Introduction: Sexual dysfunction is one of the most common problems of male sexual health in the world and includes erectile dysfunction (ED), ejaculatory disorders, curvature, formation of the penis chord and sensitivity disorders in the penis area. The aim of the study was to evaluate the frequency and pathogenesis of ED in patients who underwent surgery for urethral stricture.
Methods: The work was based on the results of examination and treatment of 116 patients with preserved erectile function (EF) with urethral stricture. The 1st group included 60 patients who underwent surgery with a complete intersection of the spongiose body, the 2nd group included 56 patients with a partial intersection of the spongiose body. Before and after the operation, the EF was evaluated according to the IIEF-5 questionnaire, as well as pharmacodopplerography (FDG) of the vessels of the penis.
Results: In group 1, ED was detected in 34 (56.7%) of 60 patients, of which 8 (23.5%) patients had moderate ED (10-15 points), 26 (76.5%) patients had mild ED (16-20 points). 21 patients underwent FGM of penile vessels before surgery. In this group, there was a decrease in peak systolic velocity (Vmax) in 9 patients (16.1-27.2cm/sec), the final diastolic blood flow velocity (Ved) was 13.2 cm/sec (0-19.0 cm/sec). 3 months after surgery, ED was detected in 39 (65%) of 60 patients, 32 (53.4%) patients noted a deterioration in EF after surgery relative to the initial one, 23 (38.4%) patients did not notice changes in EF, the development of de novo ED in 5 (8.2%) patients. According to the data of the control FDG of the vessels of the penis in this group, no deviations were detected when compared with the indicators before the operation. After 6 months, 28 (46.7%) patients noted an improvement in EF. In group 2, ED was detected in 16 (28.6%) of 56 patients, of which 7 (12.5%) patients had moderate ED (10-15 points), 9 (12.5%) patients had mild ED (16-20 points). 8 patients underwent FGM of penile vessels before surgery, which resulted in a decrease in Vmax in 4 (50%) patients (18.1-24.3cm/sec), Ved was 5.2 cm/sec (0-13.2 cm/sec). 3 months after surgery, 19 (33.2%) patients noted a deterioration in EF after surgery relative to the initial one, 35 (62%) patients did not notice changes in EF, the development of de novo ED in 2 (4.3%) patients. According to the data of the control FDG of the vessels of the penis in this group, no deviations were detected when compared with the indicators before the operation. After 6 months, 16 (28.6%) patients noted an improvement in EF
Conclusions: The high frequency of ED development and progression in group 1 is associated with neurovascular damage to the cavernous nerves during the complete intersection of the spongiose body compared to group 2. Hemodynamic parameters of the FDG of the vessels of the penis before and after surgery are comparable, which excludes damage to the vascular bed in the development of ED.
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