Erectile function in patients after urethral plastic surgery

Introduction . At present, the progress in reconstructive urology demonstrates high efficiency rates in treating urethral strictures (US), ensuring satisfactory urination parameters. Meanwhile, there is a need to maintain a high quality of life associated with male sexual function. Objective. To evaluate the erectile function in males suffering from US considering the presence of risk factors for erectile dysfunction (ED), characteristics of US and surgical techniques employed. Materials & methods . The study involved 153 sexually active patients with US who underwent surgical treatment. The assessment of erectile function was carried out using the IIEF-5 questionnaire, while considering the presence of risk factors for ED in patients (age, smoking, coronary heart disease, arterial hypertension, type 2 diabetes mellitus), stricture parameters (primary/recurrent, length) and surgical technique (transecting and non-transecting techniques). Evaluation time points: baseline (before surgery), 3, 6, and 12 months after urethroplasty. Results . The mean age of the patients was 53.0 years, and their baseline erectile function scores were 19.0 points. Regardless of the parameters under study, a decline in erectile function was observed in all study groups by the 3-month follow-up, which regressed over the one-year follow-up period. The duration of recovery and severity of erectile dysfunction were associated with age, smoking, the presence of coronary heart disease and arterial hypertension, US length, and recurrent nature of strictures. No significant differences were found in erectile function indicators after surgery, depending on the grade of transection of the spongy body. According to multivariate analysis, predictors of ED development after surgery include age (adjusted odds ratio [AOR] 1.082; 95% confidence interval [CI] 1.038–1.127; p < 0.001), arterial hypertension (AOR 4.608; 95% CI 1.089–19.511; p = 0.038), and baseline erectile function status (AOR 0.046; 95% CI 0.013–0.160; p < 0.001). Conclusion . ED following surgical treatment of urethral strictures is predominantly transient, with regression observed by the 12-month follow-up period. The recovery of erectile function is adversely affected by advanced age, smoking, cardiovascular diseases, the length and recurrent nature of US.