Erectile and Ejaculatory Function Following Anterior Urethroplasty: A Systematic Review and Meta-analysis

Abstract

Context: The degree of change in erectile (EF) and ejaculatory function (EjF) according to validated questionnaires following anterior urethroplasty and different techniques is unclear. Objective: To investigate the evidence on EF and EjF evaluated via validated questionnaires following anterior urethroplasty. Evidence acquisition: A systematic review (PROSPERO ID: CRD42021229797) of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The PubMed and CENTRAL databases were searched on February 1, 2021, with an updated search performed on December 1, 2021. Studies evaluating EF and/or EjF using validated questionnaires in men aged ≥18 yr following anterior urethroplasty were included. Evidence synthesis: Overall, 29 studies (two randomised and 27 nonrandomised) were included. The questionnaire most commonly used to evaluate EF and EjF was the International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire (MSHQ), respectively. The incidence of postoperative erectile dysfunction (ED) was 0–38% and the mean change in EF score according to the IIEF ranged from −4.0 to 2.5. The incidence of postoperative ejaculatory dysfunction (EjD) was 7.7–67% and the mean change in EjF score according to the MSHQ-EjD was 0.7–7.0. Meta-analyses revealed a mean difference of −0.87 (95% confidence interval [CI] −1.50 to −0.23; p = 0.008) in IIEF-EF score and 1.77 (95% CI 0.61–2.93; p = 0.003) in MSHQ-EjF score following anterior urethroplasty. Conclusions: EF and EjF may be affected following anterior urethroplasty and men should be counselled appropriately. Owing to the variation in questionnaires and cutoff scores used, EF and EjF outcomes following different urethroplasty techniques are heterogeneous, with limited data from randomised controlled trials. An agreement on questionnaires and cutoff scores should be established to allow consistent reporting. Future research should aim to investigate best approaches for minimising sexual dysfunction. Patient summary: Surgical repair of the urethra (urethroplasty) used to treat narrowing of the urethra (urethral stricture) may affect erectile and ejaculatory function. Different questionnaires and definitions are used to evaluate sexual function, so it is hard to compare data. The degree of disruption can be affected by different techniques and the severity of disease.