title: The effect of urethral transection on erectile function after anterior urethroplasty.
abstract: OBJECTIVE
  To prospectively assess the effect of urethral transection on erectile function after anterior urethroplasty.
  
  
  METHODS
  From February 2012 to December 2014, 104 patients were enrolled in a prospective study assessing erectile function (EF) after anterior urethroplasty. Participants completed the International Index of Erectile Function (IIEF) questionnaire preoperatively and 6 months postoperatively. Outcome measures were the incidence of erectile dysfunction (ED) defined by ≥5-point change in EF and mean change in the EF domain. Factors examined were urethral transection, stricture location, patient age and other demographics. Fisher's exact test, Student's t test and linear regression were used to evaluate associations when appropriate.
  
  
  RESULTS
  Seventeen patients were excluded because of poor EF, leaving 87 patients for analysis. Twenty-two patients (25.3 %) had urethral transection during urethroplasty, while 65 underwent non-transecting techniques (74.7 %). For the entire cohort, IIEF scores remain unchanged (20.16 versus 20.14; p = 0.98). Eighteen patients (20.7 %) developed ED, while 15 (17.2 %) experienced an improvement in EF. Urethral transection was not associated with ED (p = 0.22) or mean change in EF (-0.8 versus +0.2; p = 0.71). Stricture location was not associated with ED, but patient age ≥50 was associated with a decrease in mean postoperative EF (-2.84 versus +1.85; p = 0.04). On linear regression analysis patient age remained independently associated with adverse change in EF (p = 0.05).
  
  
  CONCLUSIONS
  Urethroplasty can result in a decline in erectile function in some patients but overall is associated with minimal change in erectile function. Urethral transection is not associated with adverse change in erectile dysfunction after urethroplasty however, advanced patient age is.
authors: Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
authors: Trevor
authors: T
authors: Haines
authors: Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada. krourke@ualberta.ca.
authors: Keith F
authors: http://orcid.org/0000-0003-4971-8657
authors: KF
authors: Rourke
mesh_terms: D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D011795:Surveys and Questionnaires; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult
keywords: Erectile dysfunction; Urethral stricture; Urethral transection; Urethroplasty