Presentation Authors: Jonathan Wingate*, Seattle, WA, Sean Elliott, Minneapolis, MN, Alex Vanni, Burlington, MA, Bradley Erickson, Iowa City, IA, Jeremy Myers, Salt Lake City, UT, Benjamin Breyer, San Francisco, CA, Nejd Alsikafi, Gurnee, IL, Jill Buckley, San Diego, CA, Bryan Voelzke, Seattle, WA
Introduction: Urethroplasty has been associated with erectile dysfunction (ED), likely due to the close proximity of the cavernous neurovascular bundle to the membranous and bulbar urethra. The relationship between erectile dysfunction and stricture location is under-reported. We hypothesize that more proximal stricture locations would be associated with erectile dysfunction.
Methods: We performed a retrospective review of urethroplasty data from 8 participating centers in the Trauma and Urologic Reconstruction Network of Surgeons. We excluded men with prior pelvic radiation or pelvic fracture urethral injuries. Erectile function was measured using the Sexual Health Inventory for Men (SHIM) pre- and post- operatively. Stricture location was classified as membranous, proximal bulbar, or mid/distal bulbar. Type of urethroplasty was classified as anastomotic or other. A clinically significant change in erectile function was defined as a SHIM change of â‰¥ or â‰¤ 5.
Results: There were 1137 patients who met inclusion criteria. Median age was 45.1 years (IQR 32.9-56.7). Median follow up time to first and last post-op visits were 3.7 (IQR 3.4-4.3) and 12.8 (IQR 6.3-24.1) months, respectively. The mean SHIM scores stratified by stricture location and type of repair are listed in Table 1. Patients had mild preoperative ED without a significant change in erectile function at time of last follow up visit. Of the 365 patients with more than one post-operative visit, 51 patients (14.0%) had a clinically significant worsening of erectile function while 26 patients (7.1%) had an improvement in erectile function.
Conclusions: Urethral stricture patients have mild baseline erectile dysfunction. Stricture location or anastomotic repairs are not associated with worsening erectile function Further research is needed to identify those patients who will experience a clinically significant reduction in erectile function.