One-Stage Direct-Vision Internal Urethrotomy and Penile Prosthesis Implantation for Severe Erectile Dysfunction with Urethral Stricture

Abstract

The safety and efficacy of one-stage direct-vision internal urethrotomy and penile prosthesis implantation (DVIU/PPI) in patients with severe erectile dysfunction (ED) combined with urethral stricture were investigated. Among the 108 cases of severe ED treated with PPI from June 2002 to May 2007, 5 patients with urethral stricture caused by a pelvic fracture or urethral injury underwent DVIU/PPI (AMS700CXM) upon the patient’s request with informed consent. The patients were 20∼35 years old and had been previously treated with a urethrourethral anastomosis. Erectile function and urinary function were evaluated by assessing the International Index of Erectile Function (IIEF5), the Quality of Life Index (QOL), the maximum urine flow rate (Qmax), and urethrography before and after the operation. The patients received follow-up examinations for 18~30 months. Two of the cases were confirmed as vasculogenic ED, and 3 were confirmed to be vasculogenic combined with neurogenic ED. The mean length of urethral stricture was 10.00±3.97 mm. All 5 patients were successfully treated by one-stage DVIU/PPI under spinal anesthesia and were satisfied with both their sexual activity and their urinary function after surgery. The mean scores of the IIEF5, Qmax, QOL, and the diameter of the urethral stricture after surgery were 24.4±0.55, 19.54±4.80 ml/s, 1.80±0.84, and 7.16±0.43 mm, respectively, which were significantly better than those before surgery (p<0.05). No severe complications were noted in any of the 5 patients. In conclusion, one-stage DVIU/PPI might be an effective and safe procedure for treating patients suffering from severe ED combined with urethral stricture.