OBJECTIVE: To determine whether ejaculatory dysfunction (EjD) and post-void dribbling (PVD) after urethroplasty are associated, providing evidence for a common etiology.
METHODS: We reviewed a prospectively maintained database for first-time, anterior urethroplasties. One item from the Male Sexual Health Questionnaire (MSHQ) assessed EjD: "How would you rate the strength or force of your ejaculation". One item from the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) assessed PVD: "How often have you had slight wetting of your pants after you had finished urinating?". The frequency of symptoms was compared after penile vs. bulbar repairs, and anastomotic versus augmentation bulbar repairs. Associations were assessed with chi-square.
RESULTS: A total of 728 men were included. Overall, postoperative EjD and PVD were common; 67% and 66%, respectively. There was a significant association between EjD and PVD for the whole cohort (p<0.0001); this association remained significant after penile repairs (p=0.01), bulbar repairs (p<0.0007), and bulbar anastomotic repairs (p=0.002), but not after bulbar augmentation repairs (p=0.052). EjD and PVD occurred at similar rates after penile and bulbar urethroplasty. The rate of EjD was similar after bulbar augmentation and bulbar anastomotic urethroplasties, but PVD was more common after bulbar augmentation (70% vs. 52%) (p = 0.0001).
CONCLUSION: EjD and PVD after anterior urethroplasty are significantly associated with one another, supporting the theory of a common etiology. High rates after penile repairs argue against a bulbospongiosus muscle damage etiology, and high rates after anastomotic repairs argue against graft sacculation. More work is needed to better understand and prevent symptoms.
Bibliographical noteFunding Information:
Funding: Alex J Vanni – Fellowship Educational Funds & PI on AUSCO study for Boston Scientific; NIH Funding-R21DK115945-91 and U01DK097772-07; Bradley A Erickson – Fellowship Educational Funds & PI on AUSCO study for Boston Scientific; PI for clinical trial for Urotronic; NIH Funding-R21DK115945-91, U01DK097772-07, U01DK082344-11 ;Benjamin N Breyer – Alafi Foundation Funding; NIH Funding R21DK115945-01; Jeremy B. Myers – Fellowship Educational Funds Boston Scientific; Consultant Cooper Surgical; Department of Defence SCI Grant-SCI150071; NIH Funding-R21DK115945-91; NIH Funding-R21DK124733-01; Neilsen Foundation Grant; Bryan Voelzke – None; Joshua A Broghammer – Consultant Boston Scientific; Clinical Events Committee for AUSCO study for Boston Scientific Keith F Rourke ; Andrew C Peterson – Fellowship Educational Funds Boston Scientific; PI on AUSCO study Boston Scientific; Scientific Advisory Board Boston Scientific; Movember Foundation Grant; NIH Funding-1UO1DK097776-01 ; Sean Elliott – Consultant & investigator for clinical trial for Boston Scientific; PI for clinical trial for Urotronic; Shareholder in Percuvision; NIH Funding-R21DK115945-01
© 2021 Elsevier Inc.
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