Impact of urethral reconstruction length on erectile and ejaculatory function

Impacto de la longitud de la reconstrucción uretral en la función eréctil y eyaculatoria

Background: Urethral stricture is a prevalent urological condition with significant functional consequences. Urethroplasty remains the gold standard treatment; however, its potential effects on postoperative erectile and ejaculatory function remain a subject of debate. This study aimed to investigate whether urethral reconstruction length influences sexual outcomes in men undergoing non-transecting buccal mucosal graft urethroplasty. Methods: In this hybrid study with retrospective baseline data collection and prospective follow-up, 72 men aged 18–75 years who underwent urethroplasty were included. Patients were categorized into short-segment (SS; ≤3 cm, n = 25) and long-segment (LS; >3 cm, n = 47) groups. Erectile and ejaculatory functions were evaluated preoperatively and at least 6 months postoperatively using the International Index of Erectile Function (IIEF-15) and the Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD). Demographic variables, urethral stricture characteristics, and surgical parameters were compared between groups. Statistical analyses included t-tests, Mann-Whitney U tests, chi-square tests, and correlation analyses (p < 0.05 considered significant). Results: Baseline demographics, urethral stricture location-length, and graft placement techniques were comparable between SS and LS groups. Pre- and postoperative IIEF total scores, orgasmic function, sexual satisfaction, and MSHQ-EjD scores showed no statistically significant differences between groups. Although LS patients exhibited slightly lower preoperative erectile and ejaculatory scores, postoperative outcomes and pre-to-postoperative changes did not differ significantly. No cases of de novo erectile dysfunction were observed. Conclusions: Our findings suggest that urethral reconstruction length may not significantly impact postoperative erectile or ejaculatory function in patients undergoing non-transecting buccal mucosal graft urethroplasty. Urethral stricture length alone should not be considered a determinant of postoperative sexual dysfunction. Larger, multicenter and prospective studies are required to validate these results and further clarify the association between urethroplasty parameters and sexual function.

Resumen

Antecedentes: La estenosis uretral es una condición urológica frecuente con consecuencias funcionales significativas. La uretroplastia continúa siendo el tratamiento de referencia; sin embargo, sus posibles efectos sobre la función eréctil y eyaculatoria posoperatoria siguen siendo motivo de debate. El objetivo de este estudio fue determinar si la longitud de la reconstrucción uretral influye en los resultados sexuales de los pacientes sometidos a uretroplastia con injerto de mucosa bucal mediante técnica no transectiva. Métodos: En este estudio retrospectivo con seguimiento prospectivo, se incluyeron 72 varones de entre 18 y 75 años sometidos a uretroplastia. Los pacientes se clasificaron en dos grupos según la longitud del segmento estenótico: segmento corto (SC; ≤3 cm, n = 25) y segmento largo (SL; >3 cm, n = 47). La función eréctil y eyaculatoria se evaluó en el período preoperatorio y al menos 6 meses después de la cirugía mediante el Índice Internacional de Función Eréctil (IIEF-15) y el Cuestionario de Salud Sexual Masculina: Disfunción Eyaculatoria (MSHQ-EjD). Se compararon variables demográficas, características de la estenosis y parámetros quirúrgicos entre ambos grupos. El análisis estadístico incluyó pruebas t, U de Mann-Whitney, chi-cuadrado y análisis de correlación (p < 0.05 considerado significativo). Resultados: Las características basales, la localización y longitud de la estenosis, así como las técnicas de colocación del injerto, fueron comparables entre los grupos SC y SL. Las puntuaciones pre y posoperatorias del IIEF (total), función orgásmica, satisfacción sexual y MSHQ-EjD no mostraron diferencias estadísticamente significativas entre los grupos. Aunque los pacientes del grupo SL presentaron puntuaciones preoperatorias ligeramente inferiores, los resultados posoperatorios y los cambios pre-posoperatorios no difirieron significativamente. No se observaron casos de disfunción eréctil de novo. Conclusiones: Los resultados sugieren que la longitud de la reconstrucción uretral no tiene un impacto significativo sobre la función eréctil ni eyaculatoria tras una uretroplastia con injerto de mucosa bucal mediante técnica no transectiva. La longitud del segmento estenótico, por sí sola, no debería considerarse un determinante de disfunción sexual posoperatoria. Se requieren estudios prospectivos multicéntricos y con mayor tamaño muestral para confirmar estos hallazgos y clarificar la relación entre los parámetros de la uretroplastia y la función sexual.

Urethroplasty; Erectile dysfunction; Ejaculatory disorders; Urethral stricture

Palabras Clave

Uretroplastia; Disfunción eréctil; Trastornos eyaculatorios; Estenosis uretral

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