1207 GOOD CLINICAL OUTCOME AFTER URETHROPLASTY AT THE EXPENSE OF ERECTILE FUNCTION LOSS?

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation1 Apr 20101207 GOOD CLINICAL OUTCOME AFTER URETHROPLASTY AT THE EXPENSE OF ERECTILE FUNCTION LOSS? Kathy Vander Eeckt and Steven Joniau Kathy Vander EecktKathy Vander Eeckt More articles by this author and Steven JoniauSteven Joniau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.709AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is common knowledge that urethral reconstruction can cause erectile dysfunction. However, only few studies have evaluated this. We aimed to assess erectile function after urethral reconstructive surgery in a single-center, single-surgeon series. METHODS 184 patients underwent urethral reconstruction between 2003 and 2009 at our institution. All patients received a questionnaire assessing remembered preoperative IIEF-5 score (r-IIEF-5) and IIEF-5 at the time of completing the questionnaire (p-IIEF-5). Any urethral instrumentation after surgery was considered a treatment failure. One-way ANOVA, Kaplan-Meier with log-rank test and Wilcoxon paired sample test were used for statistical analysis. RESULTS Mean follow up of the total group was 31 months (SD +/- 20.5). Overall 5-year failure-free rate was 89.2%. A total of 113 questionnaires were returned. 27 patients were excluded because they had no sexual partner during the full period of evaluation, in 3 patients data on IIEF-5 were incomplete. The remaining 83 were included in the analysis. Of those, 28 underwent end-to-end urethroplasty, 10 had a fasciocutaneous flap and 41 a buccal mucosa graft (BMG) reconstruction, and 4 had a urethrocutaneous fistula excision. There was a significant difference between the median r-IEFF-5 and p-IEFF-5 for the whole group: 23 (IQR 20-24) versus 18.5 (IQR 6-24) (p<0.0001). In end-to end urethroplasty group, median r-IEFF-5 and p-IEFF-5 were 23.5 (IQR 20-25) and 21 (IQR 8-24) (p=0.03). For the BMG reconstruction group, median r-IEFF-5 and p-IEFF-5 were 23 (IQR 20-25) and 22 (IQR 8-24) (p=0.002). Finally, for the fasciocutaneous flap reconstruction group, median r-IEFF-5 and p-IEFF-5 were 21 (IQR 12-21) and 6 (IQR 5-7) (p=0.004). Age at the time of surgery was the strongest predictor of retaining erectile function post-reconstructive surgery, with a clear cut-off point at the age of 55. All patients aged ≤55 (n=44) retained their preoperative erectile function: median r-IIEF-5 was 24 (IQR 22-25) and median p-IIEF-5 was 23 (IQR 21.5-24) (p=0.18). Patients aged >55 (n=39) were at a significant risk of erectile function decline: median r-IIEF-5 was 21 (IQR 11-24) and median p-IIEF-5 was 8 (IQR 5-13.75). CONCLUSIONS The overall success rate at intermediate follow-up was very satisfactory. However, overall erectile function decreased significantly after surgery. Importantly, patients >55 years and patients undergoing fasciocutaneous flap reconstruction are at the highest risk of erectile dysfunction, while patients ≤55 all retained their erectile function. Leuven, Belgium© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e467-e468 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathy Vander Eeckt More articles by this author Steven Joniau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...