Patient-Reported Sexual Function After Staged Penile Urethroplasty

Abstract

Objective: To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG).

Methods: We identified men with completed staged penile urethroplasty with OMG from the Trauma and Urologic Reconstruction Network of Surgeons database between January 1, 2010 and May 1, 2014. Our primary outcome was change in total Sexual Health Inventory for Men (SHIM) and total Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) Short Form at baseline vs after the second stage of the procedure. Second, we assessed subjective changes in penile curvature, length, and sensation.

Results: Thirty-three patients were included with a mean age of 45 years and mean body mass index of 27.6 kg/m(2). Urethral strictures arose from failed hypospadias repair in 52% and lichen sclerosus in 27%. Fifty-two percent of patients reported a previous urethroplasty. The median follow-up time between the second stage procedure and postoperative questionnaires was 6.3 months (interquartile range: 3.5-13.3). There was no significant change in the total SHIM (Δ0.64, 95% confidence interval [CI]: -3.00∼1.72) and MSHQ-EjD (Δ1.55, 95% CI: -1.53∼4.63) scores preoperatively vs postoperatively. In addition, 32% reported improved and 52% no change in satisfaction with sexual intercourse (SHIM Q5). Forty percent of patients reported reduced and 45% no change in bother with ejaculation after surgery (MSHQ-EjD Q4). Men reported new penile curvature (23%), loss of penile length (55%), and altered penile sensitivity (45%) after surgery.

Conclusion: Patients undergoing staged penile urethroplasty with OMG are likely to have minimal changes in erectile and ejaculatory function postoperatively, although many may experience new penile curvature, reduced penile length, and/or reduced penile sensitivity.

Figure 1. Distribution of Total Sexual Health Inventory for Men (SHIM) and Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD)

Pre: Pre-operatively at baseline; Post: Post-operatively after 2^nd stage completion; Post-Pre: Mean difference post-operatively after 2^nd stage completion versus pre-operatively at baseline.

Figure 2. Percentage of Patients with Worse, Same, or Better Function for each Item on the Sexual Health Inventory for Men (SHIM) and Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) after 2^nd Stage of Penile Urethroplasty

* From a regression model testing that the score difference is zero while controlling for time and institution.