Андрология и генитальная хирургия. 2023; 24: 100-114
Оценка эректильной функции у пациентов после уретропластики: систематический обзор и метаанализ
https://doi.org/10.17650/2070-9781-2023-24-1-100-114Аннотация
Введение. Успешность оперативного лечения стриктур уретры часто оценивается по параметрам качества мочеиспускания и проходимости просвета уретры. Несмотря на то что данная оценка проводится по вышеуказанным параметрам, немаловажно принимать во внимание такое возможное осложнение, как эректильная дисфункция, которая может существенно снижать качество жизни пациента. В этом заключается различие в восприятии успешности оперативного вмешательства клиницистом и пациентом.
Цель исследования – определение связи между уретропластикой и вероятностью возникновения эректильной дисфункции в послеоперационном периоде по данным мировой литературы.
Материалы и методы. Проведен поиск публикаций в базе данных PubMed с использованием ключевых слов: передняя уретропластика, задняя уретропластика, уретропластика, сексуальная дисфункция, эректильная дисфункция. Все публикации были рассмотрены двумя независимыми авторами с целью последующего включения в анализ с учетом заранее установленных критериев. Среди включенных в анализ научных работ имеются рандомизированные контролируемые исследования, систематические обзоры.
Результаты. В итоговое исследование были включены 16 научных работ с общим количеством пациентов 1476. Снижение эректильной функции после операции по данным проведенного метаанализа составило 3 %. Основным и факторами, влияющими на постоперационные показатели, были возраст и эректильная функция на момент оперативного вмешательства.
Заключение. В большинстве исследований утверждается, что уретропластика не предполагает значительного влияния на эректильную функцию, однако признается, что возникновение этого осложнения отражается на оценке результатов лечения пациентами и оказывает влияние на качество их жизни независимо от послеоперационной функции мочевыделения.
Список литературы
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2. Palminteri E., Berdondini E., Verze P. et al. Contemporary urethral stricture characteristics in the developed world. Urology 2013;81(1):191–6. DOI: 10.1016/j.urology.2012.08.062
3. 3Lumen N., Hoebeke P., Willemsen P. et al. Etiology of urethral stricture disease in the 21st century. J Urol 2009;182(3):983–7. DOI: 10.1016/j.juro.2009.05.023
4. Hampson L.A., Mcaninch J.W., Breyer B.N. Male urethral strictures and their management. Nat Rev Urol 2014;11(1):43–50. DOI: 10.1038/nrurol.2013.275
5. Palminteri E., Berdondini E., De Nunzio C. et al. The impact of ventral oral graft bulbar urethroplasty on sexual life. Urology 2013;81(4):891–8.
6. Sangkum P., Levy J., Yafi F.A., Hellstrom W.J.G. Erectile dysfunction in urethral stricture and pelvic fracture urethral injury patients: diagnosis, treatment, and outcomes. Andrology 2015;3(3):443–9. DOI: 10.1111/andr.12015
7. Chapple C., Andrich D., Atala A. et al. SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty. Urology 2014;83(3 Suppl): S31–47. DOI: 10.1016/j.urology.2013.09.012
8. Mundy A.R., Andrich D.E. Urethral strictures. BJU Int 2011;107(1):6–26. DOI: 10.1111/j.1464-410X.2010.09800.x
9. Erickson B.A., Wysock J.S., McVary K.T. et al. Erectile function, sexual drive, and ejaculatory function after reconstructive surgery for anterior urethral stricture disease. BJU Int 2007;99(3):607–11. DOI: 10.1111/j.1464-410X.2006.06669.x
10. Moher D., Shamseer L., Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4(1):1. DOI: 10.1186/2046-4053-4-1
11. Mazzone A., Anderson R., Voelzke B.B. et al. Sexual function following pelvic fracture urethral injury and posterior urethroplasty. Transl Androl Urol 2021;10(5):2043–50. DOI: 10.21037/tau-20-1287
12. Enganti B., Reddy M.S., Chiruvella M. et al. Double-face augmentation urethroplasty for bulbar urethral strictures: analysis of short-term outcomes. Turk J Urol 2020;46(5):383–7. DOI: 10.5152/tud.2020.20106
13. D’hulst P., Floyd M.S. Jr., Castiglione F. et al. Excision and primary anastomosis for bulbar urethral strictures improves functional outcomes and quality of life: a prospective analysis from a single centre. Biomed Res Int 2019;2019:7826085. DOI: 10.1155/2019/7826085
14. Angulo J.C., Dorado J.F., Policastro C.G. et al. Multi-institutional study of dorsal onlay urethroplasty of the membranous urethra after endoscopic prostate procedures: operative results, continence, erectile function and patient reported outcomes. J Clin Med 2021;10(17):3969. DOI: 10.3390/jcm10173969
15. Bertrand L.A., Voelzke B.B., Elliott S.P. et al. Measuring and predicting patient dissatisfaction after anterior urethroplasty using patient reported outcomes measures. J Urol 2016;196(2):453–61. DOI: 10.1016/j.juro.2016.01.117
16. Omar R.G., Khalil M.M., Alezaby H. et al. Evaluation of erectile function after anastomotic vs substitutional urethroplasty for bulbar urethral stricture. Arab J Urol 2020;18(4):226–32. DOI: 10.1080/2090598X.2020.1805965
17. Singh U.P., Maheshwari R., Kumar V. et al. Impact on sexual function after reconstructive surgery for anterior urethral stricture disease. Indian J Urol 2010;26(2):188–92. DOI: 10.4103/0970-1591.65384
18. Tyagi S., Parmar K., Sharma A. et al. Dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: long-term outcomes from a single tertiary care centre. World J Urol 2021;39(9):3549–54. DOI: 10.1007/s00345-021-03613-9
19. Sachin D., Chikka Moga Siddaiah M., Vilvapathy Senguttuvan K. et al. Incidence of de novo erectile dysfunction after urethroplasty: a prospective observational study. World J Mens Health 2017;35(2):94–9. DOI: 10.5534/wjmh.2017.35.2.94
20. Kałużny A., Krukowski J., Matuszewski M. Erectile dysfunction after urethroplasty. Cent European J Urol 2019;72(4):402–7. DOI: 10.5173/ceju.2019.1737
21. Soave A., Kluth L., Dahlem R. et al. Outcome of buccal mucosa graft urethroplasty: a detailed analysis of success, morbidity and quality of life in a contemporary patient cohort at a referral center. BMC Urol 2019;19(1):18. DOI: 10.1186/s12894-019-0449-5
22. Urkmez A., Yuksel O.H., Ozsoy E. et al. The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study. Int Braz J Urol 2019;45(1):118–26. DOI: 10.1590/S1677-5538.IBJU.2018.0276
23. Patel D.P., Elliott S.P., Voelzke B.B. et al. Patient-reported sexual function after staged penile urethroplasty. Urology 2015;86(2):395–400. DOI: 10.1016/j.urology.2015.04.055
24. Beloborodov V., Vorobev V., Kalyagin A. et al. Comparison of efficiency of vascular-preserving urethroplastic methods of the bulbo-membranous part of the urethra. Videosurg Other Miniinvasive Tech 2021;16(1):151–62. DOI: 10.5114/wiitm.2020.94281
25. Vorobev V., Beloborodov V., Seminskiy I. et al. Buccal mucosal graft urethroplasty of the bulbomembranous part of urethra. Cent European J Urol 2020;73(2):199–212. DOI: 10.5173/ceju.2020.0021
26. Kałużny A., Krukowski J., Frankiewicz M., Matuszewski M. The impact of post-urethroplasty erectile dysfunction on the quality of life and treatment satisfaction. Cent European J Urol 2021;74(1):116–20. DOI: 10.5173/ceju.2021.0306.R1
27. Calleja Hermosa P., Campos-Juanatey F., Varea Malo R. et al. Sexual function after anterior urethroplasty: a systematic review. Transl Androl Urol 2021;10(6):2554–73. DOI: 10.21037/tau-20-1307
28. Mundy A.R. Results and complications of urethroplasty and its future. Br J Urol 1993;71(3):322–5. DOI: 10.1111/j.1464-410x.1993.tb15951.x
29. Blaschko S.D., Sanford M.T., Cinman N.M. et al. De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis. BJU Int 2013;112(5):655–63. DOI: 10.1111/j.1464-410X.2012.11741.x
30. Xie H., Xu Y.M., Fu Q. et al. The relationship between erectile function and complex panurethral stricture: a preliminary investigative and descriptive study. Asian J Androl 2015;17(2):315–8. DOI: 10.4103/1008-682X.143312
31. Dogra P.N., Saini A.K., Seth A. Erectile dysfunction after anterior urethroplasty: A prospective analysis of incidence and probability of recovery – single-center experience. Urology 2011;78(1):78–81. DOI: 10.1016/j.urology.2011.01.019
32. Coursey J.W., Morey A.F., McAninch J.W. et al. Erectile function after anterior urethroplasty. J Urol 2001;166(6):2273–6.
33. Shakir N.A., Fuchs J.S., Haney N. et al. Excision and primary anastomosis reconstruction for traumatic strictures of the pendulous urethra. Urology 2019;125:234–8. DOI: 10.1016/j.urology.2018.05.043
34. Morey A.F., Kizer W.S. Proximal bulbar urethroplasty via extended anastomotic approach – what are the limits? J Urol 2006;175(6):2145–9; discussion 9. DOI: 10.1016/S0022-5347(06)00259-X
35. Barbagli G., De Angelis M., Romano G., Lazzeri M. Long-term followup of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol 2007;178(6):2470–3. DOI: 10.1016/j.juro.2007.08.018
36. Mondal S., Bandyopadhyay A., Mandal M.M., Pal D.K. Erectile dysfunction in anterior urethral strictures after urethroplasty with reference to vascular parameters. Med J Armed Forces India 2016;72(4):344–9. DOI: 10.1016/j.mjafi.2016.07.001
37. Jordan G.H., Eltahawy E.A., Virasoro R. The technique of vessel sparing excision and primary anastomosisfor proximal bulbous urethral reconstruction. J Urol 2007;177(5):1799–802. DOI: 10.1016/j.juro.2007.01.036
38. Andrich D.E., Mundy A.R. Non-transecting anastomotic bulbar urethroplasty: a preliminary report. BJU Int 2012;109(7):1090–4. DOI: 10.1111/j.1464-410X.2011.10508.x
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41. Palminteri E., Berdondini E., Shokeir A.A. et al. Two-sided bulbar urethroplasty using dorsal plus ventral oral graft: urinary and sexual outcomes of a new technique. J Urol 2011;185(5):1766–71. DOI: 10.1016/j.juro.2010.12.103
42. Spencer J., Blakely S., Daugherty M. et al. Clinical and patientreported outcomes of 1-sided anterior urethroplasty for longsegment or panurethral strictures. Urology 2018;111:208–13. DOI: 10.1016/j.urology.2017.08.029
43. Maciejewski C.C., Haines T., Rourke K.F. Chordee and penile shortening rather than voiding function are associated with patient dissatisfaction after urethroplasty. Urology 2017;103:234–9. DOI: 10.1016/j.urology.2016.12.047
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50. Anger J.T., Sherman N.D., Webster G.D. The effect of bulbar urethroplasty on erectile function. J Urol 2007;178(3 Pt 1):1009–11. DOI: 10.1016/j.juro.2007.05.053
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52. Zhang D.L., Chen Z., Wang F.X. et al. Adding a vacuum erection device to regular use of Tadalafil improves penile rehabilitation after posterior urethroplasty. Asian J Androl 2019;21(6):582–6. DOI: 10.4103/aja.aja_50_19
Andrology and Genital Surgery. 2023; 24: 100-114
Erectile function evaluation in patients after urethroplasty: systematic review and meta-analysis
https://doi.org/10.17650/2070-9781-2023-24-1-100-114Abstract
Background. The success of surgical treatment of urethral strictures is often assessed in terms of the quality of urination and the patency of the urethral lumen. Despite the fact that this assessment is carried out according to the above parameters, it seems important to take into account such a possible complication as erectile dysfunction, which can significantly impair the patient’s quality of life. This is the difference in the perception of the success of the surgical intervention by the clinician and the patient.
Aim. To determine the relationship between urethroplasty and the likelihood of erectile dysfunction in the postoperative period according to world literature.
Materials and methods. The PubMed database was analyzed using the keywords: anterior urethroplasty, posterior urethroplasty, urethroplasty, sexual dysfunction, erectile dysfunction. All articles were reviewed by two independent authors for inclusion based on predetermined criteria. Among the included scientific papers are randomized controlled trials, systematic reviews.
Results. Sixteen scientific papers with a total of 1476 patients were included in the final study. The decrease in erectile function after surgery in this meta-analysis is 3 %. The main factors influencing postoperative parameters were age and erectile function at the time of surgery.
Conclusion. Most studies state that urethroplasty does not imply a significant impact on erectile function, however, they acknowledge that the occurrence of this complication affects the assessment of treatment outcomes among patients and the further impact on their quality of life, regardless of postoperative urinary function.
References
1. Santucci R.A., Joyce G.F., Wise M. Male urethral stricture disease. J Urol 2007;177(5):1667–74. DOI: 10.1016/j.juro.2007.01.041
2. Palminteri E., Berdondini E., Verze P. et al. Contemporary urethral stricture characteristics in the developed world. Urology 2013;81(1):191–6. DOI: 10.1016/j.urology.2012.08.062
3. 3Lumen N., Hoebeke P., Willemsen P. et al. Etiology of urethral stricture disease in the 21st century. J Urol 2009;182(3):983–7. DOI: 10.1016/j.juro.2009.05.023
4. Hampson L.A., Mcaninch J.W., Breyer B.N. Male urethral strictures and their management. Nat Rev Urol 2014;11(1):43–50. DOI: 10.1038/nrurol.2013.275
5. Palminteri E., Berdondini E., De Nunzio C. et al. The impact of ventral oral graft bulbar urethroplasty on sexual life. Urology 2013;81(4):891–8.
6. Sangkum P., Levy J., Yafi F.A., Hellstrom W.J.G. Erectile dysfunction in urethral stricture and pelvic fracture urethral injury patients: diagnosis, treatment, and outcomes. Andrology 2015;3(3):443–9. DOI: 10.1111/andr.12015
7. Chapple C., Andrich D., Atala A. et al. SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty. Urology 2014;83(3 Suppl): S31–47. DOI: 10.1016/j.urology.2013.09.012
8. Mundy A.R., Andrich D.E. Urethral strictures. BJU Int 2011;107(1):6–26. DOI: 10.1111/j.1464-410X.2010.09800.x
9. Erickson B.A., Wysock J.S., McVary K.T. et al. Erectile function, sexual drive, and ejaculatory function after reconstructive surgery for anterior urethral stricture disease. BJU Int 2007;99(3):607–11. DOI: 10.1111/j.1464-410X.2006.06669.x
10. Moher D., Shamseer L., Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4(1):1. DOI: 10.1186/2046-4053-4-1
11. Mazzone A., Anderson R., Voelzke B.B. et al. Sexual function following pelvic fracture urethral injury and posterior urethroplasty. Transl Androl Urol 2021;10(5):2043–50. DOI: 10.21037/tau-20-1287
12. Enganti B., Reddy M.S., Chiruvella M. et al. Double-face augmentation urethroplasty for bulbar urethral strictures: analysis of short-term outcomes. Turk J Urol 2020;46(5):383–7. DOI: 10.5152/tud.2020.20106
13. D’hulst P., Floyd M.S. Jr., Castiglione F. et al. Excision and primary anastomosis for bulbar urethral strictures improves functional outcomes and quality of life: a prospective analysis from a single centre. Biomed Res Int 2019;2019:7826085. DOI: 10.1155/2019/7826085
14. Angulo J.C., Dorado J.F., Policastro C.G. et al. Multi-institutional study of dorsal onlay urethroplasty of the membranous urethra after endoscopic prostate procedures: operative results, continence, erectile function and patient reported outcomes. J Clin Med 2021;10(17):3969. DOI: 10.3390/jcm10173969
15. Bertrand L.A., Voelzke B.B., Elliott S.P. et al. Measuring and predicting patient dissatisfaction after anterior urethroplasty using patient reported outcomes measures. J Urol 2016;196(2):453–61. DOI: 10.1016/j.juro.2016.01.117
16. Omar R.G., Khalil M.M., Alezaby H. et al. Evaluation of erectile function after anastomotic vs substitutional urethroplasty for bulbar urethral stricture. Arab J Urol 2020;18(4):226–32. DOI: 10.1080/2090598X.2020.1805965
17. Singh U.P., Maheshwari R., Kumar V. et al. Impact on sexual function after reconstructive surgery for anterior urethral stricture disease. Indian J Urol 2010;26(2):188–92. DOI: 10.4103/0970-1591.65384
18. Tyagi S., Parmar K., Sharma A. et al. Dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: long-term outcomes from a single tertiary care centre. World J Urol 2021;39(9):3549–54. DOI: 10.1007/s00345-021-03613-9
19. Sachin D., Chikka Moga Siddaiah M., Vilvapathy Senguttuvan K. et al. Incidence of de novo erectile dysfunction after urethroplasty: a prospective observational study. World J Mens Health 2017;35(2):94–9. DOI: 10.5534/wjmh.2017.35.2.94
20. Kałużny A., Krukowski J., Matuszewski M. Erectile dysfunction after urethroplasty. Cent European J Urol 2019;72(4):402–7. DOI: 10.5173/ceju.2019.1737
21. Soave A., Kluth L., Dahlem R. et al. Outcome of buccal mucosa graft urethroplasty: a detailed analysis of success, morbidity and quality of life in a contemporary patient cohort at a referral center. BMC Urol 2019;19(1):18. DOI: 10.1186/s12894-019-0449-5
22. Urkmez A., Yuksel O.H., Ozsoy E. et al. The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study. Int Braz J Urol 2019;45(1):118–26. DOI: 10.1590/S1677-5538.IBJU.2018.0276
23. Patel D.P., Elliott S.P., Voelzke B.B. et al. Patient-reported sexual function after staged penile urethroplasty. Urology 2015;86(2):395–400. DOI: 10.1016/j.urology.2015.04.055
24. Beloborodov V., Vorobev V., Kalyagin A. et al. Comparison of efficiency of vascular-preserving urethroplastic methods of the bulbo-membranous part of the urethra. Videosurg Other Miniinvasive Tech 2021;16(1):151–62. DOI: 10.5114/wiitm.2020.94281
25. Vorobev V., Beloborodov V., Seminskiy I. et al. Buccal mucosal graft urethroplasty of the bulbomembranous part of urethra. Cent European J Urol 2020;73(2):199–212. DOI: 10.5173/ceju.2020.0021
26. Kałużny A., Krukowski J., Frankiewicz M., Matuszewski M. The impact of post-urethroplasty erectile dysfunction on the quality of life and treatment satisfaction. Cent European J Urol 2021;74(1):116–20. DOI: 10.5173/ceju.2021.0306.R1
27. Calleja Hermosa P., Campos-Juanatey F., Varea Malo R. et al. Sexual function after anterior urethroplasty: a systematic review. Transl Androl Urol 2021;10(6):2554–73. DOI: 10.21037/tau-20-1307
28. Mundy A.R. Results and complications of urethroplasty and its future. Br J Urol 1993;71(3):322–5. DOI: 10.1111/j.1464-410x.1993.tb15951.x
29. Blaschko S.D., Sanford M.T., Cinman N.M. et al. De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis. BJU Int 2013;112(5):655–63. DOI: 10.1111/j.1464-410X.2012.11741.x
30. Xie H., Xu Y.M., Fu Q. et al. The relationship between erectile function and complex panurethral stricture: a preliminary investigative and descriptive study. Asian J Androl 2015;17(2):315–8. DOI: 10.4103/1008-682X.143312
31. Dogra P.N., Saini A.K., Seth A. Erectile dysfunction after anterior urethroplasty: A prospective analysis of incidence and probability of recovery – single-center experience. Urology 2011;78(1):78–81. DOI: 10.1016/j.urology.2011.01.019
32. Coursey J.W., Morey A.F., McAninch J.W. et al. Erectile function after anterior urethroplasty. J Urol 2001;166(6):2273–6.
33. Shakir N.A., Fuchs J.S., Haney N. et al. Excision and primary anastomosis reconstruction for traumatic strictures of the pendulous urethra. Urology 2019;125:234–8. DOI: 10.1016/j.urology.2018.05.043
34. Morey A.F., Kizer W.S. Proximal bulbar urethroplasty via extended anastomotic approach – what are the limits? J Urol 2006;175(6):2145–9; discussion 9. DOI: 10.1016/S0022-5347(06)00259-X
35. Barbagli G., De Angelis M., Romano G., Lazzeri M. Long-term followup of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol 2007;178(6):2470–3. DOI: 10.1016/j.juro.2007.08.018
36. Mondal S., Bandyopadhyay A., Mandal M.M., Pal D.K. Erectile dysfunction in anterior urethral strictures after urethroplasty with reference to vascular parameters. Med J Armed Forces India 2016;72(4):344–9. DOI: 10.1016/j.mjafi.2016.07.001
37. Jordan G.H., Eltahawy E.A., Virasoro R. The technique of vessel sparing excision and primary anastomosisfor proximal bulbous urethral reconstruction. J Urol 2007;177(5):1799–802. DOI: 10.1016/j.juro.2007.01.036
38. Andrich D.E., Mundy A.R. Non-transecting anastomotic bulbar urethroplasty: a preliminary report. BJU Int 2012;109(7):1090–4. DOI: 10.1111/j.1464-410X.2011.10508.x
39. Chapman D.W., Cotter K., Johnsen N.V. et al. Nontransecting techniques reduce sexual dysfunction after anastomotic bulbar urethroplasty: results of a multi-institutional comparative analysis. J Urol 2019;201(2):364–70. DOI: 10.1016/j.juro.2018.09.051
40. Haines T., Rourke K.F. The effect of urethral transection on erectile function after anterior urethroplasty. World J Urol 2017;35(5):839–45. DOI: 10.1007/s00345-016-1926-z
41. Palminteri E., Berdondini E., Shokeir A.A. et al. Two-sided bulbar urethroplasty using dorsal plus ventral oral graft: urinary and sexual outcomes of a new technique. J Urol 2011;185(5):1766–71. DOI: 10.1016/j.juro.2010.12.103
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