Zongping Chen
- Department of Urology, the Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.
| | - Zidong Zhou
- Department of Urology, the Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Tao Song
- Department of Urology, the Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.,Department of Urology, Eastern Hospital of Sichuan Provincial People's Hospital, Chengdu, 610035, China
| | - Kaiyi Mao
- Department of Urology, the Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Congcong Chen
- Department of Urology, the Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Bo Chen
- Department of Urology, the Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
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Piccione F, Maccarone MC, Cortese AM, Rocca G, Sansubrino U, Piran G, Masiero S. Rehabilitative management of pelvic fractures: a literature-based update. Eur J Transl Myol 2021; 31. [PMID: 34533018 PMCID: PMC8495369 DOI: 10.4081/ejtm.2021.9933] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022] Open
Abstract
A comprehensive rehabilitation program is required after Pelvic Fracture (PF). In a PF rehabilitation setting an effective treatment and a proper management of complications is supplied by an appropriate and reliable clinical assessment. In this literature-based update, we search on MEDLINE, EMBASE, and the Cochrane Database of Systematic reviews to find articles, scientific society guidelines and practioners experiences defining the rehabilitative management of clinically PF outcomes. Based on literature evidences and expert opinions, a set of key topics was collated to generate advices and recommendations to put into daily practice. Even if there are no high-quality evidence for rehabilitative interventions after PF in terms of duration and modality of therapy, rehabilitation setting, care pathways, and long-term functional outcomes, it is strongly recommended an early multidisciplinary intervention to improve recovery from PF.
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Affiliation(s)
- Francesco Piccione
- Department of Neuroscience, Rehabilitation Unit, University of Padova, Padova.
| | | | | | | | - Umberto Sansubrino
- Department of Neuroscience, Rehabilitation Unit, University of Padova, Padova.
| | - Giovanni Piran
- Physical Medicine and Rehabilitation School, University of Padova, Padua.
| | - Stefano Masiero
- Department of Neuroscience, Rehabilitation Unit, University of Padova, Padova, Italy; Physical Medicine and Rehabilitation School, University of Padova, Padua.
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Mazzone A, Anderson R, Voelzke BB, Vanni AJ, Elliott SP, Breyer BN, Erickson BA, Buckley J, Myers J. Sexual function following pelvic fracture urethral injury and posterior urethroplasty. Transl Androl Urol 2021; 10:2043-2050. [PMID: 34159085 PMCID: PMC8185675 DOI: 10.21037/tau-20-1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate erectile and sexual function after pelvic fracture urethral injury (PFUI) by performing a retrospective review of a large multi-center database. We hypothesized that most men will have erectile dysfunction (ED) and poor sexual function following PFUI, which will remain after posterior urethroplasty. Methods Using the Trauma and Urologic Reconstructive Networks of Surgeons (TURNS) database, we identified PFUI patients undergoing posterior urethroplasty. We excluded patients with incomplete demographic, surgical and/or questionnaire data. Sexual Health Inventory of Men (SHIM), Male Sexual Health Questionnaire (MSHQ), and subjective changes in penile curvature were collected before urethroplasty surgery and at follow-up. We performed descriptive statistics for erectile and ejaculatory function using STATA v12. Results We identified 92 men meeting inclusion criteria; median age was 41.7 years and BMI was 26.5. The mechanism of injury was blunt in all patients, and average distraction defect length was 2.3 cm (SD 1.0 cm). In the 38 patients who completed both pre and post-operative SHIM questionnaires, the mean SHIM score was 10.5 (SD 7.0), with 63% having severe ED (SHIM <12). The median follow-up was 5.6 months and the mean post-operative SHIM was 9.3 (SD 6.5), with 68% having severe ED. The mean change in SHIM score was −1.18 (SD 6.29) with 6 (16%) patients reporting de novo ED (≥5 point decrease in score). Of the men with pre-operative MSHQ data, 46/74 (62.1%) had difficulty with ejaculation, 25/35 (71%) had change in penile length, and 6/33 (18%) reported penile curvature. In men with post-operative MSHQ, 19/44 (43%) expressed difficulty with ejaculation, 23/32 (72%) had change in penile length, and 9/33 (27%) reported penile curvature. Conclusions There is a high rate of severe ED, both following PFUI and remaining after posterior urethroplasty. Additionally, rates of ejaculatory difficulty and patient perceived changes in penile length and curvature underscore the complex nature of the impact of these injuries on sexual function beyond simple erectile function.
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Affiliation(s)
| | | | | | - Alex J Vanni
- Lahey Hospital and Medical Center Burlington, Burlington, MA, USA
| | | | | | | | - Jill Buckley
- University of California San Diego, San Diego, CA, USA
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Emara S, Alhasso A. Scar-modulating agents post urethroplasty: Could phosphodiesterase-5 inhibitors be the answer? JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820922428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Phosphodiesterase enzyme inhibitors (PDEIs) are most commonly prescribed by urologists for the treatment of erectile dysfunction. They are also gaining popularity as a treatment for lower urinary tract symptoms, based on their effect on smooth muscles – either vascular smooth muscles or smooth muscles in the urinary tract. For vascular smooth muscles, they cause vasodilation, enhanced microcirculatory haemodynamics through inhibition of platelet aggregation and adhesion, induction of apoptosis of adhesion fibroblasts and a reduction in the scarring process. Methodology: We reviewed articles published in English and indexed in the PubMed, Embase and Google Scholar databases, and consulted textbooks. Key search terms used were: urethral stricture, anti-fibrotic, scar-modulating agent, PDEIs, urethral scarring and urethroplasty. We created a synopsis of relevant articles, including original research studies and reviews. Level of evidence: Not applicable.
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Affiliation(s)
- Shady Emara
- Reconstructive Urology, Western General Hospital, UK
| | - Ammar Alhasso
- Reconstructive Urology, Western General Hospital, UK
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Heinsimer K, Wiegand L. Erectile and Ejaculatory Dysfunction After Urethroplasty. Curr Urol Rep 2021; 22:19. [PMID: 33554283 DOI: 10.1007/s11934-021-01039-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Kevin Heinsimer
- Department of Urology, University of South Florida, Tampa General Circle, STC Floor 6, Tampa, FL, 33606, USA.
| | - Lucas Wiegand
- Department of Urology, University of South Florida, Tampa General Circle, STC Floor 6, Tampa, FL, 33606, USA
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Chen Z, Song T, Zhuang Y, Yan Y, Liu T, Mao K, Li X, Zou C, Wen X, Yao Y, Chen C, Zhao S. A correlation study of ischiocavernosus muscle injury with different types of pelvic fractures and erectile dysfunction after pelvic fracture. OTA Int 2020; 3:e081. [PMID: 33937711 PMCID: PMC8022899 DOI: 10.1097/oi9.0000000000000081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/12/2020] [Accepted: 04/05/2020] [Indexed: 11/25/2022]
Abstract
Objective: To explore the correlation between ischiocavernosus muscle injury (ICMI) with different types of pelvic fractures and erectile dysfunction (ED) after pelvic fracture. Design: Retrospective analysis of a prospective database. Setting: The study was carried out at the affiliated hospital of Zunyi Medical University. Patients/participants: A total of 776 male patients with pelvic fracture, aged 18 to 67 years, were recruited for this study by retrospective analysis, and based on the diagnosis of ED and the presence of ICMI, the participants were divided into ED and non-ED groups as well as ICMI and non-ICMI groups. Intervention: No. Main outcome measurements: ICMI, the type of pelvic fracture, International Index of Erectile Function-5 scores. Computed tomography/magnetic resonance imaging scans, electromyography (motor unit potential) was used to diagnose ICMI. Results: The International Index of Erectile Function-5 score was 19.7 ± 5.9. The incidence of ED was 27.3%, the duration time of ED was 30 ± 23 months, and the incidence of reversible ED was 39.6% and of irreversible ED was 60.4%. The incidence of ICMI was 29.4%, among which the incidence of unilateral injury was 57.9%, and the incidence of bilateral injury was 42.1%. Among all pelvic fractures, the incidence of pubic ramus fracture was 88.1%. Bilateral pubic ramus fractures, bilateral fractures of the ischial ramus, and ICMI were independent risk factors for ED after pelvic fracture. Bilateral pubic ramus fractures and pubic symphysis separation were independent risk factors for ICMI. Unilateral ICMI was an independent risk factor for reversible ED, while bilateral ICMI was an independent risk factor for irreversible ED. Conclusions: ICMI is associated with ED and may be a cause for ED, while pubic ramus fracture, ischial ramus fracture, and pubic symphysis separation may be the main causes of ICMI. Unilateral ICMI may be the main risk factor for transient ED, and bilateral ICMI may be the main risk factor for permanent ED.
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11
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Omar RG, Khalil MM, Alezaby H, Sebaey A, Sherif H, Mohey A. Evaluation of erectile function after anastomotic vs substitutional urethroplasty for bulbar urethral stricture. Arab J Urol 2020; 18:226-232. [PMID: 33312733 PMCID: PMC7717595 DOI: 10.1080/2090598x.2020.1805965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective Patients and methods Results Conclusion
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Affiliation(s)
- Rabea G. Omar
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mostafa M. Khalil
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Hesham Alezaby
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Sebaey
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Hammouda Sherif
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Mohey
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
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12
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Kałużny A, Krukowski J, Matuszewski M. Erectile dysfunction after urethroplasty. Cent European J Urol 2020; 72:402-407. [PMID: 32015911 PMCID: PMC6979548 DOI: 10.5173/ceju.2019.1737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/17/2019] [Accepted: 11/24/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to analyze the influence of urethroplasty on sexual function. Material and methods We analyzed 75 operations: 41 anastomotic, 13 labial graft, 6 thigh skin mesh graft, and 15 penile skin flap urethroplasties. The severity of erectile dysfunction was assessed in the International Index of Erectile Function (IIEF5) questionnaire, preoperatively and at least 3 months after the surgery. The appearance of possible penile deformities was also evaluated postoperatively. Results The etiology and location of the stricture had no impact on the erectile dysfunction in men with untreated urethral stricture. The difference in mean IIEF5 score before and after the first urethroplasty was not statistically significant (12.58 ±9.01 and 10.88 ±9.28; t(42) = 1.25, p = 0.220). The length of the stricture had no impact on the preoperative and postoperative IIEF5 score. Stricture in penile urethra caused a risk of postoperative penile curvature (p = 0.023). Conclusions Patients with urethral stricture have a higher rate of erectile dysfunction than healthy men. Proper therapy should not negatively affect erectile function in a significant way, regardless of the length or location of the stricture, though it may have some influence on the penile anatomy.
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Affiliation(s)
- Adam Kałużny
- Medical University of Gdańsk, University Clinical Centre, Department of Urology, Gdańsk, Poland
| | - Jakub Krukowski
- Medical University of Gdańsk, University Clinical Centre, Department of Urology, Gdańsk, Poland
| | - Marcin Matuszewski
- Medical University of Gdańsk, University Clinical Centre, Department of Urology, Gdańsk, Poland
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Hsieh CH, Hsu GL, Chang SJ, Yang SSD, Liu SP, Hsieh JT. Surgical niche for the treatment of erectile dysfunction. Int J Urol 2019; 27:117-133. [PMID: 31812157 DOI: 10.1111/iju.14157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
Penile erection implicates arterial inflow, sinusoidal relaxation and corporoveno-occlusive function. By far the most widely recognized vascular etiologies responsible for organic erectile dysfunction can be divided into arterial insufficiency, corporoveno-occlusive dysfunction or mixed type, with corporoveno-occlusive dysfunction representing the most common finding. In arteriogenic erectile dysfunction, corpora cavernosa show lower oxygen tension, leading to a diminished volume of cavernosal smooth muscle and consequential corporoveno-occlusive dysfunction. Current studies support the contention that corporoveno-occlusive dysfunction is an effect rather than the cause of erectile dysfunction. Surgical interventions have consisted primarily of penile revascularization surgery for arterial insufficiency and penile venous surgery for corporoveno-occlusive dysfunction, whatever the mechanism. However, the surgical effectiveness remained debatable and unproven, mostly owing to the lack of consistent hemodynamic assessment, standardized select patient and validated outcome measures, as well as various surgical procedures. Penile vascular surgery has been disclaimed to be the treatment of choice based on the currently available guidelines. However, reports on penile revascularization surgery support its utility in treating arterial insufficiency in otherwise healthy patients aged <55 years with erectile dysfunction of late attributable to arterial occlusive disease. Furthermore, it is noteworthy that penile venous surgery might be beneficial for selected patients with corporoveno-occlusive dysfunction, especially with a better understanding of the innovated venous anatomy of the penis. Penile vascular surgery might remain a viable alternative for the treatment of erectile dysfunction, and could have found its niche in the possibility of obtaining spontaneous, unaided and natural erection.
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Affiliation(s)
- Cheng-Hsing Hsieh
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Geng-Long Hsu
- Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology, Taipei, Taiwan
| | - Shang-Jen Chang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Stephen Shei-Dei Yang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ju-Ton Hsieh
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
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Hsu SD, Chen CJ, Wang ID, Lin KT, Wang CC, Chien WC, Chung CH, Chang WK. The Risk of Erectile Dysfunction Following Pelvic Angiographic Embolization in Pelvic Fracture Patients: A Nationwide Population-Based Cohort Study in Taiwan. World J Surg 2019; 43:476-485. [PMID: 30242456 DOI: 10.1007/s00268-018-4803-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pelvic fracture with hypovolemic shock is a known crucial injury in trauma patients. Pelvic fracture with vessel injury often leads to hemodynamic complications; in a trauma scenario, evidence of other systems being affected is often absent. Bleeding cessation and resuscitation are important for these types of trauma patients. For this purpose, pelvic angiographic embolization is frequently used. Multiple studies have reported that angiographic embolization may cause erectile dysfunction (ED) in hemodynamically stable patients with pelvic fracture. However, no study has evaluated a large patient cohort with a long-term follow-up. We hypothesized that angiographic embolization to control bleeding may compromise blood supply to the genitourinary organs or cause secondary neurogenic injury that increases the risk of ED. Our goal was to evaluate the risk of ED following pelvic fractures in male patients treated with pelvic angiographic embolization. METHODS We used data from the National Health Insurance Research Database (NHIRD) from 1997 to 2010 provided by the Bureau of National Health Insurance of the Department of Health in Taiwan. We collected disease histories from inpatient files. The disease diagnoses were based on the International Classification of Diseases (ICD), Ninth Revision, Clinical Modification. These data were all deidentified, and we did not contact the patients. As such, informed consent was not needed. RESULTS Eighty-five and 82,802 patients were included in the case and control cohorts, respectively. All patients were aged 15-45, and the proportion of pelvic fracture locations was equal between the groups. After investigating the causes of ED among male patients aged 15-45 with pelvic fractures using logistic regression analysis in a generalized estimating equations model and after adjusting for the influence of confounders, we found that these patients had high risks (odds ratio (OR): 32.637; 95% confidence interval: 14.137-75.346; P < 0.001) of developing ED post-angiographic embolization. CONCLUSIONS Male patients in Taiwan with pelvic fractures who undergo angiographic embolization to control bleeding have a higher risk of ED than those who do not undergo the procedure. Physicians should practice caution and inform patients of this connection before the procedure.
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Affiliation(s)
- Sheng-Der Hsu
- Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Jueng Chen
- Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - I-Duo Wang
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Chi Wang
- Department of Family Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Chengong Rd, Sec. 2, Neihu, Taipei, 114, Taiwan.
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15
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Urkmez A, Yuksel OH, Ozsoy E, Topaktas R, Sahin A, Koca O, Ozturk MI. The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study. Int Braz J Urol 2019; 45:118-126. [PMID: 30521166 PMCID: PMC6442143 DOI: 10.1590/s1677-5538.ibju.2018.0276] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/17/2018] [Indexed: 01/17/2023] Open
Abstract
Objectives: to examine the effects of urethroplasty surgery on sexual functions by taking into account age, location of stenosis, length of stenosis and surgical technique parameters. Materials and Methods: The prospective study was conducted between January 2015 and August 2017 with 60 cases. Patients were categorized according to age groups (19-65 / 65-75 years), surgery technique and stricture localization and length. Before the urethroplasty operation and postoperative 6th month follow-up, the international index of erectile function (IIEF) form (15 questions), was filled, the relevant domains of sexual function; erectile function (Q1,2,3,4,5,15), orgasmic function (Q9,10) and overall satisfaction (Q13,14) were assessed. Results: The mean age of the cases is 54 ± 13. However, preoperative IIEF, sexual satisfaction and orgasmic function averages of patients with a stenosis segment length of 1-3 cm was found to be significantly higher than that of patients with a stenosis segment length of 4-7 cm. Between stenosis segment length groups, there was no statistical difference in terms of preoperative and postoperative sexual functions. And also, there was no statistically significant change in patients’ preoperative and postoperative sexual function scores in terms of localization of stricture and surgery techniques. However, there were statistically significant change in the postoperative IIEF and sexual satisfaction averages according to preoperative averages. Conclusion: Our study suggests that urethroplasty surgery itself does not significantly affect erectile function, orgasmic function, and general sexual satisfaction regardless of the type of surgery, localization and length of stenosis. Besides, there was a significant decrease in erectile function in senior adults.
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Affiliation(s)
- Ahmet Urkmez
- Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey
| | - Ozgur H Yuksel
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research & Training Hospital, Istanbul, Turkey
| | - Emrah Ozsoy
- Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey
| | - Ramazan Topaktas
- Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey
| | - Aytac Sahin
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research & Training Hospital, Istanbul, Turkey
| | - Orhan Koca
- Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey
| | - Metin I Ozturk
- Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey
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16
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Urkmez A, Yuksel OH, Ozsoy E, Topaktas R, Sahin A, Koca O, Ozturk MI. REPLY TO THE AUTHORS: RE: The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study. Int Braz J Urol 2019; 45:415-416. [PMID: 30735330 PMCID: PMC6541120 DOI: 10.1590/s1677-5538.ibju.2018.0793.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/30/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ahmet Urkmez
- Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey
| | - Ozgur H Yuksel
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research & Training Hospital, Istanbul, Turkey
| | - Emrah Ozsoy
- Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey
| | - Ramazan Topaktas
- Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey
| | - Aytac Sahin
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research & Training Hospital, Istanbul, Turkey
| | - Orhan Koca
- Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey
| | - Metin I Ozturk
- Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey
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17
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Mehmood S, Alsulaiman OA, Al Taweel WM. Outcome of anastomotic posterior urethroplasty with various ancillary maneuvers for post-traumatic urethral injury. Does prior urethral manipulation affect the outcome of urethroplasty? Urol Ann 2018; 10:175-180. [PMID: 29719330 PMCID: PMC5907327 DOI: 10.4103/ua.ua_168_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose We present our success rate and complications of delayed anastomotic urethroplasty (DAU) in patients with post-traumatic posterior urethral injury. Materials and Methods This was a retrospective study of patients aged ≥17 years that underwent DAU for post-traumatic posterior urethral injury during 2010-2014. Stricture length was measured by ascending and descending urethrogram. Success of procedure was considered when the patient was free of stricture-ralated obstruction and needed no further intervention. Primary group includes patients who underwent first time delayed urethroplasty while secondary group included patients who had some sort of urethral manipulation in local hospital. Results were analyzed using unpaired t-test, Chi-square test, binary logistic regression, Kaplan-Meier curves, and log-rank test. Results Of the 80 male patients, 73 (91.25%) patients underwent primary DAU while 7 (8.75%) patients had secondary DAU. Median age, stricture length, and follow-up were 27.0 ± 12.7, 1.6 ± 0.9, and 3.2 ± 0.9, respectively. Overall, success rate was 83.75% while success rate in primary group was 89.04% and secondary group was only 28.57% (P = 0.0059). Regarding ancillary maneuvers, urethral mobilization alone was done in 29 (36.25%) patients with success rate (72.41%), corporeal body separation in 36 (45%) patients with success rate (91.66%), inferior wedge pubectomy in 13 (16.25%) with success rate (84.61%), supracrural rerouting in 1 (1.25%) with success rate (100%), and abdominoperineal approach in 1 (1.25%) with success rate of 100% (P = 0.193). Patients who had prior urethral manipulation affect the outcome of definitive anastomotic urethroplasty. Conclusion DAU has durable success rate with less morbidity. Ancillary elaborated maneuvers are frequently needed in patients with complex and elongated post-traumatic posterior urethral defect with successful outcome.
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Affiliation(s)
- Shahbaz Mehmood
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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18
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Risk Stratification for Erectile Dysfunction After Pelvic Fracture Urethral Injuries. Urology 2018; 115:174-178. [DOI: 10.1016/j.urology.2018.01.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/24/2018] [Accepted: 01/27/2018] [Indexed: 10/18/2022]
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19
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Bhatt NR, Merchant R, Davis NF, Leonard M, O'Daly BJ, Manecksha RP, Quinlan JF. Incidence and immediate management of genitourinary injuries in pelvic and acetabular trauma: a 10-year retrospective study. BJU Int 2018; 122:126-132. [DOI: 10.1111/bju.14161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Rajiv Merchant
- Department of Trauma and Orthopaedics; Tallaght Hospital; Dublin Ireland
| | - Niall F. Davis
- Department of Urology; Tallaght Hospital; Dublin Ireland
| | - Michael Leonard
- Department of Trauma and Orthopaedics; Tallaght Hospital; Dublin Ireland
| | - Brendan J. O'Daly
- Department of Trauma and Orthopaedics; Tallaght Hospital; Dublin Ireland
| | - Rustom P. Manecksha
- Department of Urology; Tallaght Hospital; Dublin Ireland
- Department of Surgery; Trinity College; Dublin Ireland
| | - John F. Quinlan
- Department of Trauma and Orthopaedics; Tallaght Hospital; Dublin Ireland
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20
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Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty. Front Med 2017; 11:277-283. [DOI: 10.1007/s11684-017-0515-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 11/27/2016] [Indexed: 11/25/2022]
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21
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Dogra PN, Singh P, Nayyar R, Yadav S. Sexual Dysfunction After Urethroplasty. Urol Clin North Am 2017; 44:49-56. [DOI: 10.1016/j.ucl.2016.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Abstract
There is a paucity of published literature on the andrological consequences of urethral repair. Until recently authors have focused mainly on technical aspects and objective results. Reported outcomes of urethral reconstruction surgery have traditionally focused only on urodynamic parameters such as flow rates. Patient reported outcome measures have largely been neglected and there is a scarcity of well conducted systematic studies on the subject. For these reasons whether the different components of sexual life are more or less affected by different types of urethral reconstruction remains largely unknown. In an attempt to clarify the available scientific evidence, the authors make a critical review of available literature, systematizing it by sexual domain and study type. Brief pathophysiological correlations are discussed.
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23
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Anterior Urethral Stricture Disease Negatively Impacts the Quality of Life of Family Members. Adv Urol 2016; 2016:3582862. [PMID: 27034658 PMCID: PMC4791496 DOI: 10.1155/2016/3582862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/14/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To quantify the quality of life (QoL) distress experienced by immediate family members of patients with urethral stricture via a questionnaire given prior to definitive urethroplasty. The emotional, social, and physical effects of urethral stricture disease on the QoL of family members have not been previously described. Materials and Methods. A questionnaire was administered prospectively to an immediate family member of 51 patients undergoing anterior urethroplasty by a single surgeon (SBB). The survey was comprised of twelve questions that addressed the emotional, social, and physical consequences experienced as a result of their loved one. Results. Of the 51 surveyed family members, most were female (92.2%), lived in the same household (86.3%), and slept in the same room as the patient (70.6%). Respondents experienced sleep disturbances (56.9%) and diminished social lives (43.1%). 82.4% felt stressed by the patient's surgical treatment, and 83.9% (26/31) felt that their intimacy was negatively impacted. Conclusions. Urethral stricture disease has a significant impact on the family members of those affected. These effects may last decades and include sleep disturbance, decreased social interactions, emotional stress, and impaired sexual intimacy. Treatment of urethral stricture disease should attempt to mitigate the impact of the disease on family members as well as the patient.
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25
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Ali L, Shahzad M, Orakzai N, Khan I, Ahmad M. Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy. Korean J Urol 2015; 56:650-5. [PMID: 26366278 PMCID: PMC4565900 DOI: 10.4111/kju.2015.56.9.650] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/25/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To determine the efficacy of mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy (IOU). Materials and Methods This was a randomized controlled trial conducted in the Department of Urology at the Institute of Kidney Diseases Peshawar from March 2011 to December 2013. A total of 151 patients who completed the study were divided into two groups by the lottery method. Group A (cases) comprised 78 patients in whom mitomycin C 0.1% was injected submucosally in the stricture after conventional IOU. Group B (controls) comprised 73 patients in whom IOU only was performed. Self-clean intermittent catheterization was not offered in either group. All patients were regularly followed up for 18 months. Recurrence was diagnosed by use of retrograde urethrogram in all patients and flexible urethroscopy in selected cases. Data were collected on a structured pro forma sheet and were analyzed by SPSS. Results The mean age of the patients in group A was 37.31±10.1 years and that in group B was 40.1±11.4 years. Recurrence of urethral stricture was recorded in 11 patients (14.1%) in group A and in 27 patients (36.9%) in group B (p=0.002). The mitomycin group also showed a delay in recurrence compared with the control group (p=0.002). Conclusions Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU.
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Affiliation(s)
- Liaqat Ali
- Department of Urology, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar, Pakistan
| | - Muhammad Shahzad
- Department of Urology, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar, Pakistan
| | - Nasir Orakzai
- Department of Urology, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar, Pakistan
| | - Ihsanullah Khan
- Department of Urology, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar, Pakistan
| | - Mubashira Ahmad
- Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
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