The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study. Ozgur H. Yuksel 2. Metin I. Ozturk 1.
Many published studies focus on the treatment outcomes and the relatively high recurrence rates after surgical repair. Secondary NPH. Moreover, Rogers et al. However, there was a Bulbar sexual dysfunction failure rate. Also sexual function was not the primary objective of the studies. Wet or gurgly voice. Patients were asked to read 3 standard passages from the Thai Nasality Test. Speech Assessment Forty-nine patients were given a speech assessment at 6 months after rysfunction placement. Patient demographic data are shown in Table 3.
Celebrity sex tape previews. Services on Demand
ED after urethroplasty was first reported by Mundy. The degeneration of the neurons is something which cannot be reversed. He presented at Bulbar sexual dysfunction months of age with difficulty in swallowing, Bulbar sexual dysfunction, and pooling of secretions. In case of AR, the corpus spongiosum is circumferentially freed at the level of the stricture. Parents were reluctant to start her on neostigmine early, but by 5 months dysfuncction age her symptoms had significantly increased. What is the best technique for urethroplasty? Adv Biomed Res. J Pediatr Neurosci. The trial of neostigmine led to a marked clinical improvement with increased energy and stronger vocalization along with improved chewing and Buy first issue playboy abilities. With the availability of molecular genetics these conditions Bulbar sexual dysfunction now be diagnosed early and specific treatment initiated, thus preventing morbidity and mortality. For children with CMS, specific molecular diagnosis esxual help to determine the prognosis along with genetic counseling for the families. Volume 3 ydsfunction, Issue 3 May Pages This is usually caused by stroke. Figure 2. Hemophilia: Causes, Symptoms, Treatment, Diagnosis.
N ormal pressure hydrocephalus NPH is a syndrome characterized by gait disturbance, cognitive impairment, and urinary incontinence, as well as enlargement of the ventricles, which results from disturbance of CSF circulation in a setting of normal CSF pressure.
- Bulbar palsy refers to a range of different signs and symptoms linked to impairment of function of the cranial nerves 9, 10, 11, 12, which occurs due to a lower motor neuron lesion in the medulla oblongata or from lesions of the lower cranial nerves outside the brainstem.
- Bulbar Palsy also known as Progressive Bulbar Palsy is a pathological condition in which the nerve cells which are responsible for movement get affected.
- Professional Reference articles are designed for health professionals to use.
- Wayne J.
N ormal pressure hydrocephalus NPH is a syndrome characterized by gait disturbance, cognitive impairment, and urinary incontinence, as well as enlargement of the ventricles, which results from disturbance of CSF circulation in a setting of normal CSF pressure. Secondary NPH occurs after trauma, subarachnoid hemorrhage, meningitis, or intracranial surgery, and the idiopathic form is characterized by no known causative disorders.
The pathogenesis of NPH remains uncertain, although several hypotheses have been proposed. Suggested mechanisms responsible for the associated clinical symptoms include reduction in blood flow and metabolism, and altered neuronal conduction due to stretching of periventricular white matter PVWM.
Many other symptoms have been reported, including subsequent apathy, anxiety, depression, 34 , 39 , 43 impaired wakefulness, 7 , 24 and sexual dysfunction, 31 but on our review of the literature, no previous studies have investigated and reported on bulbar dysfunction in NPH.
We observed that several patients with a history of frequent choking had been admitted to the intensive care unit because of aspiration pneumonia before a diagnosis of NPH was made. Soon after shunt placement surgery, these patients had no further episodes of aspiration or choking. Moreover, these patients experienced hoarseness or hypophonia, which is usually concomitant with some degree of aspiration.
The cessation or reduction in severity of aspiration also occurs after the CSF tap test. These symptoms may be explained by a stretching of PVWM.
An enlarged ventricle can affect corticospinal integrity, thereby causing gait disturbance in a patient with NPH. The primary objective of this study was to compare preoperative and postoperative prevalence of bulbar dysfunction in patients with NPH. Secondary objectives included assessing the results of surgery for swallowing, speech, gait, cognition, and urination, and evaluating the correlation between bulbar dysfunction and triad symptoms.
Candidates for our study were patients with probable NPH. The following inclusion and exclusion criteria were adopted. The inclusion criteria all required were as follows: 1 patients with more than 1 of the following symptoms: gait disturbance, cognitive impairment, and urinary incontinence; 2 patients with clinical symptoms that could not be completely explained by other diseases; 3 patients with ventricular dilation documented by CT or MRI; and 4 patients with CSF pressure lower than 20 cm H 2 O with normal CSF cell count.
The exclusion criteria at least 1 required were: 1 patients with diseases or medical conditions of the head and neck region that could cause swallowing and speech problems e. Patients who met all of the above inclusion criteria were enrolled.
Enrolled participants then underwent shunt placement surgery with a ventriculoperitoneal shunt VPS or lumboperitoneal shunt LPS , depending upon surgeon and patient preference. Enrolled participants were evaluated before shunting and at 1, 3, and 6 months after surgery. The initial pressure for the shunt system was set after surgery. Valve pressure was readjusted at postoperative intervals, as required.
Shunt function was assessed regularly, especially when there was no improvement in clinical symptoms. The outcome measurements included: the number of steps and time seconds needed to walk 10 m at free speed; the Thai Mental State Examination TMSE ; 48 and an ordinal urinary incontinence scale, 8 in which the level of incontinence ranged from 1 to 6, with a higher score indicating a more incontinent condition.
Bulbar dysfunction was categorized into swallowing problems and speech problems. A swallowing problem was evaluated using the Swallowing Problem Questionnaire SPQ and a speech problem was evaluated using an articulation test, the volume and frequency of the voice, and resonance. Designed by Manochiopinig et al. The maximum score is 16, with a score of 0 indicating normal swallowing function. The patient or a relative was interviewed by a physician to facilitate the completion of the SPQ. All patients were evaluated by a professional speech-language pathologist.
The assessment consisted of 3 component parts. Articulation Test. Patients were tested using the Thai Articulation Test TAT , 26 , 27 , which consists of all Thai phonemes, including 21 initial consonants, 8 final consonants, 12 clusters, 24 vowels, and 5 tones in the Thai language. Patients pronounce a list of words aloud until the test is completed and articulation is determined to be normal or abnormal.
Volume and Frequency of Voice. Using normal-conversation voice volume, patients count from 1 to 10 into a microphone that is connected to a computer. The software then computes and analyzes voice volume dB and voice frequency Hz. The distance between the patient's mouth and the microphone was 6 inches.
Patients performed this exercise 2 times, with the average of the 2 times recorded as the test result. Resonance is the speech quality that results from sound vibrations in the pharynx, oral cavity, and nasal cavity. Normal resonance is highly dependent on normal velopharyngeal structures and function. Velopharyngeal structures include the velum, lateral pharyngeal walls, and posterior pharyngeal wall.
Hypernasality is a resonance disorder that results from velopharyngeal inadequacy VPI. Specifically, in patients with hypernasality, oral sounds inappropriately resonate into the nasal cavity due to inadequate closure of the velopharyngeal valve. The RST is composed of 3 short speech sentences and 2 examinations of velopharyngeal function. Each of the 5 items is rated as being either normal successful or abnormal unsuccessful.
The maximum score is 5, with a score of 0 score indicating normal velopharyngeal function. A nasometer —3, Kay Elemetrics Corp. This device consists of a headset that has directional microphones for the nose and mouth.
These microphones are separated by a baffle that rests against the upper lip Fig. The microphones pick up acoustic energy from the nasal and oral cavities. The ratio of nasal to total nasal plus oral acoustic energy is then calculated. Individuals with VPI were assumed as having hypernasality, which manifested as high nasalance scores.
Patients were asked to read 3 standard passages from the Thai Nasality Test. The second passage is an oral passage that is devoid of nasal consonants. The third passage is an oronasal passage that comprises a mix of oral and nasal consonants used in everyday conversation. Nasalance scores were compared with normative data of Thai subjects. In the present study, only the oronasal passage was used to determine whether resonance was hypernasality or not.
Comparisons between before and after shunt placement were performed using the Wilcoxon signed ranks test or McNemar's test. Correlations were analyzed using Spearman's rank correlation coefficient r s , Pearson's correlation coefficient r , or point-biserial correlation coefficient r p. There were 35 males and 18 females, with a mean age of Of 53 patients who underwent shunt surgery, 3 patients were lost to follow-up at the 6-month time point for the following reasons: 1 patient died due to upper airway obstruction, 1 patient developed pneumonia with sepsis, and 1 patient suffered a traumatic intracranial hematoma ICH; Fig.
Patient demographic data are shown in Table 3. Patient clinical data are given in Table 4. Fifty-two patients improved in at least 1 of 3 triad symptoms. One patient was a nonresponder, having failed to improve in any of the 3 triad symptoms. The nonresponding patient also developed acute kidney injury at 1 month after shunt placement.
Fifty patients received swallowing assessment at 6 months postoperatively. Three patients were lost to followup for the reasons described immediately above. The maximum SPQ score in our study population was 10 points out of a possible maximum of 16 points Fig.
Distribution of change in swallowing problem severity score from preoperatively to 6 months postoperatively. The numbers in the first row and first column represent the number of symptoms SPQ score. Clear cells indicate no change, light gray cells indicate improvement, and dark gray cells indicate deterioration.
Forty-nine patients were given a speech assessment at 6 months after shunt placement. Three patients were lost to follow-up for the reasons mentioned above, 1 of whom developed an ICH due to coagulopathy.
The articulation of 28 patients remained abnormal postoperatively Table 3. No correlation was identified between loudness and triad symptoms. Of the 37 patients with preoperatively abnormal RST scores, 11 became zero RST scores, 10 had a decreased RST score, 13 had no change, and 3 experienced deterioration in their condition at 6 months after shunt placement. Distribution of change in RST score from preoperatively to 6 months postoperatively.
The numbers in the first row and first column represent the RST score. Mean nasalance scores are shown in Table 4. No significant difference was observed between preoperative and postoperative mean nasalance scores.
In , Adams remarked that his patients with NPH became quiet and had slow speech that progressively developed into whispering or no ability to speak at all.
Of 53 probable patients with NPH, only 1 was identified as a nonresponder after shunt placement surgery. After shunt placement, significant improvement was observed in swallowing function, speech characteristic resonation , and speech quality increasing volume. Statistically significant correlations were found between swallowing problem and gait disturbance, articulation disorder and gait disturbance, and speech problem and cognitive impairment. Interestingly, no previous investigation has reported on bulbar dysfunction in NPH, even though dysphagia is a very common feature in neurological disorders.
We also found bulbar dysfunction to be significantly correlated with TMSE score. One patient was lost to follow-up due to pneumonia with sepsis. The diseases of the patients before NPH consisted of 7 with supratentorial tumor, 3 with supratentorial ICH, 2 with subarachnoid hemorrhage, 1 with traumatic epidural hematoma, and 1 with previous craniectomy.
None of the patients had bulbar symptoms when they had these diseases before NPH and they experienced a good recovery after treatment. As such, the comorbid disease of secondary NPH in the present study should not have caused the bulbar palsy. The patients with neurological lesions that cause bulbar palsy were not enrolled because of the exclusion criteria. Based on our clinical experience, we observed that severity of bulbar symptoms correlated well with late or worsening NPH triad symptoms, which were usually found in cases with severe apathy or sleepiness.
Inadequate drainage after CSF shunting also correlated with worsening of bulbar symptoms. As such, they can be used as landmark symptoms for diagnosis and treatment monitoring. There are 2 possible pathoanatomical causes of bulbar dysfunction in NPH.
The first cause involves PVWM damage. Levine et al.
The awareness of distinct phenotypes can also help to facilitate targeted genetic diagnosis. Inflammatory conditions like Guillain-Barre syndrome is also one of the causes of Bulbar Palsy. However, interpretation of the results is hampered by the small number of patients. International Brazilian Journal of Urology. Palminteri E. She developed right eye ptosis, soon followed by the involvement of the other eye.
Bulbar sexual dysfunction. What Causes Bulbar Palsy?
Muscle tone was reduced in all four limbs but reflexes were normal. Barium swallow and laryngo-bronchoscopy were normal along with the MRI of the brain. Video fluoroscopy showed lack of palatal movements and pooling of secretions. The trial of neostigmine led to a marked clinical improvement with increased energy and stronger vocalization along with improved chewing and swallowing abilities.
Currently, he is 2 years old, got a normal motor development, and is on a combination of neostigmine and ephedrine. This patient is the younger sibling of our second case.
Parents were not keen on prenatal testing. She was born by elective caesarean section in a good condition. From day 1, there were concerns with her feeding. She took about an hour to complete a feed and this was associated with choking, spluttering, and coughing. She developed right eye ptosis, soon followed by the involvement of the other eye. Molecular testing of the AChR epsilon subunit confirmed a homozygous mutation c. Parents were reluctant to start her on neostigmine early, but by 5 months of age her symptoms had significantly increased.
She had pooling of secretions and unsafe swallow needing nasogastric tube feeding. She was started on neostigmine with a marked improvement in her swallowing, vocalization, and activity. She looked more alert and responsive. CMS are currently classified based on the site of defect as presynaptic, synaptic based lamina associated, and postsynaptic, with the latter being the commonest.
It is often associated with arthrogryposis multiplex congenita and structural abnormalities of the jaw and palate. These patients usually respond well to anticholinesterases. An early recognition of this genotype can prevent death in a condition, which is easily treatable with a good long-term outcome. Kinali et al. Stridor, which was an early feature in our patient, has not been reported so far with RAPSN mutation.
Our second child and his younger sibling had a homozygous mutation c. She had poor suck and ptosis in the neonatal period and bulbar dysfunction at 4 months of age. The current therapy of CMS is primarily symptomatic and includes various pharmaceutical drugs and other supportive measures. The specialist services of a pediatric gastroenterologist may be required as children with bulbar symptoms may have significant dysphagia, which may require nasogastric tube or gastrostomy feeding.
In children with severe weakness of respiratory muscles, nocturnal or h noninvasive ventilation may be required. For children with CMS, specific molecular diagnosis can help to determine the prognosis along with genetic counseling for the families.
Although rare, CMS are an important and expanding group of disorders involving neuromuscular junction, often requiring a high index of clinical suspicion. These three cases highlight the fact that in any infant or young child with unexplained swallowing difficulties, the possibility of a myasthenic disorder warrants consideration.
With the availability of molecular genetics these conditions can now be diagnosed early and specific treatment initiated, thus preventing morbidity and mortality. The awareness of distinct phenotypes can also help to facilitate targeted genetic diagnosis. Source of Support: Nil. Conflict of Interest: None declared.
National Center for Biotechnology Information , U. Journal List J Pediatr Neurosci v. J Pediatr Neurosci. Jayaprakash A. Author information Copyright and License information Disclaimer. Address for Correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Abstract Congenital myasthenic syndromes are a group of rare genetic disorders affecting neuromuscular transmission.
Keywords: Cholinergic receptor, nicotinic, and epsilon, clinical phenotype, congenital myasthenic syndromes, receptor-associated protein of the synapse, stridor. However, even after 6 months, changes in genital sensitivity were still frequently reported, and this occurs also in patients treated with oral mucosa. This might be explained by damage to some sensory branches of the perineal nerves that supply the ventral surface of the penis [ 24 ].
By transecting the entire corpus spongiosum, one would expect a higher rate of impaired glans tumescence after AR. This was not observed in this series.
However, interpretation of the results is hampered by the small number of patients. This series again underlines the concern of possible alterations in sexual functioning and genital sensitivity after bulbar urethroplasty. Therefore it should be part of the evaluation of patients treated by urethroplasty.
Jackson et al. However, this PROM lacks a section on sexual functioning. Furthermore, it would be interesting to evaluate whether modifications in urethroplasty techniques such as muscle- and nerve-sparing bulbar urethroplasty [ 28 ] and vessel-sparing anastomotic repair [ 29 ] will be associated with less sexual dysfunction.
Important limitations of the present series are the small sample size and the missing data in the postoperative questionnaires. Bulbar urethroplasty is likely to provoke changes in genital sensitivity. Further prospective studies with validated and internationally accepted patient reported outcome measures PROMs are needed for further confirmation. National Center for Biotechnology Information , U. Journal List Adv Urol v.
Adv Urol. Published online Oct 1. Author information Article notes Copyright and License information Disclaimer. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract Objectives. Introduction Although a short bulbar stricture can be treated by dilation or endoscopic urethrotomy, longer or recurrent strictures are best treated by urethroplasty as it provides the best chance of success [ 1 — 3 ].
Materials and Methods 2. Patient Recruitment Out of male patients who underwent urethroplasty between October and February , 90 patients with a bulbar stricture only were planned to be treated with AR or FGU and eligible to participate in this prospective study. Open in a separate window. Figure 1. Statistical Analysis Descriptive statistics were performed to evaluate the whole population and both subgroups.
Figure 2. Discussion Although this series is a prospective study, no randomization was done between AR and FGU because the use of AR is limited by the stricture length. Figure 3. Conclusions AR is associated with a transient decline in erectile and ejaculatory function. Conflict of Interests The authors have no conflict of interests.
References 1. Morey A. Buckley J. Chapple C. Lumen N. Urethroplasty for urethral strictures: quality assessment of an in-home algorithm. International Journal of Urology. Meeks J. Stricture recurrence after urethroplasty: a systematic review.
The Journal of Urology. Xie H. Evaluation of erectile function after urethral reconstruction: a prospective study. Asian Journal of Andrology. Erickson B. Prospective analysis of erectile dysfunction after anterior urethroplasty: incidence and recovery of function.
Palminteri E. The impact of ventral oral graft bulbar urethroplasty on sexual life. Rosen R. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function IIEF-5 as a diagnostic tool for erectile dysfunction.
International Journal of Impotence Research. The international index of erectile function IIEF : A multidimensional scale for assessment of erectile dysfunction. Multi-institutional 1-year bulbar urethroplasty outcomes using a standardized prospective cystoscopic follow-up protocol. Andrich D. What is the best technique for urethroplasty? European Urology. Etiology of urethral stricture disease in the 21st century.
Carlton J. Erectile function after urethral reconstruction. Erectile function, sexual drive, and ejaculatory function after reconstructive surgery for anterior urethral stricture disease.
BJU International. Coursey J. Erectile function after anterior urethroplasty. Anterior urethroplasty and effects on sexual life: which is the best technique? Minerva Urologica e Nefrologica. Al-Qudah H. Extended complications of urethroplasty. International Brazilian Journal of Urology.
Barbagli G. Long-term followup of bulbar end-to-end anastomosis: a retrospective analysis of patients in a single center experience.
Johnson E. The impact of urethroplasty on voiding symptoms and sexual function. Anger J. The effect of bulbar urethroplasty on erectile function. Ekerhult T. Low risk of sexual dysfunction after transection and nontransection urethroplasty for bulbar urethral stricture.
Mundy A. Results and complications of urethroplasty and its future. British Journal of Urology. Yucel S. Neuroanatomy of the male urethra and perineum. Akman Y. Penile anatomy under the pubic arch: reconstructive implications.
Prospective analysis of ejaculatory function after anterior urethral reconstruction. Jackson M. Defining a patient-reported outcome measure for urethral stricture surgery. Muscle- and nerve-sparing bulbar urethroplasty: a new technique. Gur U. Vessel-sparing excision and primary anastomosis for proximal bulbar urethral strictures BJU International. Articles from Advances in Urology are provided here courtesy of Hindawi Limited. Support Center Support Center.
Wayne J. Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. Urethral stricture disease, pelvic fracture urethral injury PFUI , and their various treatment options are associated with erectile dysfunction ED. The etiology of urethral stricture disease is multifactorial and includes trauma, inflammatory, and iatrogenic causes. Posterior urethral injuries are commonly associated with pelvic fractures.
There is a spectrum in the severity of both conditions and this directly impacts the treatment options offered by the surgeon. Many published studies focus on the treatment outcomes and the relatively high recurrence rates after surgical repair. This communication reviews the current knowledge of the association between ED and urethral stricture disease, as well as PFUI. The incidence, pathophysiology, and clinical ramifications of both conditions on sexual function are discussed.
The treatment options for ED in those patients are reviewed and summarized. The male urethra is divided into four parts: prostatic, membranous, bulbar, and penile urethra. Each urethral segment has recognized differences in the surrounding anatomy and apparent etiologies of urethral narrowing.
Historically, urethral stricture disease was most often associated with gonococcal urethritis. Instrumentation is a possible cause of injury to the urethral mucosa. Posterior urethral injury is usually associated with pelvic fractures. Shear mechanisms resulting in pelvic fracture may tear through the bulbomembranous urethra and lead to urethral disruption and displacement.
Treatment options vary as a consequence of these differences. More traditional therapies for urethral stricture disease include urethral dilation, direct visual internal urethrotomy DVIU and a variety of open urethroplasty techniques.
Treatment options are selected based on the severity length and density , location, patient comorbidities, and surgeon preference. It is postulated that surgical treatment of urethral stricture itself might affect sexual function. The objective of this article is to review the associations between urethral stricture, PFUI and ED; namely incidence, pathophysiology, and the consequences on sexual function that occur after each type of operative intervention.
The subsequent treatment of ED in this cohort is also addressed. The true incidence of ED in urethral stricture patients is not known. Currently, there are only limited studies aimed primarily at evaluating the incidence of ED in this population.
There are many factors that affect the incidence of ED in these patients, including baseline erectile function, the underlying cause of the stricture, the location, and severity of the stricture. Other investigators have documented that urethral stricture had a significant impact on sexual life, particularly in relation to ejaculatory function. The etiology of urethral stricture varies widely from one patient to another.
As such, it is difficult to ascertain whether the etiology of ED is the urethral stricture itself, or the psychological impact of the urethral stricture which may affect sexual interest and erectile function prior to definite treatment, or other causes unrelated to the urethral stricture.
Urethral injury is a major risk factor for ED after pelvic fracture. Clinicians postulate neurovascular injury as the likely cause of ED in traumatic urethral injury patients. Cavernous nerves and branches of the internal pudendal artery are located near the apex of the prostate and pass through the urogenital diaphragm to enter the corporal bodies.
Penile duplex doppler ultrasound documented that A multivariate analysis documented that diastasis of the pubic symphysis, lateral prostatic displacement, and a long urethral gap at surgery all of which occur with more severe pelvic traumas are the predictors of ED after pelvic fracture urethral injuries with an odds ratios OR of The mean length of the urethral gap in patients with normal erectile function was 2.
Age at the onset of urethral injury is another risk factor for ED. Treatment options for urethral stricture disease include urethral dilation, DVIU and various techniques of open urethroplasty.
It has been difficult for researchers to evaluate the impact each treatment modality has on sexual dysfunction. Confounding factors include the high incidence of ED before surgery and prior surgeries to treat recurrent urethral stricture. Furthermore, the stricture length and location in each patient are different, even in patients offered the same treatment, making it difficult to predict the effect on sexual outcome.
Urethral dilation and DVIU are less invasive treatments when compared with open urethroplasty and are suitable for short urethral strictures.
DVIU was introduced by Sachse in Sexual dysfunction outcomes after DVIU are reported in the range 2. ED after urethroplasty was first reported by Mundy. The reported incidence of ED after anterior urethroplasty varies from 2. The mean international index of erectile function IIEF score decreased by Urologists may need to perform more aggressive dissection in the bulbar region with a corresponding higher risk of injury when performing a direct bulbar anastomosis, as compared with a bulbar graft urethroplasty.
This technique preserves the remaining urethral plate and avoids the use of a wide single dorsal or ventral graft. However, as an obvious limitation, only 5 of the 36 studies used the IIEF questionnaire to evaluate erectile function before and after surgery. Also sexual function was not the primary objective of the studies. Published studies are mostly retrospective, underpowered and use rudimentary assessment tools e.
The total ED incidence after posterior urethroplasty was significantly lower than before surgery [ In addition, patients reported improvement on the MSHQ in the ejaculatory categories after repair.
It is postulated that this occurs from trauma itself, before urethroplasty is performed. Posterior urethral distraction injury patients usually have more scar tissue and fibrosis around the stenotic area as compared with patients who have undergone anterior urethroplasty. Sixty percent remained potent and of these almost all 64 of 66 patients remained potent after posterior urethroplasty.
Two patients became impotent after surgery and this was attributed to a complex and lengthy transpubic procedure 9 and Furthermore, the incidence of ED after posterior urethroplasty was significantly lower than before operation Hence, it appears that there are no significant deleterious effects on erectile function after posterior urethroplasty.
Excision of scar and fibrotic tissue during surgery will decompress nerves and may lead to improvement of erectile function after urethroplasty. In addition, the elimination of a suprapubic tube after surgery, and improvement of body image, as well as psychological factors are other possible explanations for the improvement of erectile function after surgery.
The possible pathophysiology of ED related to posterior urethroplasty is shown in Fig. Patients who did not respond to sildenafil were subsequently treated with intracavernosal injection ICI therapy. Penile rehabilitation has been examined as well. There is a high response rate especially in patients with neurogenic ED. However, more clinical studies are needed to validate the benefits of penile rehabilitation after PFUI or after urethroplasty.
However, there was a high failure rate. The diagnosis of an arterial occlusion needs to be defined by both PDDU and pelvic arterial angiography prior to surgery. The patency of the IEA is evaluated by angiography. Theoretically, PR can correct arteriogenic ED. Data are limited on the outcomes of PR after pelvic fracture with associated urethral injury, because of the lack of randomized trials and small series.
Duplex ultrasound peak systolic velocity of the cavernosal arteries increased from baseline by There are limited published data on the outcomes of penile prosthesis placement after treatment of urethral stricture disease and posterior urethral distraction defect. Generally, the urethral stricture and PFUI should be corrected before penile prosthesis implantation to minimize the risk of prosthesis infection.
One case report suggests caution should be exercised when implanting a prosthesis in the setting of a long urethral defect. Eighteen months after penile prosthesis implantation, the patient developed a prosthesis infection and the prosthesis was removed.
The urethrogram revealed complete obliteration of the urethra distal to the previous repair. The authors postulated that the compression of the urethral tissues as a result of the prosthesis in a patient with a shortened urethra lead to ischemia, erosion, and ultimately the infection. For this reason, the authors recommended using an inflatable rather than semirigid penile prosthesis and using a smaller prosthesis to reduce the chances of prolonged ischemia and necrosis of the urethra. However, this technique of combined urethral and prosthesis surgery is not routinely recommended, because of the high risk of device infection.
DVIU and anterior urethroplasty have minimal effects on sexual function. Some PFUI patients may regain erectile function after scar excision and subsequent nerve decompression from posterior urethroplasty. The limited available medical literature has resulted in no specific guidelines for the treatment of ED in urethral stricture and PFUI patients. Doppler results help guide the clinician's treatment and predict response rates.
PR has reported inconsistent outcomes and, because of the need for specific microvascular expertise, should only be performed in specialized centers. Penile prosthesis implantation provides excellent results in ED patients who have failed medical therapy.
Volume 3 , Issue 3. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username.
Review Article Free Access. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Summary Urethral stricture disease, pelvic fracture urethral injury PFUI , and their various treatment options are associated with erectile dysfunction ED.
ED in urethral stricture patients The true incidence of ED in urethral stricture patients is not known. ED after treatment of urethral stricture disease Treatment options for urethral stricture disease include urethral dilation, DVIU and various techniques of open urethroplasty.
Direct visual internal urethrotomy Urethral dilation and DVIU are less invasive treatments when compared with open urethroplasty and are suitable for short urethral strictures.