The Impact of Ventral Oral Graft Bulbar Urethroplasty on Sexual Life

Enzo Palminteri1, Giovanni Battista Di Pierro2, Elisa Berdondini1, Cosimo De Nunzio3, Lorenzo Larocca4
  • 1 Centro di Chirurgia Uretrale (Arezzo)
  • 2 Università "La Sapienza" - Dipartimento di Urologia (Roma)
  • 3 Ospedale Sant'Andrea - Dipartimento di Urologia ( Roma)
  • 4 Ospedale di Martinafranca - - Dipartimento di Urologia (Martinafranca)

Objective

The potential complications of the urethral surgery need to be better understood in order to reduce their probability of occurrence and enable the specialist to provide the right information during counseling. With the aim of studying sexual complications following urethroplasty, some Authors have recently used different validated questionnaires. Others used adapted but non validated questionnaires. However, most of the studies mix repairs of different urethral segments and different reconstructive techniques making interpretation of results difficult.
We evaluated the pre- and postoperative aspects of sexual life (SL) in patients with bulbar urethral stricture who underwent ventral oral graft urethroplasty using the MSHQ-Long Form (LF) and the unvalidated Post-Urethroplasty Sexual Questionnaire (PUSQ).

Methods and results

Between 2009 and 2010, men undergoing ventral oral graft bulbar urethroplasty were enrolled in a prospective study to ascertain sexual disorders before and after surgery. The validated Male Sexual Health Questionnaire-Long Form(MSHQ-LF) was completed pre- and postoperatively; the unvalidated but adapted Post-Urethroplasty Sexual Questionnaire(PUSQ) was completed postoperatively. Data were compared using the non parametric Wilcoxon test.
Regarding the pre-operative disorders related to the urethral stricture, 44 patients(84.6%) reported reduced ejaculatory stream, 14(26.9%) painful ejaculation, 14(26.9%) ejaculation failure, 10(19.2%) infections or burning after sexual intercourse. These sexual disorders have persisted for a long time(>5 yrs in 30 pts, 57.7%) and influenced enough or markedly(24 pts, 46.2%) the QoL. With regard to the changes in erection following urethroplasty, none of the patients complained of a worsened erection, while 18 patients(34.6%) reported an improved erection. Only 2 patients(3.8%) reported a small penile curvature associated with a slight shortening. All(100%) reported a completely swollen glans during erection.
In what concerns the changes in ejaculation following urethroplasty, 34 patients(65.4%) had an improved ejaculation due to a stronger/non-obstructed stream or because the burning/pain during ejaculation had disappeared. Only 10 pts(19.2%) reported a worsened ejaculation because of post-ejaculation dribbling or reduced stream.
Regarding the postoperative sensitivity genital disorders, 22 pts(42.4%) localized them in the scroto-perineum, and 4(7.6%) in the glans. Only 2(3.8%) pts felt their glans cold during erection. Nobody reported problems in the sexual activity due to these sensitivity disorders.
As regards the changes in genital cosmesis, only 8 pts(15.4%) noticed aesthetic changes, mainly located in the scrotum and/or in the perineum. Nobody experienced problems in the sexual activity due to these aesthetic changes.
No patient reported problems in the sexual activity due to oral harvesting.
In what concerns the surgery impact on SL, 14 pts(27%) reported an increased frequency of intercourses, while only 4(7.6%) a decreased frequency. Nobody reported a decreased sexual desire, while 36 patients(69.2%) reported an improved desire. The quality of SL improved in 34 patients(65.4%). The sentimental relationship with partner resulted improved in 12 patients(23%). This improvement was confirmed by 38.5% of partners.
As regards the satisfaction degree with urethroplasty, none of the patients complained of a worsening in the QoL; on the contrary all(100%) reported an improved QoL and were satisfied with the final result of urethroplasty.
In relation to the importance of Counseling, 38 patients(73.2%) declared a medium/high anxiety degree tackling urethroplasty and 50 patients(96.2%) declared that it is important to be informed in detail about the various surgical techniques that could be used during urethroplasty. Thirty-eight patients(73%) declared they have been provided with all the necessary information regarding possible sexual complications following urethroplasty, while 14(27%) denied having been adequately information.
With regard to the most significant fears prior to undergoing urethroplasty, 44 patients(84.6%) declared to be afraid that surgery might not be resolutive, 18(34.6%) to be afraid of a postoperative worsening in the quality of SL and 16(30.8%) to be afraid of the postoperative genital scars.

Discussion

Literature has supposed that bulbar urethroplasty has the potential to adversely affect sexual life, potentially involving different anatomical structures concerned with sexual function, but to date it is lacking an exhaustive analysis of several pre- and postoperative aspects of SL in selected series of patients undergoing bulbar reconstruction. Our study suggests that urethral stricture disease determines sexual disorders which have a significant impact on SL. Patients confessed a marked anxiety tackling urethroplasty and declared that one of their deepest fears regarded a potential further deterioration in the quality of SL. The minimally-invasive ventral graft urethroplasty showed to improve SL in all its aspects.

References

1- Johnson EK, and Latini JM: The Impact of Urethroplasty on Voiding Symptoms and Sexual Function. Urology 2011; 78: 198-201.
2- Dogra PN, Saini KA, and Seth A: Erectile Dysfunction After Anterior Urethroplasty: A Prospective Analysis of Incidence and Probability of Recovery—Single-center Experience. Urology 2011; 78: 78-81.
3- Palminteri E, Berdondini E, Shokeir AA, et al: Two-sided Bulbar Urethroplasty Using Dorsal Plus Ventral Oral Graft: Urinary and Sexual Outcomes of a New Technique. J Urol 2011; 185: 1766-1771.

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