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Impact of Urethral Reconstruction on Sexual Function

  • Enzo Palminteri
  • Nicolaas Lumen
  • Mirko Preto
  • Marjan Waterloos
Chapter

Abstract

Established beliefs concerning outcomes following anterior urethral reconstruction are changing, both with regards to the genital cosmetics and to the impact on the sexual activity. To-day, the aim of the stricture repair is not only to reinstate urinary function but also to safeguard sexual activity and guarantee genital cosmesis. A thorough evaluation of anterior urethroplasty results should include the sexual viewpoint which appears to play an important role in overall post-operative patient satisfaction. The most commonly reported sexual problems following anterior urethroplasty include: erectile and ejaculatory dysfunction, penile curvature or shortening, dissatisfaction with genital cosmetic appearance and sensorial impairments of glans. The prevalence of specific post-operative sexual problems may be related to the site of reconstruction (penile or bulbar) and to the technique of urethroplasty employed. In penile urethral reconstruction, the wide use of buccal mucosa grafts seems to excel the use of skin flaps which easily distort the cosmesis and elasticity of the penis. In bulbar reconstructions, graft augmentation techniques seem to impact less on sexual outcome than excision anastomotic techniques. Therefore, the policy of primarily indicating an excision anastomotic procedure, whenever possible, should come under scrutiny. Eventual sexual outcomes should be incorporated in the choice of the optimal anterior urethral reconstruction and in pre-operative patient counselling.

Keywords

Sexual function Urethral stricture Urethroplasty 

References

  1. 1.
    Elliott SP. The evolution of urethral reconstruction. J Urol. 2011;185:1564–5.PubMedGoogle Scholar
  2. 2.
    Aboseif SR, Lue TF. Impotence after urethral injury. In: McAninch JW, Carroll PR, Jordan GH, editors. Traumatic and reconstructive urology. Philadelphia: W. B. Saunders Company; 1996. p. 455–62.Google Scholar
  3. 3.
    Lue T, Zeineh SJ, Schimdt R, Tanagho E. Neuroanatomy of penile erection: its relevance to iatrogenic impotence. J Urol. 1984;131:273–80.PubMedGoogle Scholar
  4. 4.
    Lepor H, Gregerman M, Crosby R, et al. Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: a detailed anatomical study of the adult male pelvis. J Urol. 1985;133:207–12.PubMedGoogle Scholar
  5. 5.
    Breza J, Aboseif SR, Orvis B, et al. Detailed anatomy of penile neurovascular structures: surgical significance. J Urol. 1989;141:437–43.PubMedGoogle Scholar
  6. 6.
    Hinata N, Murakami G, Miyake H, Abe S, Fujisawa M. Histological study of the cavernous nerve mesh outside the periprostatic region: anatomical basis for erectile function after nonnerve sparing radical prostatectomy. J Urol. 2015;193(3):1052–9.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Blakely S, Caza T, Landas S, Nikolavsky D. Dorsal onlay urethroplasty for membranous urethral strictures: urinary and erectile functional outcomes. J Urol. 2016;195(5):1501–7.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Palminteri E. Anatomy of the male urethra. pp. 29–40 In: Atlas of reconstructive penile surgery. Austoni E. Pacini Editore Ospedaletto. 2010.Google Scholar
  9. 9.
    Yucel S, Baskin LS. Neuroanatomy of the male urethra and perineum. BJU Int. 2003;92:624–7.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Barbagli G, et al. Muscle- and nerve-sparing bulbar urethroplasty: a new technique. Eur Urol. 2008;54(2):335–43.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Turner-Warwick R. The anatomical basis of functional reconstruction of the urethra. In: Droller M, editor. Surgical anatomy. Mosby year book; 1992. p. 740–814.Google Scholar
  12. 12.
    Morey AF, Kizer WS. Proximal bulbar urethroplasty via extended anastomotic approach – what are the limits? J Urol. 2006;175:2145–9.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Coursey JW, Morey AF, McAninch JW, et al. Erectile function after anterior urethroplasty. J Urol. 2001;166:2273–6.Google Scholar
  14. 14.
    Mundy AR. Results and complications of urethroplasty and its future. Br J Urol. 1993;71:322–5.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Al-Qudah HS, Santucci RA. Buccal mucosal onlay urethroplasty versus anastomotic urethroplasty (AU) for short urethral strictures: which is better? J Urol. 2006;175:103–313.Google Scholar
  16. 16.
    Barbagli G, De Angelis M, Romano G, et al. Long-term follow up of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol. 2007;178:2470–3.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Kessler T, Fish M, Heitz M, et al. Patient satisfaction with the outcome of surgery for urethral strictures. J Urol. 2002;167:2507–11.PubMedGoogle Scholar
  18. 18.
    Beysens M, et al. Anastomotic repair versus free graft Urethroplasty for bulbar strictures: a focus on the impact on sexual function. Adv Urol. 2015;2015:p. 912438.PubMedGoogle Scholar
  19. 19.
    Jordan GH, Eltahawy EA, Virasoro R. The technique of vessel sparing excision and primary anastomosis for proximal bulbous urethral reconstruction. J Urol. 2007 May;177(5):1799–802.Google Scholar
  20. 20.
    Guralnick ML, Webster GD. The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol. 2001;165:1496–501.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Andrich DE, Mundy AR. Non-transecting anastomotic bulbar urethroplasty: a preliminary report. BJU Int. 2012;109:1090–4.Google Scholar
  22. 22.
    Morey AF, Watkin N, Shenfels O, Eltahawy E, Giudice C. SIU/ICUD consultation on urethral strictures: anterior urethra-Rrimary anastomosis. Urology. 2014 Mar;83(3 Suppl):S 23–6.Google Scholar
  23. 23.
    Mangera A, Patterson MJ, Chapple CR. A systematic review of graft augmentation Urethroplasty techniques for the treatment of anterior urethral strictures. Eur Urol. 2011;59:797–814.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Barbagli G, Selli C, Tosto A, Palminteri E. Dorsal free graft urethroplasty. J Urol. 1996;155:123–6.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Barbagli G, Palminteri E, Guazzoni G, Montorsi F, et al. Bulbar urethroplasty using buccal mucosa grafts placet on the ventral, dorsal or lateral surface of the uretra: are results affected by the surgical technique? J Urol. 2005;174:955–8.Google Scholar
  26. 26.
    Iselin CE, Webster GD. Dorsal onlay graft urethroplasty for repair of bulbar urethral stricture. J Urol. 1999;16:815–8.Google Scholar
  27. 27.
    Barbagli G, Sinselone S, Djinovic R, et al. Current controversies in reconstructive surgery of the anterior urethra: a clinical overview. Int Braz J Urol. 2012;38:307–16.PubMedGoogle Scholar
  28. 28.
    Kulkarni S, Barbagli G, Sinsalone S, Lizzeri M. One-sided anterior urethroplasty: a new dorsal onlay graft technique. BJU Int. 2009;104:1150–5.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Palminteri E, Berdondini E, Fusco F e a. Versatility of the ventral approach in bulbar urethroplasty using dorsal, ventral or dorsal plus ventral oral grafts. Arab J Urol. 2012;10:118–24.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Asopa HS, Garg M, Singhal GG, et al. Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology. 2001;58:657–9.Google Scholar
  31. 31.
    Morey AF, McAninch JW. When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology. 1996;48:194–8.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Palminteri E, Manzoni G, Berdondini E, et al. Combined dorsal plus ventral double buccal mucosa graft in bulbar urethral reconstruction. Eur Urol. 2008;53:81–9.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Palminteri E, Berdondini E, De Nunzio C, Bozzini G, et al. The impact of ventral oral graft bulbar urethroplasty on sexual life. Urology. 2013;81:891–8.Google Scholar
  34. 34.
    Abouassaly R, Angermeier KW. Augmented anastomotic urethroplasty. J Urol. 2007;177:2211–5.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Palminteri E, Berdondini E, Shokeir AA, et al. A. Two-sided bulbar urethroplasty using dorsal plus ventral oral graft: urinary and sexual outcomes of a new technique. J Urol. 2011;185:1766–71.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Bracka A. Hypospadias repair: the two-stage alternative. Br J Urol. 1995;76:31–41.PubMedGoogle Scholar
  37. 37.
    Palminteri E. Penile Urethroplasty. In: Austoni E, editor. Atlas of reconstructive penile surgery. Ospedaletto: Pacini Editore; 2010. p. 137–47.Google Scholar
  38. 38.
    De Pasquale J, Park AJ, Bracka A. The treatment of balanitis erotica obliterans. BJU Int. 2000;86:459–65.Google Scholar
  39. 39.
    Barbagli G, Palminteri E, Bracka A, Sariol JC. Penile urethral reconstruction: concepts and concerns. Arch Esp Urol. 2003;56:549–56.PubMedGoogle Scholar
  40. 40.
    Andrich DE, Mundy AR. What is the best technique for urethroplasty? Eur Urol. 2008;54:1031–41.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Barbagli G, Lizzeri M. Penile urethral stricture reconstruction – flap or graft? Graft J Urol. 2011;186:375–6.PubMedGoogle Scholar
  42. 42.
    Gonzalez C. Penile urethral stricture reconstruction – flap or graft? Flap J Urol. 2011;186:376–7.PubMedGoogle Scholar
  43. 43.
    Dubey D, Vijjan V, Kapoor R, Srivastava A, et al. Dorsal Onlay. Buccal mucosa versus penile skin flap urethroplasty for anterior urethral strictures: results from a randomised prospective trial. J Urol. 2007;178:2466–9.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Enzo Palminteri
    • 1
  • Nicolaas Lumen
    • 2
  • Mirko Preto
    • 1
  • Marjan Waterloos
    • 2
  1. 1.Center for Urethral Surgery, Humanitas InstituteTorinoItaly
  2. 2.Department of UrologyGhent University HospitalGhentBelgium

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