Background: The constellation of persistent sexual, neurological, and physical adverse effects in patients who discontinue 5α-reductase inhibitors (5ARIs) has garnered recent concern. The objective of this study was to evaluate potential penile vascular changes and persistent adverse effects of 5ARIs in men treated for androgenic alopecia (AGA).Methods: This was a prospective case-control study with 25 subjects with a history of 5ARI use for AGA and 28 controls. Patient self-reported questionnaires including the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), Patient Health Questionnaire-9 (PHQ-9), the Epworth Sleepiness Scale (ESS) and the Androgen Deficiency in the Aging Male (ADAM) were used. Penile duplex Doppler ultrasound (PDDU) results were evaluated in men with a history of 5ARI use.Results: A significant difference in total IIEF score between the 5ARI (median: 35; IQR: 29-43) and control group (median: 29; IQR: 27-32) (P=0.035) was observed. Seventeen 5ARI subjects (68%) had a vascular abnormality on PDDU. The median (IQR) for total IPSS score for the 5ARI group was 10 [5-16] compared to 3 [2-8] for the controls (P<0.01). The 5ARI group had a higher median total PHQ-9 score than controls [10 (6.5-16) vs. 1 (0-2) (P<0.001)]. Two subjects (8%) committed suicide during or after the study.Conclusions: While the sexual side effects of 5ARIs are well known, there may be persistent genitourinary, physical, psycho-cognitive, anti-androgenic and penile vascular changes after 5ARI discontinuation. Use of 5ARIs for treatment of AGA may lead to persistent sexual, genitourinary, physical, psycho-cognitive, and anti-androgenic sequelae even after cessation of 5ARI therapy.

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After reading this review, the urologist should have a deeper understanding of the breadth of disorders in genitourinary oncology and a clearer approach to the management of these problems. Additionally, ongoing avenues for research are highlighted.

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METHODS: A preschool male child presented to us with urinary incontinence and penopubic epispadias. He had no other congenital anomaly and no prior surgery. Stretched penile length was 44 mm and there was no chordee. Anatomical repair was performed using corporal disassembly technique. The external sphincter complex was identified and wrapped around posterior urethra after completion of the urethroplasty.RESULTS: Operative time was 130 minutes. Blood loss was minimal. Post-operative course was uneventful. Urethral splint was removed on post-operative day 12. Satisfactory cosmetic appearance and complete urinary continence was achieved with no residual chordee. The urethra was easily catheterizable. Uroflowmetry at six weeks after surgery was normal with normal urine stream and the child could hold urine for 3 to 4 hours.CONCLUSIONS: Anatomical repair of epispadias using corporal disassembly technique along with restoration of external sphincter complex gives good cosmetic and functional outcomes.