Factors associated with erectile dysfunction in traumatic urethral strictures following epa urethroplasty: a single center experience.

Introduction: Urethral repair with Excision and Primary Anastomosis (EPA) urethroplasty offers excellent outcome in managing traumatic urethral strictures. However, its impact on erectile function (EF) is largely unknown. Study to evaluate EF outcome post-operatively is still limited worldwide. We report factors associated to EF following EPA Urethroplasty performed by single surgeon in tertiary hospital. In this study, we aim to evaluate the risk of erectile dysfunction (ED) following EPA Urethroplasty.

Materials and methods: This is a retrospective study on patients with traumatic urethral strictures who underwent EPA Urethroplasty from 2013 to 2023. Variables including age, body mass index, systemic disease, etiology, stricture length, prior procedures and erection hardness score (EHS) score prior and 12 months after surgery were recorded. Pre-Operative ED was determined using Penile Doppler Ultrasound, which was defined as a peak systolic velocity of less than 25 cm/s. Univariate and Multivariate logistic regression analysis were performed using IBM SPSS Statistic.

Results: A total of 89 patients were included. Among them, 33 patients (33.7%) suffered from initial ED prior to surgery. Pelvic fracture urethral injury (PFUI) was the predominant etiology (74%); 29% of the patients were active smokers, and 68.5% had prior endoscopic treatment. Among the 48 patients without ED prior to surgery, 7 of them (14.6%) developed ED following surgery in 12 months of follow up. After EPA, there was a reduction of mean EHS score from 2.70 to 2.53 (p=0.176). Multivariate analysis showed that smoking status (p=0.035; OR 4.41), PFUI as the mechanism of injury (p=0.007; OR 2.89), prior urethrotomy (p=0.020; OR 4.69), and prior dilatations (p=0.046; OR 0.18) were related as risk factors of ED following EPA urethroplasty.

Conclusions: Risk of ED following EPA is inevitable, although the number is not as high as expected. Smoking, PFUI and prior treatment rather than EPA, emerge as predominant risk factors associated with the development of ED subsequent to surgical repair.