The effect of preoperative risk factors on changes in erectile function after urethroplasty

Introduction. Modern advances in the development of reconstructive urology show high efficacy in treating urethral stricture (US) in men and maintaining an acceptable quality of life. An urgent task in the treatment of this category of patients is not only the restoration of physiological urination and relief of symptoms of emptying, but also the preservation and restoration of erectile function (EF). The purpose of the study. To evaluate the effect of preoperative risk factors for erectile dysfunction (ED) in men with stricture disease of the urethra on erectile function and hemodynamic parameters of penile blood flow. Material and methods. The study included 153 sexually active patients with US, who underwent reconstructive and reconstructive surgery on the urethra. The EF assessment was carried out using the IIEF-5 questionnaire. The study patients were divided into 2 groups, depending on the presence of risk factors for erectile dysfunction (hypertension, coronary heart disease, type 2 diabetes mellitus, tobacco smoking). Control points of assessment: initially (before surgery), 3, 12 months after urethroplasty. Penile hemodynamics in patients was assessed during preoperative preparation based on the results of pharmacodopplerography of penile vessels using alprostadil 10 micrograms. Results. The age of the study patients ranged from 18 to 80 years (Me = 53.00, Q1 – Q3 =38.00 – 64.00). Before urethroplasty, signs of ED were noted in 55.6% (n=85) of patients (median IIEF-5 - 19,0 [13,0- 22,0]). A significant progression of ED signs was noted 3 months after urethroplasty, the presence of ED signs was recorded in 75.8% (n=116) of patients (median IIEF-5: 13,0 [5,0; 20,0], p=0.001). According to the results of the EF examination for the 12th month of the postoperative period, a significant improvement in EF indicators was confirmed (median IIEF-5: 21,0 [18,0; 23,0], p <0.001). The presence of ED risk factors was noted in 52.9% (n=81) of patients with US. With an increase in the World Health Organization (WHO) age group, there is an increase in the prevalence of ED risk factors. In the age group of patients from 18 to 45, risk factors for ED were identified in 29.6% (n=16), and in the group from 60 to 74 - 72.3% (n=34). According to the result of comparing groups of patients, depending on the presence of ED risk factors, during the preparation for urethroplasty, the EF indicators of the studied groups did not significantly differ. 3 and 12 months after urethroplasty, the EF scores of the group without ED risk factors were significantly better (median IIEF-5 - 16.0 [10.75-21.0] versus 10.0 [5.0-16.0], p<0.001; 22.0 [21.00-24.0] versus 18.0 [15.0-22.0], p<0.001). In the group of patients with risk factors for ED, there was a higher incidence of severe ED, reaching 56.8% (n=46) 3 months after urethroplasty, and a higher incidence of signs of ED during the 12th month of the postoperative period (50.6%, n=41). The presence of risk factors in patients with US is associated with poorer indicators of penile hemodynamics. According to the results of pharmacodopplerography of the vessels of the penis before surgery, in the group of patients with ED risk factors, higher values of the end diastolic velocity (EDV) and lower resistance index (RI) were recorded compared with the group without ED risk factors (EDV: 9.38 [6.46; 13.90] vs. 3.29 [0.10; 5.68], p<0.001; RI: 0.70 [0.63; 0.73] vs. 0.84 [0.78; 1.00], p=0.001). According to the results of a multifactorial analysis, the predictors of ED development 3 months after surgery are age (AOR 1.082; 95% CO 1.038 – 1.127; p < 0.001), hypertension (AOR 4.608; 95% CO - 1.089 – 19.511; p = 0.038) and baseline status of erectile function (AOR 0.046; 95% CO - 0.013 – 0.160; p < 0.001). However, the examination after 12 months confirmed a decrease in the effect of concomitant pathology and age on the negative dynamics in EF indicators. Conclusion. The presence of modifiable and unmodifiable ED risk factors is associated with more pronounced EF changes in patients with US after urethroplasty. The predictors of the development of ED after urethroplasty are age, concomitant pathology (arterial hypertension) and the initial level of EF of the patient, followed by a decrease in the effect of predictors on EF by the 12th month of the postoperative period. Keywords: urethral stricture; urethral plastic surgery, erectile dysfunction, risk factors for erectile dysfunction.